Pain three years after plate and screws for broken ankle

Me again...also wondering what the future holds for my ankle and what I will have to deal with as I age. I am 72 now and in good health.

Not sure if this help, but I got a long spinal fusion from the thoracic to lumbar spine when I was age 11 (I’m now 40), so it’s been a good while. I’m not sure if it’s the same with an ankle, as ankles have a lot of range of motion, but while the spinal fusion (multiple rods and screws) solved one issue, I do have chronic back and neck pain from it.

I was told that where the metal naturally restricts my range of motion, it transfers that force to the bones and muscles surrounding it, which aren’t necessarily designed to take that much load. A side effect is I’m more likely to develop osteoarthritis.

Again, not sure if that would be similar with screws in your ankle, but the other thing that affects me is restriction from scar tissue. Even though the scars look fine on the outside, scar tissue can pile on and pile on under the skin causing restrictions that can also refer pain. A PT was able to help me with exercises for the pain and also recommend some scar manipulation techniques I could do on my own to help loosen it up.

@janieben I had a bad ankle fracture in 2020 with both the tibia and fibula fractured. It was also compound with the fibula breaking through the skin and dislocation of the joint. It has been a difficult recovery that has been like living with a sprained ankle for 4 years that limited how much I could do before I had to get off my ankle. The scar tissue is significant because of the surgeries to fix the ankle.

First there was an external cage screwed into the front of the tibia and both sides of the heel bone to stabilize it for a couple weeks before it could be fixed in surgery. Then surgery that placed plates and screws on the tibia in a new incision and also used the incision from the broken fibula when they had cleaned that wound. This second surgery also placed a screw inside the fibula. At a year and a half past the fracture, I chose to have all the hardware removed because it was causing throbbing pain, giving me large patches of hives, and developing some pigmentation on the skin over where the plates were. They used the same incision scars to cut for the next surgery.

What would happen sporadically was my ankle would collapse in pain when I was stepping off of it, and I would end up having to get off my foot and rest. I had learned a lot about stretching scar tissue from my physical therapist, and I used her techniques of myofascial release to work on the scar tissue on my ankle and shin and to loosen the tight muscle in the calf and shin. The injured side is of course weaker, and the stronger side kind of pulls on the weaker side putting excess tension on the ligaments and tendons on the weak side. I started to try to equalize that tension by working on the scar tissue and muscle tighness, and that worked. I was able to cure the pain and walk without pain for the first time in 4 years. This lets me rebuild strength slowly now that my joint is held in better alignment because the uneven tension has been worked out. I also got more supportive shoes that come up farther on my ankle and I moved my orthotic inserts into those shoes. It has helped a lot.

I had a bad injury called a bimaleolar frature which in simple terms means I broke off the "knobs" off on both sides of the ankle. The tibia on the front also had a compression that caused pieces like "puzzle pieces", but those that not been displaced.

The scar tissue led to this by being too tight and pulling through the front of the joint causing it to pinch and cause the pain. The subsequent surgeries also used the same scars for new incisions. The scar over the fibula had been cut 3 times, the scar on the inside of the tibia had been cut twice, and the scars from the external cage were cut once, but were very deep piercing the muscle on the front of the shin and adhering to the tibia bone. By loosening all of this, my ankle is now able to operate better and to stay in alignment better. I do circle my foot around to kind of reset it, and sometimes use distraction by pulling on my foot downward away from the leg.

There certainly can be arthritis after an injury like this, and my surgeon promised that would happen and I could expect to become a candidate for an ankle replacement in the future. I am determined to prevent that. If I can keep it moving better and use supportive shoes with my custom orthotics, I can stay out of pain. I am now working on walking more and adding in hills and uneven ground. That had always been a problem when the tension was unequal on the links that connect all the muscle to the bones (Tendons), and bones to bones (Ligaments). With stronger muscles, hopefully the joint will be held in better alignment. Pain can be caused by scar tissue and also reactions to the metal hardware. Some patients don't tolerate foreign materials inside their body very well, and that is me. Since removing my hardware from my ankle and doing the physical therapy work, I am now pain free.

Here is our discussion on myofascial release that can give you more information.

Neuropathy - "Myofascial Release Therapy (MFR) for treating compression and pain"
https://connect.mayoclinic.org/discussion/myofascial-release-therapy-mfr-for-treating-compression-and-pain/

There is a provider search at https://myofascialrelease.com/

Has your physical therapist talked about releasing scar tissue? Has your surgeon discussed the possibility of the hardware itself causing pain?

Janie, you might talk to your surgeon about having screws removed. They could be causing the pain and there is probability that you no longer need them.

I have had both ankles operated on for Posterior tibial tendonitis. I have plates and screws in both feet. My right was done by a Doctor who retired.I've never had a problem with it.
My left, however, has been a problem.Because they only put the graph in with a staple instead of using a plate and screws.So I had to have revision surgery to correct that problem.

I suggest that you go to the doctor a new doctor and find out if your hardware is still okay.
Good luck God Bless

I had a plate and screws put into my right ankle which I broke falling down the stairs in 2002. Twenty two years later I still have occasional pain in that ankle. It may be arthritis since both feet have that or it’s just age related. Sometimes it happens when it’s cold out. But I put a Biofreeze on it when it really bothers me and either it helps or is it that I just get busy and forget about it but after awhile pain seems to go away. I guess pain is expected because they did put titanium into my leg. Hope your pain eventually goes away.

Wow! You have gone through so much! Thank you for your response.

I have not gone to a PT about this pain. I am able to walk pretty well without pain at this point. I plan to visit my surgeon and ask about what may be causing the intermittent pain. I kind of dread even thinking about another surgery and the convalescent period!

No, I have not. I believe I will at some point, although I dread another surgery and convalescent time, of not being able to walk for a while again. Thank you for your thoughts. 🙂

Thank you for responding to my post.

It's good to hear you are still walking after 22 years. 🙂 That's what I would like to happen to me. The pain I have off and on doesn't impede any activity, I just don't want it to get worse. I believe I will speak with my surgeon about the future and also about having the repercussions of having hardware removed, in case that is causing the pain.

Thank you for writing to me. Good explanation of how the bones and muscles respond to the metal and surgery.

I hope your pain is not severe, emo. Broken bones are no joke, for sure. I have broken both fibulas, both tibias, two lamina in my back, two knee replacements, and right wrist so far. All but knees due to falling, and I am not a klutz! Maybe just unlucky...

I do try to manipulate and exercise my ankle each day; I think that helps. Hope you continue to do well.