Lisa's TIB/FIB fracture with ankle dislocation

5 weeks ago I fell over a child's gate and have a vertical fracture of the Fibula, the end of my tibia was broken off and I dislocated my ankle. They put the ankle back in place while I was in the emergency room and I was awake at the time. They couldn't wait until I went into surgery because there was a 3 hour wait. They put a plate and 7 screws in my fibula and two screws from the front into my TibIa. I was in a cast for 2 weeks. They said it would be 8 weeks of cast and no weight bearing, but I was having trouble with the area where they took out my staples, so they put me in a boot. So today it has been 5 weeks. I have to wear the boot constantly except when showering. I am supposed to keep my foot 6" above my heart as much as possible. My concerns are:
1. My foot still turns a purple/black color whenever I get up. How long will this continue?
2. They have only done x-rays. How will we know how much ligament and cartlidge damage there is? Shouldn't we have an idea for when I start physical therapy?
3. My foot feels like it is asleep most of the time, or it is tingly. I also have no movement except for my toes. Is this normal?
4. When I ask Questions at the doctors office, they ussually respond with, "These are bad fractures and we will just have to check on it each time you come in."
5. I am a very independent person but do not want to risk further injury. I work retaIl sales on my feet all day and drive 45 minuntes to work. When should I expect to be able to return to work?
6. I have been post menopause for 11 years and wonder if I should have a bone density test, because this seems like a lot of damage for a little fall. Should I?
Thanks for any input!

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Lisa's TIB/FIB fracture with ankle dislocation

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Jun 12, 2009
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answers
by: Bart - SII

1. The discoloration may continue for some time, as the body continues to heal. Having the foot immobilized doesn't allow for a lot of circulation, and so the fluid pools when you are up on your feet - thats why they recommend elevation as much as possible.
2. Ligament damage will heal as much as possible while you are immobilized for the fracture...so an MRI or other diagnostics likely won't be done. It isn't common to do any type of ligament repair in the ankle until after the fractures heal, and then only if you have ankle instability. And instability isn't likely after this type of injury because of all of the scarring that takes place while immobilized.
3. Swelling can cause restriction in movement, and the tingling feelings, so if you have a lot of swelling, which most injuries of this type do, that may be the cause. You may have also had some irritation of the nerves with the fibula fracture, which can cause the tingling as well.
4. Unfortunately, most of the questions you have - like when will I be able to to ... can't be answered because every case heals differently. So, it is very much a "wait and see" type of situation.
5. This type of injury will take a long time to heal and be back to "normal". After you are out of the immobilization (boot), you will have a lot of motion restriction. Therapy after you come out of the boot is a must to help restore motion and strength. Being up on your feet will be a slow process to get back into. Ankle fractures/dislocations often take upwards of a year to 18 months to get back to "normal".
6. A bone density scan would be a good idea, regardless of this injury. It is a good thing to know so you can adjust diet and supplements (calcium) to help be as healthy as possible.

Most of this is not good news - you do have a serious injury that is going to take a long time to heal. There are a lot of ankle fracture/dislocation stories on the site - I would encourage you to read through some of them and ask questions, as many people have gone through what you are experiencing and can give some advice on how to deal with life post-injury.

Good Luck!

Bart

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Jun 12, 2009
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Submitted by: Bart - SII

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1. The discoloration may continue for some time, as the body continues to heal. Having the foot immobilized doesn't allow for a lot of circulation, and so the fluid pools when you are up on your feet - thats why they recommend elevation as much as possible. 2. Ligament damage will heal as much as possible while you are immobilized for the fracture...so an MRI or other diagnostics likely won't be done. It isn't common to do any type of ligament repair in the ankle until after the fractures heal, and then only if you have ankle instability. And instability isn't likely after this type of injury because of all of the scarring that takes place while immobilized. 3. Swelling can cause restriction in movement, and the tingling feelings, so if you have a lot of swelling, which most injuries of this type do, that may be the cause. You may have also had some irritation of the nerves with the fibula fracture, which can cause the tingling as well. 4. Unfortunately, most of the questions you have - like when will I be able to to ... can't be answered because every case heals differently. So, it is very much a "wait and see" type of situation. 5. This type of injury will take a long time to heal and be back to "normal". After you are out of the immobilization (boot), you will have a lot of motion restriction. Therapy after you come out of the boot is a must to help restore motion and strength. Being up on your feet will be a slow process to get back into. Ankle fractures/dislocations often take upwards of a year to 18 months to get back to "normal". 6. A bone density scan would be a good idea, regardless of this injury. It is a good thing to know so you can adjust diet and supplements (calcium) to help be as healthy as possible. Most of this is not good news - you do have a serious injury that is going to take a long time to heal. There are a lot of ankle fracture/dislocation stories on the site - I would encourage you to read through some of them and ask questions, as many people have gone through what you are experiencing and can give some advice on how to deal with life post-injury. Good Luck! Bart

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Jun 12, 2009
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Thank you
by: Lisa

Thank you Bart for addressing all of my concerns! That was very helpful!

Jun 17, 2009
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Update
by: Anonymous

I went for my 6 week checkup. Everything looks good. I get to start Physical Therapy next week. They will show me how to allow 30-40 lbs of weight on the toe and start Range of Motion Therapy. Now we get to keep our fingers crossed and hope all the screws stay put. I cannot wait until I can move something besides my toes. The entire foot seems so locked-up

Jul 08, 2009
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Out of the Boot and Scared
by: Lisa

I am at 9 weeks now since my fall and surgery. Yesterday the surgeon took me out of the big black boot! I was excited about that until they put me into an ASo ankle brace. It seems like a very extreme change. After all this time being protected by that big heavy boot, I miss it. I am very nervous about weightbearing as tolerable and my limited range of motion is very evident now when I walk. I am still on crutches and trying to find shoes that fit around the ASO Brace. I believe this is the scariest part of the healing process. How do I know if I am pushing myself enough or doing too much? So far the Surgeon says I am doing a great job and everything is healing fine. The break is still evident of the Fibula although it looks like it is healing at the ankle area, but I guess this is not the weight bearing bone. The Tibia is held in place at the bottom with two screws. Since starting physical therapy I have gained a little range of motion (up and down some, no side to side) I have physical therapy twice a week with a terrific therapist. Is everyone this scared when the boot comes off? It feels so bare, exposed and still quite locked up.

Jul 13, 2009
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scared
by: Bart - SII

9 weeks is a long time to go with the boot on (normal for this injury, but still a long time). Your body gets used to having that security, and to your ankle/foot not moving. So, now you have to get used to not having the boot. And that takes time. It is normal to feel apprehensive and scared at this point. Your body really doesn't know what to do without that support anymore. Which is one reason why they therapy is so important. Not only do you have to regain your motion over time, and build your strength, but you have to re-teach the foot how to work - this includes the muscles, the joints, and the sensorimotor system that controls it all.

It sounds like you are in good hands - having a therapist that you trust and enjoy working with is half the battle when it comes to rehab. You are probably doing some gait training in rehab, or if not yet, you will. It will feel so weird as you learn to walk again, but it will all be worth it.

Give it some time - you are still fairly early in the recovery - a long way to go, but you will make it.

Bart

Jul 18, 2009
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lisa questions for you or anyone else with advicw
by: joni

hi lisa. omg your story i svery close to mine. i fell. had 2 surgeries, tib with 2 screws, fib with platw and 7 screws and a dislocated ankle. my cast was removed after 3 weeks due to blood clots and pulmonary embolism. i am 47 with 4 kids. i have been in the boot now to for 54 weeks. i do not feel it supposrt the tib break. the boot is much heavier than the cast and i havent got to take a shower. i dont sleep because the metal bars on the boot dig in to the incisions on each side of my ankle. how do you shower and does the ankle move forward when you do??? i am supposed to start therapy this week and i am petrified thanks joni

Jul 18, 2009
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So sorry to hear of your accident
by: Lisa

Hi, So sorry to hear about your fall. I am definitely not the expert here, but Bart has been a big help.
I really feel for you having to wear the boot for so long. I understand how you feel about the weight of it. I know most of the time you think it must weigh about 100 pounds! However when you finally get to have it off you have withdrawals and miss the protection of it. I was allowed to take it off to shower after week two and did fine. I was very careful and lucky to have a walkin shower with a seat.
Physical therapy is going fine. My therapist has started thing very slowly and painfree. Having the expercises to do at home has given me something positive to focus on and we see changes in my range of motion almost daily.
Hang in there! We will be dancing around again!
I wonder if anyone else has dreams about running and dancing? Mine were very frequent the first few weeks.
I hope my post have been helpful.

Jul 25, 2009
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hi lisa
by: joni

yes your post was very helpful. i started therapy this week and wish i liked my therapist like you do. i hurt so bad after day 1 i was crying. he isnt patient and allthough i know i have at least 2 months ahead he seems to think i should be running. he said i was in the boot too long.8 weeks. my ankle would not move at all the first day and then a bit the second. i have some rubber band excersises to do at home but was wondering was your ankle as frozen up as mine is. i can move it only about a half inch back and forth. also my big toe will not move at all. any suggestions?anyone??? thanks so much

Jul 28, 2009
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Physical Therapy
by: Liss

It is good that you are in physical therapy. I read about so many people that aren't referred or just don't go. If you aren't happy with your therapist, I suggest trying to find another. It is very important to have a good relationship and build trust with that person. It is also so important for both of us to go to physical therapy if we want to walk and walk without pain in the future. I didn't have and movement in my foot either in the beginning, but since 4 weeks of therapy I have gained a lot in my range of motion. It started off very slow. Make sure you ask them about the big toe. He may have a suggestion of stretches or something. When mine wouldn't move they had me try excersizing it with my fingers, just bending it a little, but I wouldn't suggest anything for you. You should talk to your doctor first.
I have started riding the bike for warm up in therapy and yesterday he added weights to my leg excersizes. It feels like I gain a little everyday! I also do about seven different stretches/excersizes at home all recommended by my therapist. They all help and several of them are helping my achilles to stretch and lossen up. I hope you are able to find a physical therapist that you like!

Jul 28, 2009
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Full weight questions
by: Lisa

Today I met with my surgeon for my 12 week follow-up. He said everything is healing well and I should begin full weight bearing. I already put full weight on it while standing, but still use my crutches to help with walking. My therapist says I have 5 degrees to go before I can walk on it. My question is what should I be changing? what do I differently?

Jul 30, 2009
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hi lisa
by: Anonymous

wow. way to go. how incouraging. you mentioned your achhiles needing to loosen up. little did i know that even the achilles would need help too. what was yours like at first?? it seems to me that i cannot bring my foot forward toward me when i stretch and just pint my toes a bit the other way. i know its early?? any other suggestions and tell me how you were at day 3 of therapy. congrats to you and the weight bearing.joni

Jul 31, 2009
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therapy question
by: Lisa

when I began therapy I had no motion in my foot, only a little toe wiggle in three toes! On the third visit I had some motion up and down but none side to side and one leg looked shorter than the other. (Achilles and other muscles needed a lot of stretching). I am now into 4th week of therapy and just need a little more range of motion to walk normally. This part is painfully, (hello swelling!) but so worth it!

Aug 07, 2009
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therapy update
by: Lisa

Yesterday I went to back to my therapist. We add the leg press machine to my workout. Things look great. I still do not have enough ROM to walk, but can get around the house on one crutch and put full weight on the foot. I started independent therapy and water walking at the CP center. They have a great pool and staff to help you get around. It was scary with all of the wet surfaces, but they wheeled me to the pool and I use the railing and steps to get in. No crutches are allowed on the pool deck. It is too dangerous. I feel like I am making real progress. Since I did pool therapy on Tuesday, my swelling has disappeared! I walked holding onto the pool edge for 15 minutes and then tried the kick board for a 10-15 minutes.
The pain will go away in time and soon I will be walking on my own. The only problem right now is that my insurance has limited my therapy to 12 sessions. My last one will be Monday unless my therapy center can convince my insurance that I still need more. I do need more! I am almost there on ROM and I need more therapy to get there to be able to walk correctly. Please keep your fingers crossed and pray that my insurance comes thru.

Sep 06, 2009
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hi lisa
by: Anonymous

lisa what happened witht he insurance??? and when you went to therapy at first and the brace was off did you ever use a walker/ i am using the walker without the boot to walk now but my lower leg gets so red and it seems the blood pools. also how much pain did you have when you used cruthes and or walker. i barely put weight on it with walker and it hurts soooo bad.joni

Sep 07, 2009
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question for Bart, update on therapy progress
by: Lisa

They were wrong about the insurance. My insurance approved 26 physical therapy sessions not 12! Thank God!
I am no longer counting weeks, now we report in months! It has been almost 4 months since my accident. How do pro athletes heal so quickly?
My physical therapy sessions are down to one a week. I now do independent pool therapy 3 times a week and get a massage every other week. I am back to work two days a week. I need two more degrees in my dorsiflexion ( toes toward shin)to be able to walk correctly.
Question: I have had an issue since the cast came off. It seems like the angle of my knee and foot do not line up. When I stand or walk, to have my foot facing forward requires an inward turn of my knee and hip. Bart is this normal? The response I seem top receive is that I am compensating for my lack of ROM, but most of that is back.
In answer to the walker and pain questions. Yes I did use a walker until they said I could start putting weight on it, then I switched to crutches. There definitely was pain and still is at times. It gets better! Now at 4 months I am down to one crutch and can go without that if I am home. It still has its painful times, but is manageable. It still swells and I ice it everyday. Nighttime is the worst for pain and swelling and mornings are all about stiffness. Uneven ground is the most painful to walk on.
All in all: I am able to move all my toes; I am on only one crutch when I leave the house; I have almost all my ROM back; I am back to work part-time and I no longer worry about what I won't be able to do! Now It is all about, when!

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Sep 07, 2009
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Submitted by: Lisa

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They were wrong about the insurance. My insurance approved 26 physical therapy sessions not 12! Thank God! I am no longer counting weeks, now we report in months! It has been almost 4 months since my accident. How do pro athletes heal so quickly? My physical therapy sessions are down to one a week. I now do independent pool therapy 3 times a week and get a massage every other week. I am back to work two days a week. I need two more degrees in my dorsiflexion ( toes toward shin)to be able to walk correctly. Question: I have had an issue since the cast came off. It seems like the angle of my knee and foot do not line up. When I stand or walk, to have my foot facing forward requires an inward turn of my knee and hip. Bart is this normal? The response I seem top receive is that I am compensating for my lack of ROM, but most of that is back. In answer to the walker and pain questions. Yes I did use a walker until they said I could start putting weight on it, then I switched to crutches. There definitely was pain and still is at times. It gets better! Now at 4 months I am down to one crutch and can go without that if I am home. It still has its painful times, but is manageable. It still swells and I ice it everyday. Nighttime is the worst for pain and swelling and mornings are all about stiffness. Uneven ground is the most painful to walk on. All in all: I am able to move all my toes; I am on only one crutch when I leave the house; I have almost all my ROM back; I am back to work part-time and I no longer worry about what I won't be able to do! Now It is all about, when!

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Dec 17, 2009
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Its been 7 months!
by: Lisa

First I want to say thank you again to Bart for all of your help! Its so comforting to have professional people available to ease our minds!
These types of injuries can be scary and reaching a professional by phone to answer general questions can be frustrating! THANK YOU!
It has now been 7 months and I am recovering nicely. I don't see the therapist or surgeon again until February. I have most of my range of motion back except 2-3 degrees of dorsal-flexion. So my difficulty now is going down stairs or moving quickly. I walk (slowly on the treadmill every other day. I still experience some pain especially in the evening, when it is cold outside or about to rain. Maybe I should change my career to a meteorologist! There is not much swelling these days which is a blessing! The surgeon said he may want to remove the plate and 7 screws in the fibula next spring, since this area is causing me the most pain. He also is very concerned about Post Traumatic Arthritis and continues to monitor the area between the tibia and talus. He said that I may need surgery for that later and recommend the fusion surgery. I pray that never comes to pass. We just wait and see. The good news is my Bone Density test was fine! Thanks again for your help!