Advice on recovery from ankle fracture

Been riding on-road for 45 years and decided to take an off-road course to sharpen my on-road skills; form of cross-training. While excelling (i.e., probably going faster than I should have been) in higher speed turns on hard packed dirt I managed to drop the bike and my left foot came up pointing 90 degrees to the side. I have a closed spiral fracture of my distal fibula and transverse fracture of my medial malleolus, which allowed my foot to rotate laterally. Apparently the articular surface of the heal bone (talus) was scraped by the tibia as the heal rotated laterally. My foot was re-aligned within 10 minutes and I had surgery within 5 hours of the accident. The fibula was plated and the medial malleolus has a single screw in it. I was told 4 weeks non-weight bearing, 4 weeks in a boot and 4 weeks in normal shoes, but no heavy duty use. I'm 6 days out and have been surprised the pain has been far greater after the surgery than prior to it. If I go any distance on the crutches or leave my leg down for extended periods my toes start to swell and the ankle begins to ache. I've limited my intake of hydrocodone, but usually need it to sleep. Last night was the first time I was able to sleep off my back. I rolled to the right and placed a pillow between my legs.
I would very much appreciate any insights from anyone who has suffered a similar injury regarding things like when will the pain subside, when in the boot will I still need crutches-if so how long, what will my foot feel like when back in shoes (painful or just different), what your experience is years later, etc??? I realize every fracture is different so I am searching for a general range of experiences.

Thanks
Dave

I had a fracture of my right tibia and fibula along with massive damage to the medial ligaments a few years ago. I was 50 at the time. I had also injured them several times while in the Army. While the bones healed up after 3 months, the ligaments did not fare so well. I now say that the only thing holding my right ankle together is "skin" and has limited my ability to play action type sports like football, basketball, etc.

Your injury sounds similar to mine. My advice is to not try to hurry the recovery. You don't want to develop a "failed fusion" of the bones where they never actually grow back together. Additionally, try to get some rehab for your ankle once your cast is off and you are able to ambultate to help restore the proprioception of your ankle joint.

Also, wear some good MX boots when trying to do off-road which I am now doing. My road boots did not provide sufficient support to my ankles for off-roading.

FWIW, I had to keep my foot elevated for almost a month due to the swelling resulting from the ligamentous damage. So don't freak out about your current status.

Hang in there!!!

Ankles are a real PITA to stabilize and heal after such an injury. After a car accident 18 years ago, I needed over twenty hours of reconstructive surgery to plate and screw bones everywhere but my left ankle. That ankle was only badly twisted and sprained.

Go figure. My left ankle remained the size of a grapefruit for a year afterward. All of the "bad" injuries healed up fine, to where I don't notice anything now. It has taken a lot of work to get the left ankle stable enough that I can run without problems. You need to listen to your doc and do all of the therapy. Be patient! You will probably need a compression support sleeve to stabilize the ligaments. Expect to be able to predict the weather.

Even a broken hip later didn't give me near the problems of that damned ankle! The hip is fine now.

Get good boots with solid ankle support! Alpinestars Tech-8's have been great for me. Even with my gimpy left ankle I've walked away from drops where my foot gets turned like that. You will need similar sturdy boots for street riding as well. Believe me, nothing is worse than putting your foot down at a stop, only to notice the "Out to Lunch" sign where you're counting on foot support.

Good luck with the healing!

Thanks for the input. Due to decades of aggressive racquet sports I developed degenerative joint disease in my right knee. I gave up sports a decade ago because of the associated knee pain and risk of accelerating the need for an artificial knee. What I am hoping for with my foot is relatively pain free walking and bicycle riding.

As a start I would get your vitamin D-3 levels checked. Get a good, bioavailable multi mineral/magnesium supplement, and check your urine PH 3X/day.
If you're eating the SAD diet (standard american diet) you'll probably find you're on the acidic side of neutral (7). If so, you're loosing minerals from your bones to buffer that acidic PH which makes it hard for you to repair the fracture.

Once you are able to, work on building muscle strength. The ligaments and other connective tissue don't recover as well.

I have ankle problems just from sprains. Some of it is from weak joints genetically, with hyper-flexibility. But I've gotten a few big/serious sprains, and my ankle still makes grinding noises if I move it wrong.

+1 after two tedious recoveries from lower leg injuries i wear oxtar mx boots with extra ankle support for road riding too. looks vaguely ridiculous clumping into coffee shops but worth it when saving your feet, ankle and lower legs in offs.

my docs said no supplements will help if you have a healthy diet, but suggested calcium tablets only if diet didnt provide this (e.g. not drinking milk). once the docs clear you for load bearing, get in heaps of exercise and stretching. you'll probably find the ankle will never 100% recover but continuing exercise and stretches etc in the years ahead will maximize what you can regain, and protect ligaments in future spills.

As anyone would do I've mentally revisited the turn and what would have prevented my outcome. Going slower certainly would have, but excluding that I suspect had I been wearing an appropriate off-road boot I may well have walked away with only a bruised ankle. Not sure what I'm going to do for my future on-road riding. I've got plenty of time to dwell on it.
I already was taking supplements of Vit D3, Ca/Mg and a multivitamen and have for a very long time been on an excellent diet as my wife is borderline vegetarian; we do eat poultry, fish, dairy products, eggs etc...just no red meat or anything fried.
During my active years as a vet, now retired, I stayed up with the literature on glucosamine and chondrotin sulfate. Most of the credible studies came to the conclusion that for chronic arthritis it is a waste of money. I recalled one study in sheep where there was a statistical benefit in acute joint injury; therefore, I figure I've got nothing to loose but a few bucks.

When you get older, things tend to break.
You need to use good gear and try not to crash.
I suspect your future dirt riding might be limited?

I crashed bad last year, and have not been dirt riding since (no bike).
I was looking for a tw200, I might be able to ride that without it ending in a helicopter ride, maybe..
After dirt riding for 40 years, I have one leg that works right.
All my other limbs (plus my back) are trashed.

I did break my ankle on the working leg, but it does not bother me at all.
The damage was nothing like yours.

Hope you heal up 100%!

Having had a similar injury, I'd be concerned about cartilage damage at the Talotibial joint. AKA arthritis and loss of range of motion. Do the PT vigorously as permitted.

I was 8 weeks on crutches then permitted to start weight bearing. Took me 2 weeks to get off the crutches and walk unassisted wearing a rigid brace with a limp. Be patient. Swelling was an issue for six months. Oxycontin was my friend. Wish you well.

Allergic to oxycontin, but not hydrocodone; however, I don't enjoy the drugged up affect. I find I can endue the entire day until about 7 PM then the heal begins to throb and my choice is to either take hydrocodone or not eat due to associated nausea.
At what time interval from your surgery were you able to take a shower? Very important time point for me presently.

I've had two fractures of the left leg. I am now a year and a half since the last and have progressed very well.
Be careful with the swelling. You may think you should be more mobile but swelling interferes with healing so keeping it up above your heart as much as possible. Any increase in pain or severe swelling should be reported to the dr. as it could be complications.

I used to do leg lifts every morning and night while laying in bed, good for the abs as well.

Pain is not your friend so when you do start physio do not push to pain. Good physio is hard to find I would look for someone who does a lot of orthopaedic work especially if they have rights in a gym and pool. A lot of good exercises can be done in the pool that you wouldn't be able to do on the ground.

The biggest trick is to get flexibility back, to that end I have found doing Tai Chi extremely beneficial.

When you get a walking cast you begin applying different percentages of weight bearing. Until you are able to do 70% or so then you toss the crutches and use a cane for several weeks.

Just listen to your body and progress as it lets you progress and you will be fine.

Good luck,

There are many published studies. Here's one.

Keywords: ARTHRITIS - Osteoarthritis, Chondroitin Sulfate, Glucosamine Hydrochloride, Glucosamine Sulfate
Reference: "Recent Advances in Glucosamine and Chondroitin Supplementation," Owens S, Wagner P, Vangsness CT, J Knee Surg, October 2004;17(4):185-193. (Address: C. Thomas Vangsness Jr, MD, Dept Orthopedic Surg, Keck School Med, Univ Southern California, Healthcare Consultation Center, 1520 San Pablo St, #200, Los Angeles, CA 90033-4608, USA)
Summary: One out of every 8 Americans report having arthritis, and >50% of people older than 65 years of age report arthritis. Osteoarthritis is a significant health problem in developed countries. Cartilage degeneration, osseous eburnation and osteophytosis, synovial hypertrophy and an inflammatory and proteolytic synovial fluid environment are key elements of this disease process. Nonsteroidal antiinflammatory agents have been the mainstay of treatment, but they do nothing for the pathogenesis of the disease. They increase the risk of peptic ulcer, renal hypertension and hemorrhage and are problematic in the elderly. There is a growing concern that nonsteroidal antiinflammatory drugs have a negative effect on cartilage metabolism. Ibuprofen and fenoprofen have been shown in vitro to reduce glycosaminoglycan synthesis in canine cartilage, and indomethacin has been shown to speed the progression of osteoarthritis in humans. Glucosamine and chondroitin are very important parts of the cartilaginous matrix. Glucosamine is a topical agent which was first used in 1969 in arthritis patients. It has been used for the past 15 years in Europe and Asia. It became popular in the United States after the 1997 publication of The Arthritis Cure. The Arthritis Foundation maintains a neutral position regarding the use of glucosamine and chondroitin sulfate, and notes that there are no long-term studies and if used, it should be used only for several months unless there is benefit, then it may be continued. Glucosamine hydrochloride has a purity of 99% compared with glucosamine sulfate having a purity of 74%. This equates to a dose equivalent of 2,608 mg glucosamine sulfate for a 1,500-mg dose of glucosamine hydrochloride. The oral absorption rate of glucosamine hydrochloride compared with glucosamine sulfate has been shown to be equivalent. Chondroitin sulfate has a lower oral absorption of about 70%. Most of the studies have been done on glucosamine sulfate when given by itself. Studies have shown improvement in pain and range of motion. Glucosamine sulfate by itself at 1,500 mg/day compared with 1,200 mg/day of ibuprofen has shown a delayed but progressive and longer-lasting effect. Glucosamine hydrochloride by itself has shown an insignificant improvement in the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index score over placebo, although there have been positive trends in the glucosamine group. A daily diary by each subject has shown significantly less pain with glucosamine hydrochloride than placebo, and the knee range of motion was significantly better at the end of the study with glucosamine hydrochloride. Studies with glucosamine have shown less joint space narrowing over placebo over a 3-year period. Several chondroitin trials showed reduction in pain and improvement in joint function in osteoarthritis, as well as a lower number of joints involved in osteoarthritic erosions. Experimental studies have shown a synergistic effect with glucosamine and chondroitin sulfate when given together, with a greater increase in glycosaminoglycan production than for either agent alone, although the mechanism of action may be different for each agent. The combination of glucosamine hydrochloride, chondroitin sulfate and manganese ascorbate showed only improvement in knee pain, without any benefit to the back. The National Institutes of Health is currently conducting a study with glucosamine/chondroitin, called the Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT), involving the following groups: placebo; chondroitin sulfate with glucosamine; glucosamine alone; chondroitin sulfate alone; and nonsteroidal antiinflammatory drugs. Results of the GAIT trial will be available in November 2005. The current recommendations of 1,500 mg of glucosamine and 1,200 mg of chondroitin are accepted by the Arthritis Foundation, but the products should be discontinued if symptoms do not improve within a few months. Overall, the results of glucosamine and chondroitin in treating osteoarthritis have been favorable. Although no long-term studies have been done, there are very minor side effects to short-term use of glucosamine and chondroitin sulfate. Glucosamine's effect on insulin resistance needs to be followed. Also, glucosamine's purity has been shown to vary from product to product.

I showered the day after surgery while still in the hospital. Get a shower stool for home use.

+1 to good boots!

I had an undisplaced spiral fracture of my right fibula, along with crushing of my foot and ankle after a bit of a boneheaded manouver...thankfully, no ligament or tendon damage, and no surgery needed.

Aircasts (walking boot) make me wary after mine allowed the break to move enough that even after 6 months there was unhealed bone. 8 weeks no weight, 4 months light activity, then back to no weight for 8 weeks...

It was roughly ten days before the swelling started to subside. Until then, if my foot was not raised, it was very painful.

Tylenol 3's don't work for roughly 30% of people, because not everyone has the enzyme to turn codeine to morphine.

Two and a half years later, I still have bruising on my foot, and the doc says it may not ever go away completely.

I don't ride without my Alpinestars now. I would have walked away if I was wearing them.

It is going on 2 years since my tib/fib spiral adventure began and it will take some time. The main thing is DO NOT bear weight on the foot until your Doc approves. Mine still puffs up and bruises after vigorous use so I continue to ice it down after use. Arthritis will certainly pay a visit also. It sucks, but it could be worse. Rehab it well.

It has been my experience that once you "wack" your ankle that is it. It will never ever be the same....again! It will feel better but never have the strength or be as flexible.

I have a heavily bandaged fiberglass splint that wraps under my heel and up 2 sides of my calf about 3/4 of the way to my knee and was told emphatically no shower or bath. I found that by putting a plastic garbage bag on my leg and securing the top with a large rubber band I can hang my left leg over the side of the tub and get a reasonable bath without risk of wetting my bandage. So how did you manage to shower?

PS- For anyone with an ankle fracture that reads this thread in the future I was finally able to sleep on my right side vs back with tolerable discomfort (and hydrocodone) 6 days after the surgery. It does require a pillow be placed between the legs.

Bad ankle sprain, torn ligaments here (basketball). No breaks. Military clinic gave me an ace bandage but no crutches since I was outprocessing the installation & they wouldn't get 'em back.... "but I guess you can have this old wooden cane here..." Thanks. Had no money and no idea where to actually buy crutches so figured I'd just tough it out. Worst cross-country drive ever -- pain & swelling worsened tenfold into that night & following day. Eventually bought crutches out of desperation (corner drug store -- who knew?). PT was unheard of but at least I was mobile.....
Ankle reached steady-state after about a year, maybe a bit longer. Now, 20+yrs later, it "dangles" outward, pronates inward while squatting, and makes a racket descending stairs. Only mildly noticeable in the mornings, very tolerable; running's no prob.
But I can't help but think that the relatively recent problems in my opposite hip are the result of many years of compensating for that old, untended injury. Was that sprain the gift that kept on giving....?

Separate note, had an A-Ha! moment just this week when taking a left out of a parking lot, hitting some well-camouflaged gravel, sliding the front for an instant. ST1100 flopped to the side just enough to catch the toe of my boot on the ground and start rotating the ankle just as the tire re-gripped, righting the bike. Had the maneuver continued in a 7mph low-side, no doubt that ankle would've completed the 180 deg rotation. Hmm, so that's how it happens.....

Here's to your healing, Doc.

Waste basket sized garbage bag taped to the leg at the top with 4" 3M Microfoam tape. Had no problen with water entrance. ...and of course the shower stool since there was no way I could stand on one leg long enough. Put the shower head on a hose too.