@lucky77 Welcome to Connect. I appreciate your detailed explanation and questioning of what is wrong and how you are advocating for yourself. Many patients don't understand how to do that, so thank you for your example. We are all patients, and not medical professionals, so we can't diagnose a problem, however we can share similar experience which can give you an insight toward your journey.

It may be that the simple answer could be that hardware causes pain in some people. In my case, I know that is true. I had a compound bimaleolar fracture of the tibia and fibula at the lower ankle end of these bones that was also a dislocation and a serious sprain. I did have some loss of cartilage in the joint, so the joint space is slightly smaller than it should be. It was broken in a movement similar to rolling my ankle and it happened falling off a horse, so it was a high speed impact with the ground. I also had an external fixator cage for a couple weeks before I had surgery at Mayo to place 2 plates on the front and medial side of the tibia, and a screw placed inside the fibula from the lower end upward because it was displaced and had broken through the skin. I had my hardware for about a year and a half before I had it removed. I always felt like someone was kicking me in the shins with every step I took and it throbbed an ached a lot of the time. I also developed extensive chronic hives 6 months after getting titanium plates, and that resolved after hardware was removed.

I have not been able to be as active as previously because every once in a while, my ankle collapses under me with a sharp pain. I think this is when it fatigues, and it just doesn't take much effort until it wears out. That leg is still smaller, and I have weakness in the muscle on the lateral side of the calf and there has been a deficit there with slight muscle atrophy, so my ankle is weak in moving the foot to the lateral side, although it has improved a lot since the cast was removed. With the imbalance between strength of the lateral and medial sides, it allows the strong side to beat up the weak side and stress the tendons and ligaments that were sprained. I am having success with using vet wrap to wrap around my foot to help stabilize it and I have been wearing a lace up ankle brace since the cast came off, and I have custom orthodontics from a podiatrist. I think the joint can shift alignment a bit from laxity in the ligaments, and cause fatigue because it is off just a bit. It also helps to use my hand and rotate the ankle through it's range of motion so it doesn't lock up.

I do well walking on level firm surfaces, but soft uneven ground where my ankle has to stabilize is very difficult and fatigues my ankle quickly. I have learned that it takes time.... lots of time.... and my recovery may be over several years in baby steps. I'm guessing it may be possibly 6 years until I get to maximum recovery, although doctors don't really say that and may not know unless they have had a similar experience. I have talked to my podiatrist about stem cell injections to help heal and clean up the joint, but that needed to wait until at least a year past the last surgery, so I have not done that yet. He said it takes a long time to see results, and it's not a miracle fix, but it can help.

Pain also happens because of scar tissue that can pull on the capsule around a bone where there are lots of nerve endings. You can take your hands and firmly grasp your leg, and pull on the skin and just hold it and wait for the fascia to reorganize itself and release some tension. That is how myofascial release therapy works and I have learned a lot of it working with my therapist. I have also had medial knee pain similar to what you describe, and that was from misalignment of my pelvis. I have worked with a physical therapist on exercises to realign my body and it resolves that, so if that happens it is my clue to check my alignment. Misalignment like that can create wear an tear unevenly leading to a future knee replacement. I pay attention and if I can't solve it, I see my PT.

(Continued in next post)