Seven months after undergoing surgery for a fracture above the left ankle with the placement of a metal plate, there is still persistent numbness and tingling below the ankle?
Hello Doctor, I am writing on behalf of my father.
He is 56 years old.
Last September, he had an accident while riding an electric scooter and fell into a ditch, resulting in a fracture above his left ankle.
My father works as a mechanic, and to speed up his recovery and ensure safety at work, he decided to have a metal plate installed to prevent the fracture from reoccurring.
He also had a pre-existing issue with his knee, specifically a torn meniscus, and he opted to address both issues in one surgery to avoid undergoing two separate procedures.
Currently, his knee is functioning well, and he has been following the rehabilitation protocols, allowing him to walk normally.
The follow-up doctor has also confirmed that there are no significant issues with his knee.
However, since the surgery, he has been experiencing numbness and tingling below his left ankle.
This sensation is not localized to just the sole or the top of the foot; rather, the entire area feels numb and tingly.
Initially, he experienced swelling and pain severe enough to disrupt his sleep, leading to a painful half-awake state.
A few weeks post-surgery, he consulted a traditional Chinese medicine practitioner who suggested that the swelling was due to blood accumulation pressing on the nerves.
The practitioner performed acupuncture to release the blood, which provided some relief.
However, after two visits with no further improvement, he discontinued that treatment.
Months have passed, and while he can now manage to sleep, he still experiences numbness and tingling while walking, similar to the sensation of a limb falling asleep after prolonged positioning.
We suspect it might be related to sciatica, and an MRI was performed, which indicated a low probability of spinal nerve compression, as the symptoms do not involve the entire leg—only below the ankle.
We also considered whether the metal plate might be pressing on a nerve, but the surgeon focused more on the knee and assured us that the area where the plate was installed does not contain nerves, thus ruling out that possibility.
The surgeon referred us to another orthopedic specialist who specializes in sciatica, but his opinion was confusing as he suggested there could be nerve involvement.
He arranged for another MRI and nerve conduction studies, which indicated possible nerve damage.
We eventually gave up on that route due to the cycle of uncertainty and sought opinions from other hospitals, but the responses were largely similar, with medications primarily aimed at nerve repair, such as B12, prescribed for 1-2 months at a time.
However, there has been little to no improvement, and he continues to experience numbness and tingling.
Currently, he receives daily massages, which he reports provide slight relief, although he has already broken one massage gun in the process.
Recently, we heard from someone with a similar condition, albeit in the neck, who mentioned it might be a lifelong issue.
Some doctors have suggested it could be peripheral neuropathy, which has further depressed my father's spirits.
I would like to clarify a few points:
1.
Are there nerves located on the outer side of the ankle?
2.
Are there documented cases where a metal plate installed after a fracture has compressed a nerve?
3.
After installing a metal plate, how long is it generally recommended to wait before considering its removal?
4.
If the condition persists after the plate is removed, what should be done? Is it just a matter of long-term B12 supplementation while waiting for recovery?
Thank you for taking the time to read this lengthy message.
I apologize for the length, but I wanted to provide a complete picture for better understanding.
We are planning to visit another hospital next Tuesday, and honestly, this situation has been exhausting.
It is heartbreaking to see my father struggle to walk after what seemed like a minor fracture.
Zhuang, 20~29 year old female. Ask Date: 2023/04/13
Dr. Jiang Junyi reply Neurology
Hello: You mentioned that your father is experiencing peripheral nerve damage.
If the peripheral neuropathy is caused by nerve compression, it may exhibit the following characteristics: 1.
The pain is described as burning or electric-like.
2.
Symptoms have a specific dermatomal distribution, and touching or pressing the area can provoke symptoms.
3.
There may be accompanying muscle soreness and weakness.
Examinations for peripheral nerve issues typically involve electrophysiological studies to assist in diagnosis.
Nerve conduction studies assess the conduction velocity and waveform of large fiber nerves.
Electromyography (EMG) evaluates the muscle response in the affected nerve distribution area.
It is recommended that your father's examination includes an EMG.
Regarding treatment, it may be beneficial to consider hyperbaric oxygen therapy as part of the recovery process.
Thank you for your inquiry, and feel free to discuss any related questions! Wishing you good health and peace.
Dr.
Jiang Junyi, Taoyuan Medical Center, cares for you.
Reply Date: 2023/04/13
More Info
Post-surgery nerve pain, especially following an ankle fracture, can be a complex issue that often requires a multidisciplinary approach to management. Based on your father's situation, it seems he is experiencing significant discomfort and neurological symptoms after undergoing surgery to repair his ankle fracture and address a meniscus issue in the same leg. Here are some insights into your questions and suggestions for managing his condition.
1. Nerve Presence in the Ankle Area: Yes, there are several nerves in the ankle region, including the superficial peroneal nerve, deep peroneal nerve, and tibial nerve. These nerves can be affected by swelling, hematoma formation, or even surgical trauma, leading to symptoms like numbness, tingling, and pain. The fact that your father is experiencing widespread symptoms below the ankle suggests that there may be some involvement of these nerves, possibly due to inflammation or compression.
2. Nerve Compression from Hardware: It is indeed possible for surgical hardware, such as plates and screws, to cause nerve compression, although this is not very common. If the hardware is positioned in a way that it exerts pressure on nearby nerves, it could lead to the symptoms your father is experiencing. However, this would typically be evaluated through imaging studies and clinical examination.
3. Timing for Hardware Removal: The decision to remove surgical hardware depends on several factors, including the healing process, the presence of symptoms, and the type of hardware used. Generally, if the hardware is causing significant pain or neurological symptoms, a surgeon may consider removal after the bone has fully healed, which can take several months to a year. In your father's case, if the symptoms persist and are attributed to the hardware, discussing the possibility of removal with his orthopedic surgeon would be prudent.
4. Management of Persistent Symptoms: If hardware removal does not alleviate the symptoms, or if the symptoms are due to nerve damage or neuropathy, a comprehensive pain management strategy may be necessary. This could include:
- Physical Therapy: Engaging in a tailored rehabilitation program can help improve mobility and reduce pain. A physical therapist can provide exercises that focus on strengthening and improving the range of motion.
- Medication: While B12 and other nerve repair medications may be prescribed, other options include anticonvulsants (like gabapentin or pregabalin) and antidepressants (like amitriptyline) that are often effective for neuropathic pain.
- Alternative Therapies: Techniques such as acupuncture, massage therapy, and transcutaneous electrical nerve stimulation (TENS) may provide relief for some patients.
- Psychological Support: Chronic pain can lead to emotional distress. Counseling or support groups may help your father cope with the psychological aspects of living with chronic pain.
5. Follow-Up and Second Opinions: It’s understandable to feel frustrated with the lack of clear answers. Seeking a second opinion from a pain specialist or neurologist who specializes in neuropathic pain may provide new insights or treatment options. They can perform nerve conduction studies or other diagnostic tests to better understand the nature of the nerve involvement.
In conclusion, your father's situation is not uncommon after significant orthopedic surgery, and while it can be distressing, there are various avenues for treatment and management. It’s essential to maintain open communication with healthcare providers and advocate for a comprehensive approach to his recovery. Encourage him to stay engaged in his rehabilitation and explore all available options for pain management.
Similar Q&A
Post-Surgery Ankle Pain: Understanding Symptoms After Fracture Repair
Hello, on August 21, I was hit by a car while walking, resulting in a closed fibula fracture about five centimeters above my right ankle. I underwent surgery on August 22. Now, at the beginning of September, the swelling has mostly subsided, but since early September, I've b...
Dr. Li Yongheng reply Orthopedics
Hello Mr. Li, based on your symptoms, there is a high possibility of peripheral neuropathy. It is recommended that you continue to elevate your legs and follow up with your surgeon for further examination. Wishing you a speedy recovery.[Read More] Post-Surgery Ankle Pain: Understanding Symptoms After Fracture Repair
Post-Fracture Joint Issues: Understanding Complications After Surgery
1. The occasional numbness and burning sensation in the ankle, foot, and toe joints two months after the fracture surgery may be due to nerve irritation or compression, possibly related to swelling or scar tissue formation. 2. The discoloration and mild swelling of the affected ...
Dr. Shi Guozheng reply Orthopedics
After a lower limb fracture and surgery, it is normal for swelling to persist if blood circulation has not yet returned, which may take more than three months to recover. For a clavicle fracture, do not elevate the arm as it may cause the metal pins to shift. It is normal to feel...[Read More] Post-Fracture Joint Issues: Understanding Complications After Surgery
Post-Fracture Complications: Managing Nerve Damage and Recovery
Hello Doctor, I was in a car accident on May 20th and suffered a tibial fracture in my lower leg. However, the day after the surgery, I developed compartment syndrome, which required an emergency fasciotomy. Unfortunately, this also resulted in nerve damage, affecting the nerves ...
Dr. Wang Shouji reply Orthopedics
Hello: This type of nerve injury has a poor recovery prognosis, but it is essential to determine whether there is a nerve rupture or temporary paralysis. If there is a rupture, recovery may be inadequate, leading to long-term sequelae. Rehabilitation is recommended as necessary. ...[Read More] Post-Fracture Complications: Managing Nerve Damage and Recovery
Managing Pain and Discomfort After Tibial Fracture Surgery
Hello doctor, in February of this year, I had a tibial fracture in my left ankle and underwent surgery for internal fixation with a plate. It has been six months since the surgery, but my foot still experiences persistent soreness and numbness, especially when walking. I also hav...
Dr. Chen Yongxue reply Orthopedics
Hello, fractures typically allow for full weight-bearing approximately three months after surgery. In your case, it is possible that a lack of weight-bearing for some time has led to stiffness in the tendons and joints. Please visit an orthopedic outpatient clinic for further eva...[Read More] Managing Pain and Discomfort After Tibial Fracture Surgery
Related FAQ
Ankle
(Neurology)
Ankle Injury(Surgery)
Thigh Nerve Pain(Neurosurgery)
Ankle Fracture Recovery(Orthopedics)
Ankle Pain(Orthopedics)
Pain In Limbs(Neurology)
Post-Tibial Fracture Surgery(Orthopedics)
Nerves(Neurosurgery)
Feet(Neurosurgery)
Left Foot Numbness(Neurosurgery)