Ankle Swelling After Fracture Rehab: Causes and Solutions

Ankle fracture, swelling after rehabilitation three months later, what could be the issue? How should it be managed?

Hello, Doctor: I injured my foot around mid-November last year, resulting in a fibula fracture.
I had two screws and a plate inserted.
By mid-January, I underwent another surgery to remove one of the horizontal screws.
After twelve weeks, I started to put weight on my foot and gradually transitioned from using a single crutch to not using one (though I still wear an ankle brace).
Initially, it felt okay, just a bit unnatural.
However, since last week, I’ve noticed that my ankle has swollen again, and it feels uncomfortable when at rest (a feeling of heaviness, and the swelling is visibly noticeable).
Additionally, the range of motion in my foot seems to have decreased, and there is pain when I move it.
I would like to ask you what this might indicate.
Is this a symptom cluster or a sequela? Should I refrain from movement or continue to move? What would be the best way to manage this? Would cold or heat therapy help? Thank you for your response!

Bo Zhi, 30~39 year old female. Ask Date: 2016/02/24

Dr. Shi Guozheng reply Orthopedics

It is best to return to the physician for a re-evaluation, as your description does not clearly indicate whether there is redness, swelling, heat, or localized pain.
It is also unclear if there is pain when not moving.
Please have a physician assess the situation before deciding on further management.

Reply Date: 2016/02/24

More Info

After experiencing an ankle fracture and undergoing rehabilitation, it is not uncommon to encounter issues such as swelling, discomfort, and restricted range of motion. Your situation, where you have noticed swelling in your ankle and discomfort during movement, is a common concern among individuals recovering from fractures. Let's delve into the potential causes of your symptoms and explore effective strategies for managing them.

Causes of Ankle Swelling After Fracture Rehab
1. Inflammation: Following a fracture, the body initiates an inflammatory response to promote healing. This can lead to swelling, especially in the early stages of rehabilitation. Even after the initial healing phase, inflammation can persist due to increased activity levels or overexertion.

2. Fluid Accumulation: After surgery, fluid can accumulate in the tissues surrounding the ankle joint. This is often exacerbated by prolonged immobility or limited movement, which can lead to poor circulation and lymphatic drainage.

3. Muscle Weakness and Atrophy: After a period of immobilization, the muscles surrounding the ankle may weaken, leading to instability. This can cause compensatory movements that may strain the joint and surrounding tissues, resulting in swelling and discomfort.

4. Scar Tissue Formation: Surgical interventions can lead to the formation of scar tissue, which may restrict movement and contribute to discomfort. This can also lead to a sensation of tightness or stiffness in the ankle.

5. Post-Traumatic Arthritis: In some cases, individuals may develop post-traumatic arthritis after a fracture, especially if there was significant joint involvement. This condition can lead to chronic pain, swelling, and reduced range of motion.

Management Strategies
1. Rest and Elevation: It is crucial to allow your ankle adequate rest, especially if you are experiencing significant swelling. Elevating the ankle above heart level can help reduce swelling by promoting venous return and lymphatic drainage.

2. Ice Therapy: Applying ice to the swollen area can help alleviate inflammation and numb the pain. It is recommended to ice the ankle for 15-20 minutes every few hours, especially after activities that may exacerbate swelling.

3. Compression: Using a compression bandage or ankle support can help manage swelling and provide stability to the joint. Ensure that the compression is snug but not so tight that it restricts circulation.

4. Gentle Range of Motion Exercises: While it may be tempting to avoid movement due to discomfort, gentle range of motion exercises can help maintain flexibility and prevent stiffness. Start with non-weight-bearing movements and gradually progress as tolerated.

5. Physical Therapy: Engaging in a structured physical therapy program can be beneficial. A physical therapist can guide you through exercises tailored to your specific needs, focusing on strengthening the muscles around the ankle and improving mobility.

6. Pain Management: Over-the-counter pain relievers, such as NSAIDs (e.g., ibuprofen), can help manage pain and reduce inflammation. However, consult with your healthcare provider before starting any medication.

7. Monitoring Symptoms: Keep track of your symptoms and any changes in swelling or pain. If the swelling persists or worsens, or if you experience severe pain, it is essential to consult your healthcare provider for further evaluation.

Conclusion
In summary, ankle swelling after a fracture is a common occurrence during rehabilitation and can arise from various factors, including inflammation, fluid accumulation, muscle weakness, and scar tissue formation. Implementing strategies such as rest, elevation, ice therapy, compression, and gentle exercises can help manage your symptoms effectively. If your symptoms do not improve or worsen, it is crucial to seek medical advice to rule out any complications. Remember, recovery takes time, and patience is key to regaining full function of your ankle.

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