Persistent Ankle Swelling After Fracture: What You Need to Know

Persistent swelling after a fracture?

Hello Doctor, I sprained my ankle on November 27, 2015, resulting in a fracture of the smaller bone on the outer side of the ankle, located near the bottom of the ankle.
I had a cast for six weeks, and after it was removed, an X-ray showed that the condition was good with no displacement, but the bone had not completely healed.
My foot is very swollen.
I asked the doctor if I should continue elevating my foot and if I could apply heat, but the doctor said it wasn't necessary and advised me to continue using two crutches and to move my foot up and down when possible.
I was told to return for a follow-up appointment in two weeks.
Since the cast was removed, my foot's range of motion is very limited, and the swelling has not improved.
Whenever I lower my foot, it swells significantly, affecting the entire foot and toes.
As soon as I elevate my foot, the swelling sensation subsides, but it remains very swollen overall, and I feel no reduction in swelling.
In the morning, I experience knee pain upon waking.
Since the cast was removed, my foot has been persistently swollen, and I cannot place it down without it swelling even more.
Is this situation normal? I am very worried because I am an athlete, and I fear it will affect my ability to perform in the future.
Please help me address my concerns.
Thank you.

Xiao Yun, 40~49 year old female. Ask Date: 2016/01/26

Dr. Shi Guozheng reply Orthopedics

Fractures typically take at least six weeks to begin healing, and complete healing may take up to twelve weeks.
Therefore, swelling in the foot before the fracture has fully healed is normal.
The bones themselves are richly supplied with blood vessels, and after a fracture, blood flow is interrupted.
As healing progresses, blood circulation will gradually improve.
Generally, this will not affect future mobility if the fracture heals well.
It is recommended to elevate the foot and perform ankle joint movements, including dorsiflexion and plantar flexion.
Additionally, the calf muscles should be exercised through repeated contraction and relaxation to enhance blood circulation.

Reply Date: 2016/01/26

More Info

Persistent ankle swelling after a fracture can be a concerning issue, especially for athletes who rely on their mobility and physical performance. It’s understandable that you are worried about the swelling and its potential impact on your future athletic activities. Let’s break down the situation and provide some insights based on medical knowledge.

Firstly, after an ankle fracture, it is common to experience swelling as part of the healing process. The body responds to injury with inflammation, which can lead to fluid accumulation in the affected area. This is particularly true in the case of fractures, where the surrounding tissues may also be injured. Swelling can persist for weeks or even months after the cast is removed, especially if the fracture was significant.

In your case, it sounds like you have been following your doctor's advice by using crutches and keeping your foot elevated. Elevation is crucial in managing swelling, as it helps reduce fluid accumulation in the lower extremities. However, if you are still experiencing significant swelling and discomfort, it may indicate that your body is still in the healing phase, or there could be other underlying issues.

Here are some considerations regarding your situation:
1. Continued Swelling: It is not uncommon for swelling to persist for some time after the removal of a cast. However, if the swelling is severe and does not improve with elevation, it may warrant further investigation. Persistent swelling could be a sign of complications such as lymphedema, which is a buildup of lymph fluid, or even issues related to circulation.

2. Activity and Rehabilitation: While your doctor has advised you to use crutches and limit weight-bearing activities, it is also essential to gradually introduce movement to the ankle. Gentle range-of-motion exercises can help improve circulation and reduce swelling. However, these should be done under the guidance of a physical therapist or your physician to avoid exacerbating the injury.

3. Heat and Cold Therapy: While your doctor advised against heat application, cold therapy (ice packs) can be beneficial in reducing swelling and pain. Applying ice for 15-20 minutes several times a day can help manage inflammation. After the acute phase, transitioning to heat may be appropriate to promote blood flow and healing, but this should be discussed with your healthcare provider.

4. Follow-Up Care: It is crucial to keep your follow-up appointments with your doctor. If you notice that your symptoms are not improving or if they worsen, do not hesitate to reach out for further evaluation. Additional imaging, such as an ultrasound or MRI, may be necessary to assess the soft tissues and ensure there are no complications.

5. Physical Therapy: Engaging in physical therapy can be incredibly beneficial for recovery. A physical therapist can provide tailored exercises to improve strength, flexibility, and range of motion in your ankle. They can also guide you on how to safely return to your sport without risking further injury.

6. Long-Term Outlook: While it is natural to be concerned about the long-term effects of your injury on your athletic performance, many athletes successfully return to their sports after ankle fractures. With proper rehabilitation and adherence to your healthcare provider's recommendations, you can work towards regaining full function.

In conclusion, while persistent swelling after an ankle fracture can be concerning, it is often part of the healing process. However, it is essential to monitor your symptoms closely and communicate with your healthcare team. They can provide the best guidance tailored to your specific situation and help you navigate your recovery effectively. Remember, patience and adherence to rehabilitation protocols are key to a successful return to your athletic activities.

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