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Recovery Guide : Plantar Fasciitis

What Is It?

Plantar fasciitis is a common foot problem effecting an estimated 10% of the population at some time during their lifetime. Millions of Americans are diagnosed with Plantar Fasciitis each year.  The plantar fascia is the tough fibrous band under the sole of the foot that is responsible for maintaining the integrity and arch of the foot.  Since the foot is used in many types of activities, it is subject to numerous types of traumatic, degenerative, and inflammatory conditions and many of these involve the plantar fascia.  Therefor the causes of plantar fasciitis are numerous.  Some of the more common causes include;

  • Repetitive trauma. Very common in athletes especially distance runners.
  • Obesity
  • Flat feet
  • Bone spurs
  • Poor fitting footwear
  • Aging
  • Degenerative conditions such as arthritis.

Diagnosis

Pain is the most common symptom.  The pain often begins in the heel area, but may be in any part of the fascia.  It is typically worse when beginning to use the foot such as getting out of bed only to subside somewhat after the foot stretches and then get worse with prolonged weight bearing or activity.  There is often point tenderness to touch in the afflicted area.  Typical signs of inflammation such as redness and swelling are usually not present.  For the most part, the diagnosis is based on the
historical and clinical findings.

The finding of pain, especially in the heel, point tenderness, one of the causative factors, and the clinical presentation is often enough to give the Doctor a presumptive diagnosis of plantar fasciitis.  Routine foot x-rays are sometimes done to rule out other causes of pain such as a stress fracture, or a degenerative condition like arthritis.  Other more complex radiological studies such as
CT, MRI or ultrasonography are usually not needed unless there has been treatment failure and other conditions must be ruled out.  Once a presumptive diagnosis is made the initial treatment is usually conservative.

Treatment

The initial treatment is to rest the foot as much as possible and to minimize trauma and irritation to the afflicted area.  Several simple things can be done such as;

  • Avoid flat shoes, flip-flops or going barefoot
  • Use over-the- counter heel inserts or foot pads to provide arch support
  • Stretching exercises first thing in the morning and through out the day
  • Minimizing (if possible) the aggravating factors such as running, dancing or jumping. Icing the instep.
  • Rolling the instep over a frozen water bottle is an easy way to do this.
  • If expecting a lot of walking such as visiting a theme park, consider using a knee walker or
    wheelchair.

If focal areas of tenderness are located, injections with glucocorticoids and a local anesthetic provide immediate and sometimes long-lasting relief.  The use of mild analgesics such as aspirin or Tylenol often helps.  Non-steroidal anti-inflammatory drugs (NSAIDs) are helpful but they should not be given for more than a few weeks.  Initial conservative treatment often results in up to 90% of the patients getting relief or improvement of the pain.  If the condition persists, more aggressive and costly treatments can be considered.

  • Custom molded shoes
  • Night splints
  • Immobilization in a cast.
  • Extracorporeal shock wave therapy
  • Surgery is indicated in very few cases

In summary, plantar fasciitis is a common foot problem affecting in millions of Americans each year causing inconvenience, and pain.  The diagnosis is usually by clinical means and the initial treatment conservative.  Improvement or cure can be expected in most cases.

Disclaimer: The information compiled in this guide was taken from sources made available to the
public and from consultation with physicians. We are not medical professionals and do not regard
ourselves as experts. Always listen to the instructions given by your doctor first and foremost.
However, we encourage patient education and recommend that you research your injury further.
Your medical institution website may have further useful information. Otherwise please check our
list sources for more detailed reading.

Bibliography
“21 Surprising Plantar Fasciitis Statistics.” Heel That Pain. November 20,
2016. https://heelthatpain.com/plantar-fasciitis- statistics/.
Karl B. Fields, MD. “Evaluation and diagnosis of common causes of foot pain in adults.” UpToDate (Wolters
Kluwer ), January 2018.
Rachelle Buchbinder, MMBS, MSc, PhD, FRACP. "Plantar Fasciitis." UpToDate, (Wolters Kluwer) May 5, 2017.

Renting vs. Buying a Knee Scooter

You have an upcoming surgery and you are a candidate for utilizing a knee scooter to stay mobile. You’re shopping around and trying to figure out, “Do I rent or do I buy a knee scooter?” Everyone’s situation is different, but in today’s post we’ll try to help you through that decision.

Some of the factors to consider when deciding between renting and purchasing a knee walker or knee scooter include Time, Space, Quality and Value:

1. How much time is the knee scooter needed? Purchasing provides the flexibility of not having to worry about how many weeks you will need the unit. If you are going to use it long term, it makes sense to purchase a unit. But, if you will only need the knee scooter for a couple of weeks, why would you want to deal with the hassle of finding a place to store the knee scooter when finished?

2. How much space do I have? Knee scooters are bulky. Though the tiller bar can be folded down, they still weigh over 20 lbs and can be oddly shaped enough to not be stowed away easily in a closet or garage. If you purchase your unit, you will have to find somewhere to store it until you can discard it. Renting allows you the ability to quickly return the unit and regain some space.

3. Resale value? If you purchased a unit and now want to get rid of it, are you willing to assume the liability if the next user gets hurt on it? Rental companies care for their knee walkers and do a thorough inspection before sending out a unit. If you purchase a knee walker and want to get rid of it you most likely will assume the liability should something happen to the next owner. Donating the unit to a non-profit is probably your best bet.

4. Quality of knee scooter? The old addage, “You get what you pay for” applies here. You most certainly can find a knee scooter online for less than it costs to rent a unit. Beware though of the quality of the unit and assembly required of the lower quality units. Renting a knee scooter allows you to obtain a high quality unit and even pay for it over time.

Knee Walker Central’s mobility team is ready to help with your rental and/or purchase decision. We offer high quality units both for rent and for sale with fast shipping. Give us a call today at 866-802-0580.

Adjust the Height to Get it Right

So you’ve had a foot or ankle injury or perhaps you are getting prepared for surgery to heal a stress fracture or remove bunions.  Crutches are uncomfortable and they can cause nerve damage, so you choose the best alternative and rent a knee walker / knee scooter! What happens now? You have to set up the knee walker / knee scooter correctly. How do you know you’ve set everything up correctly?

  1. First, read the instructions…pictures are not enough.
  2. Make sure you have all the parts you are supposed to have.
  3. Put the knee post into the frame. The proper height is when your good leg is flat on the floor while wearing a closed toe shoe such as a sneaker and your injured leg is bent at a 90-degree angle.
  4. You should be able to stand up straight and walk forward without having to hop on your tiptoes with your good foot.
  5. Make sure you have the knee post adjustment knob or pin going through both the knee post and the frame. Some frames have the hole under the frame; others are located above the frame. Having the knob or pin through both the knee post and the frame will secure the knee pad so it cannot move left and right.
  6. Do you have a split knee pad? If so place your knee on the front knee pad and your lower leg on the back knee pad with the lip of your cast or boot between the knee pads. This type of knee pad is designed to relieve pressure on your shin caused by the cast or boot.
  7. Now to the handlebars. Make sure your tiller is in the upright and locked position. The tiller is the folding mechanism that allows the handlebars to fold down for easy transport. If the tiller is still a bit wobbly spin the tiller latch clockwise (tighty righty, lefty loosey) and tighten it back down.
  8. Adjust the handlebars so that your arms are resting comfortably on them at a 90-degree angle or higher. You don’t want your handlebars too low as a quick stop could cause you to lose your center of gravity.
  9. Make sure your height adjustment knob for your handlebars is snug as well.  This will also help keep your handlebars from being wobbly.
  10. Put on your basket or tote bag

Now you’re ready to roll!  Take your time though!  Go slow and get used to using the knee walker / knee scooter.  Watch out for things on the road such as rocks, sticks and uneven sidewalks.

If something doesn’t feel right to you on the knee walker / knee scooter – stop using it immediately!  Call us at 866-802-0580 and we are happy to help assist you.

Faster Delivery Times

Shipping Map Graphic - rev 2

If you’ve suffered a recent injury or need to rent a knee walker or knee scooter quickly, we’ve made changes over the past several months to faster serve our rental customers.  We have always been able to serve New York, Philadelphia, Boston, Los Angeles, San Diego and Las Vegas with one day service.

We have now added facilities in Florida and Texas that allow us to serve Atlanta, Montgomery, Jacksonville, Orlando, Tampa, Miami, Dallas, Houston, Austin, San Antonio, Little Rock, Oklahoma City and Wichita with one day service!

We also are now able to serve Washington D.C. with one day service!

Orders received by 3:00 PM we commit to ship that day.  Check out our handy Shipping Map for more information.

We offer a diverse selection of knee walkers to meet your needs.  Give us a call at 866-802-0580 and talk to our knowledgeable team for more information!

Recovery Guide: Foot Fracture

What Is It?

Fractures of the foot can come in many different forms. More of the most common types of foot fractures are discussed in their own categories (see Lisfranc, Jones stress, and Calcaneal fractures for more details). Almost a quarter of our bones are in our feet and since we use our feet frequently to bear our weight and move, they are constantly exposed to a lot of forces. Sometimes during extreme activities your bones become overworked and are prone to fracture. That is why athletes and dancers, such as ballerinas, are prone to getting foot fractures. Foot fractures also occur due to sudden sharp movements or as a result of a post traumatic accident, such as a fall or a motor vehicle crash. Post-traumatic breaks tend to be more severe since they are the result of high-impact forces. Calcaneal and Lisfranc fractures are a good example of breaks that can occur due to a high-impact injury. Low-impact injuries result in stress fractures, fractures that occur due to exposure and overuse at the same spot over and over again. Stress fractures are the products of overuse and exceeding too rapidly in physical activity. Pain, bruising, and swelling can be an indication of a foot fracture, though clinical evaluation and x-rays will be needed to confirm the presence of a fracture.

Treatment

Most types of foot fractures can be treated without surgery. Surgical intervention will be required if the bones become displaced, meaning that are shifted out of their original anatomic position. If a break is stable, then it can be treated conservatively with casting to hold the bones in place while they heal. For forefoot and toe fractures, you may be placed in short-walking cast allowing you to walk in a boot or with minimal amount of weight bearing. Sometimes your doctor may brace the injury without a cast depending on the type of injury. For a break in the toes, your doctor might tape the broken toe to a neighboring good toe to stabilize it. This is known as “buddy-tapping”. If the break in the foot is displaced, then your surgeon will realign the bones and fix them in place using hardware such plates and screws. Recovery time for conservative and surgical treatment can range anywhere from 6 to 8 weeks depending on factors such as the type of injury, age, smoking, and other medical conditions. A patient may be instructed to be non-weight bearing during this period to not expose the break to any unnecessary forces and to allow the bones to heal. Your doctor will tailor make your recovery to fit your type of fracture.

Disclaimer: The information compiled in this guide was taken from sources made available to the public and from consultation with orthopedic surgeons. We are not medical professionals and do not regard ourselves as experts. Always listen to the instructions given by your doctor first and foremost. However, we encourage patient education and recommend that you research your injury further. Your medical institution website may have further useful information. Otherwise please check our list sources for more detailed reading.

Sources

1.)   http://www.hss.edu/condition-list_foot-ankle.asp

2.)   http://www.footeducation.com/foot-and-ankle-conditions

3.)   http://orthoinfo.aaos.org/menus/foot.cfm

 

Recovery Guide: Calcaneal Fracture

What Is It?

The calcaneus is the bone that makes up your heel. Calcaneal fractures usually occur after a high-energy accident, such as in a motor vehicle crash or a fall from a great height. Because of this calcaneal fractures tend to come with other problems that vary with the extent of the injury. This is usually related to the amount of force that was used to cause the break. The worst case scenario is that the calcaneus shatters resulting in many fragments. This is known as a comminuted fracture (a break that results in three or more fragments). Because calcaneal fractures are usually the result of a high-force impact, there is a chance that the bones can damage soft tissue and puncture the skin as well.

Calcaneus_Fracture

Breaks of the calcaneus can be very serious since they can affect the subtalar joint; the joint that is comprised of the calcaneus and the talus (the ankle bone). This joint is responsible for the side-to-side motion of your foot.  Therefore, a severe break in the calcaneus can also result in a stiff ankle, limiting movement. In addition, the calcaneus is also where the Achilles tendon joins from the calf muscle. Tendons are connective tissue that connects muscle to bone and allows us to perform our movements. The Achilles tendon allows us to point our foot down when walking and running. It also helps our heel to support our body weight. A fracture in the calcaneus can disrupt the union of the heel and the Achilles tendon, thus destabilizing our foot and ankle. Lastly, since it typically takes a lot of force to break the calcaneus, other bones in the foot and ankle can be broken as well. All of these features can attribute to instability, swelling, and pain. If a fracture is really severe, it might limit or prevent the patient from walking or even weight bearing all together.

Treatment Options

Calcaneal fractures that present with a displacement of bone can result in the formation of deformity if not properly realigned. The bone also risks not healing altogether if not taken care of. Therefore displacement fractures or fractures that result in many broken fragments (such as comminuted fractures) are treated operatively. Surgery will require internal fixation, such as the use of plates, nails, and screws to realign the bone and fix them in place. Any damaged tissues will be fixed, such as reattachment of ligaments or the Achilles tendon, if separated. The difference between conservative and surgical treatments all depend if there is any displacement of bone or not. If the bones look intact and the soft tissues are relatively undamaged, then casting and immobilization will be the primary means of treatment. Any fracture that results in puncturing of the skin will require immediate surgery to clean and sterilize the wound. Calcaneal fractures that result in an avulsion of the Achilles tendon (the bone that connects with the Achilles tendon breaks away and detaching it from the main body) would also require immediate surgery to reattach the tendon. A non-weight bearing scooter is almost always recommended.

Prognosis

Because they can be pretty severe, breaks of the calcaneus take quite a bit of time to heal. Recovery time is about the same for conservative and surgical patients.  It takes about 10 to 12 weeks for the bone to fully heal. During this time period patients will be expected to be non-weight bearing. This is followed by a period where the patient will transition from partial to full weight bearing. Physical therapy is key because the subtalar joint will be stiff and will need to be conditioned back into mobility. After about 4-6 months patients will start seeing some real progress, though it could take up to a year or a year and a half to achieve maximum recovery. However, there is no guarantee that patients will achieve the same status that they were in prior to injury.

Disclaimer: The information compiled in this guide was taken from sources made available to the public and from consultation with orthopedic surgeons. We are not medical professionals and do not regard ourselves as experts. Always listen to the instructions given by your doctor first and foremost. However, we encourage patient education and recommend that you research your injury further. Your medical institution website may have further useful information. Otherwise please check our list sources for more detailed reading.

Sources

1.)   http://www.hss.edu/condition-list_foot-ankle.asp

2.)   http://www.footeducation.com/foot-and-ankle-conditions

3.)   http://orthoinfo.aaos.org/menus/foot.cfm

Recovery Guide: Jones Fracture

What Is It?

A Jones fracture is a special type of stress fracture (see “Stress Fractures” for detailed information on what defines a stress fracture) that appears at the base of the fifth metatarsal (the long bone on the outside aspect of the foot that connects to the big toe). Patients with Jones fractures will feel pain on the far right of their midfoot. Like with any other stress fracture, patients who are highly active or progress to increased physical activity too rapidly are more likely to obtain a Jones fracture. However, Jones fractures can also occur acutely, as in a sudden break due to injury. What makes Jones fractures stand out is the fact that the break is located in an area where blood supply is limited, making them difficult to heal. Adequate blood supply is essential for healing, since blood supply carries nutrients to the bone that are necessary for healing. Without sufficient blood supply, the fracture risks becoming a nonunion (the bone fails to join together and heal) or it might require an extended period of time to heal. Though a Jones fracture can potentially heal on it’s own, surgical intervention is often necessary.

Prognosis

Individuals who have high arches in their feet have an increased likelihood of developing a Jones fraction since there is more loading on that side of the foot (the side of the foot facing away from the body). Conservative treatments such as protective footwear and being non-weight bearing can allow a Jones fracture to heal, but patients run the risk of re-fracture, especially if they have high arches or repeat the activity that developed the fracture in the first place (such as dancing or running). Surgery allows an individual to recover faster (since it forces the two pieces of bone together) and helps to prevent the risk of re-fracture. Typically, the bone is brought together and fixed in place with a screw. Drilling at the site of injury also stimulates blood flow which brings the needed nutrients to the fracture site. Most times athletes choose to undergo surgery to get them active again sooner, rather than taking the time for the fracture to heal on it’s own. The screw can be removed later on if it becomes a discomfort to the patient. This is left up to the patient and the discretion of the surgeon. Realignment surgery is also an option to help correct their high arches and prevent re-fracture. Custom shoe orthotics, such as inserts, can help to balance out the high arches and alleviate the added stress to the medial side of the foot. Recovery is usually 6 to 8 weeks for a Jones fracture, but those who choose to recover more conservatively might take a while longer to heal. Patients will be expected to be non-weight bearing during the healing process and will progress to weight bearing only when advised by the surgeon.

Disclaimer: The information compiled in this guide was taken from sources made available to the public and from consultation with orthopedic surgeons. We are not medical professionals and do not regard ourselves as experts. Always listen to the instructions given by your doctor first and foremost. However, we encourage patient education and recommend that you research your injury further. Your medical institution website may have further useful information. Otherwise please check our list sources for more detailed reading.

Sources

1.)   http://www.hss.edu/condition-list_foot-ankle.asp

2.)   http://www.footeducation.com/foot-and-ankle-conditions

3.)   http://orthoinfo.aaos.org/menus/foot.cfm

Recovery Guide: Lisfranc Fracture

What Is It?

A Lisfranc fracture describes a fracture of the midfoot that can range from mild to very serious. Sometimes an injury can occur at the midfoot that does not break any bones. This is known as a Lisfranc injury. The midfoot is comprised of many tiny bones that are held together by ligaments, a type of connective tissue. Ligaments connect the two ends of bones together to form a joint. The ligaments that cross the midfoot connect the midfoot bones to the metatarsals (the long bones that connect to the toe bones). These joints form what is known as the Lisfranc joint complex and spans across the entire midfoot. It is essential for maintaining the shape of the foot and providing it with stability.

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Unfortunately, with so many little pieces it makes the foot prone to injury. Lisfranc injuries can be caused by low-energy impacts, resulting from something as simple as a twist in the foot. The injury therefore, can result in fractures, tears in the ligaments, or both. This can cause the bones to displace and the joints to be dislocated. If left untreated, a flat foot deformity can develop as well as arthritis and other medical conditions.

Symptoms

The first symptoms that appear are usually bruising and swelling at the site of injury. Bruising along the bottom aspect of the midfoot is highly indicative of a Lisfranc injury. Pain might be so extreme that the patient may have difficulty weight bearing. The only real way to diagnosis a Lisfranc injury is through clinical evolution. Your doctor will most likely perform a series of test to identify a Lisfranc injury. One such test called the piano key test places stress along the midfoot by pulling the toes up and down. Sharp pain is a positive sign of injury. Radiographic assessment is the most surefire way to confirm an injury. An MRI might be required to confirm if there is any damage to the soft tissues. It’s important to identify the number of joints that are afflicted and the extent of their damage. Some injuries can be so severe that it causes displacement of the toes. Surgical intervention will be required to realign them in their normal anatomical position.

Treatment 

If there is no displacement and only minor damages to the soft tissues, then conservative treatment is the most likely course of outcome. Casting and/or splinting will be used to immobilize the bones. Patients will be non-weight bearing for about 6 weeks. During this period it is critical not place any weight on the foot. Since the midfoot is comprised of many small bones any type of pressure can cause them to shift around and prevent healing. Even worse, bone displacement can occur. When you progress to partial weight-bearing, some sort of orthotic or shoe/boot will be provided to ease you into activity. If there is any evidence that the bones have been shifted during recovery, surgery will be needed.

Recovery

If it is apparent right when you present with your injury that you have displaced bone and torn ligaments, then surgical intervention is a must. Your surgeon will set the bones in place using internal fixation such as a plate or screws. This will not only realign them, but also fix them in place to prevent movement. If the joints and cartilage are badly damaged, they might need to be fused to eliminate pain (known as an arthrodesis). Fusion might also be an option down the road if midfoot arthritis occurs as a result of the injury. Post-operative recovery is similar to conservative treatment. The patient will experience 4 to 6 weeks of non-weight bearing in a cast or splint followed by a transition into a boot/shoe or orthotic when the patient returns to weight bearing. Again, it cannot be greater emphasized how critical it is to remain non-weight bearing when instructed. Once weight bearing is established, you might be instructed to wear your protective footwear for a further 4 to 8 weeks. This is followed by transitioning into a stiff shoe for a further few weeks. The recovery time from a Lisfranc injury can be long and some individuals may not retain their pre-injury levels of activity.

Disclaimer: The information compiled in this guide was taken from sources made available to the public and from consultation with orthopedic surgeons. We are not medical professionals and do not regard ourselves as experts. Always listen to the instructions given by your doctor first and foremost. However, we encourage patient education and recommend that you research your injury further. Your medical institution website may have further useful information. Otherwise please check our list sources for more detailed reading.

Sources

1.)   http://www.hss.edu/condition-list_foot-ankle.asp

2.)   http://www.footeducation.com/foot-and-ankle-conditions

3.)   http://orthoinfo.aaos.org/menus/foot.cfm

 photo credit

Recovery Guide: Stress Fracture

What Is It?

Stress fractures are typically non-displaced breaks in bone that occur through overuse of physical activity. Fractures are brought on by high energy and low energy injuries. High energy breaks are termed traumatic fractures and occur through a significant amount of force. Stress fractures are low energy breaks and occur through rapid exposure to low energy forces. Thus, a break can form when the same site is exposed over and over again to the same amounts of force. These types of fractures are common in athletes who increase the intensity, severity, and frequency of their activity (such as running). In a nut shell, stress fractures are an injury of overuse. Sometimes transitioning to higher level activities too soon or running on improper terrain can also lead to a stress fracture. This is one of the reasons why healthcare and exercise specialists recommend progressing steadily to more active workout routines and running on soft terrain like a treadmill. Though stress fractures are typically attributed to overuse, other underlying medical conditions can contribute. Conditions that weaken the bone such as osteoporosis or malnutrition can make individuals more prone to obtaining a stress fracture.

stressframe

Stress fractures in the foot and ankle are common since we are on our feet all the time. The metatarsals (second and third metatarsals most commonly), the calcaneus (heel bone), and navicular (one of the main bones of the midfoot that connect to the ankle bone) are the most common bones that obtain a stress fracture. Stress fractures in the tibia (long bone of the lower leg), fibula (smaller long bone of the leg that runs along the tibia), and talus (ankle bone) also run the risk of acquiring a stress fracture. It could be difficult to tell if you have a stress fracture since signs can be subtle. Pain can rise with activity, but dissipate with rest. Pain levels can also increase over time depending on how active and aggressive individuals are in their daily routines. Swelling, bruising and some tenderness may also appear. The only real way to rule out a stress fracture is to visit a doctor and have an x-ray or MRI taken. MRI’s are stronger then x-rays, but are often not needed to confirm a diagnosis.

Treatment Options

Fortunately, most stress fractures do not require surgery and can heal on their own. However, recovery times depend on the location of the breaks since some bones can take longer to heal then others. The goal is to reduce activity and to protect the break. Doctor’s will most likely prescribe protective footwear such as an orthotic boot, shoe or a brace, and occasionally require a knee scooter. The length of wearing such footwear can take anywhere from 4-6 weeks. Your level of activity will also be decreased. Runners for example will most likely need to reduce activity to biking or another workout that does require placing pressure on the foot. A stress fracture can take about 1 to 2 months to heal so you would most likely be advised not to return to your typical active routine until at least after two months. Again, this all depends on the bone broken. The navicular, talus, and fifth metatarsal bones take the longest to heal so patients with these types of stress fractures may have a longer recovery period.

Prognosis

It is important to listen to your doctor and only progress back to active duty once the stress fracture is fully healed. Even after a stress fracture is healed it’s important to make a gradual progression in activity to prevent the risk of re-fracture. Low impact exercises are key as well as comfortable and supportive footwear. If surgery is needed, it’s typically because the break has not healed after conservative methods. A surgeon will most likely have to fasten the bones together using internal fixation such as screws, plate or nails.

Disclaimer: The information compiled in this guide was taken from sources made available to the public and from consultation with orthopedic surgeons. We are not medical professionals and do not regard ourselves as experts. Always listen to the instructions given by your doctor first and foremost. However, we encourage patient education and recommend that you research your injury further. Your medical institution website may have further useful information. Otherwise please check our list sources for more detailed reading.

Sources

1.)   http://www.hss.edu/condition-list_foot-ankle.asp

2.)   http://www.footeducation.com/foot-and-ankle-conditions

3.)   http://orthoinfo.aaos.org/menus/foot.cfm

photo credit

Recovery Guide: Ankle Fracture

What Is It?

A fracture is the term used to describe a break in the bone. Breaks usually result due to high energy or low energy injuries. A fracture that occurs due to a high energy injury is termed a traumatic fracture and is a result from a significant amount force. Low energy fractures are termed stress fractures and are a result from repeated exposure to low amounts of force. Fractures of the ankle can be a serious problem depending on the level of severity. The ankle joint is a very complex system and disruption of the joint from severe fractures can lead to joint instability. A joint, simply put, is a surface that is comprised of the ends of at least two bones (where the bone come together and meet), cartilage (which cushions our joints), tendons (which connects muscle to bone), and ligaments (which connects bone to bone). All work together to give our joints the ability to move. Any injury that disrupts this unity eliminates the joints ability to function properly.

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The two main bones of the ankle are the tibia (long bone of the lower leg) and the talus (the ankle bone). The fibula also comprises the ankle joint, though the tibia and fibula make up it’s own joint as well, known as the syndesmosis joint. Both joints are held together by ligaments. In the gap between the tibia and talus is cartilage to cushion the joint during movement. The malleolus is the term used to describe the prominence on each side of the ankle (the bony bumps that you feel). This is comprised of the bones that make up the ankles and are classified into three regions. The lateral malleolus is comprised of the fibula and is located on the side of the foot away from the body. The medial malleolus is the inner side of the foot and is comprised of the tibia. The posterior malleolus is the back part of the tibia, so the side behind the body. Doctor’s classify fractures based on these regions and their level of severity.

Types of Fractures

Fractures of the ankle can come in many shapes and forms and can affect one or more of the bones that make up the ankle. A Bi or Trimalleolar fracture for example implies that two or three sections of the malleolus are fractured respectively. In addition, patients can have a non-displaced fracture or a displaced fracture. Non-displaced fractures imply that the fragments of bone that make up the fracture are intact, while displaced fractures mean that the fracture fragments are separated. Typically, breaks result in non-displaced fractures and can be treated conservatively by casting and wearing a boot. Healing time for conservative treatment is about a month. Displaced fractures can be more serious and run the risk of disrupting the anatomy of the ankle. Some serious high energy accidents can result in severe displacement fractures. In pediatric patients, displaced fractures also run the risk of disrupting the growth plate, causing growth arrest. For these types of injuries, surgical intervention is most likely necessary.

One of the more severe types of ankle fracture is the pilon fracture. Pilon is the French word for pestle, a tool used for grinding in labs and apothecaries. Here it is used to describe the damage done to the ankle during a high-energy accident (you might hear a pilon fracture called a high-energy ankle fracture). The talus acts like a jack hammer and grinds into the tibia. Shattering or splintering of all three ankle bones can result. Patients typically present with a pilon fracture after a motor vehicle accident or fall from a large height. Though a pilon fracture can be a serious injury, in some instances it could be treated conservatively.

Treatment Options

For most displacement injuries, surgical correction will be needed. Surgery will require internal fixation (such as nails, screws, and plates) to reset the bones and to hold them in place while they heal. This is to realign the bones back to their normal anatomic position. Sometimes displaced bone fragments can heal improperly resulting in a deformity. Surgical correction and fixation will also be needed to correct any deformity that is present. It may possible to remove the hardware down the road, though this depends on the individual. Sometimes an individual can live comfortably with the hardware remaining in place.

Recovery

Because of the wide range of injuries that could be present, recovery times can vary. Other factors like age, smoking, and medical conditions such as diabetes can also have an impact on healing. Patients will be expected to be non-weight bearing for several months after surgery. Casting and splinting may likely follow surgery to help further immobilize the joint and minimize movement while the bone heals. A non-weight bearing scooter is recommended. It could take as soon as six weeks for the bones to fuse together, but may take longer depending on the individual. Soft tissue structures such as ligaments will take longer to heal. Your doctor will instruct when to progress to partial and full weight bearing. It is essential to not put weight on your ankle until told to do so. Placing pressure on the joint too soon might shift the bones if they have not set yet. Two to three months is the typical time frame for progression to full weight bearing. Most individuals can expect to be back to regular activities such as work and driving after three months.

Prognosis

Physical therapy will be essential during the recovery period and beyond. It is important to train your foot and ankle in the months after healing is completed. Studies have shown that patients can still be in the recovery process for up to two years after surgery. This all depends on the extent of the injury. Some severe injuries like a pilon fracture could also limit the function of an individual even after healing is completed. Athletes for example may not be able to reach the full range of activity that they had before surgery. Again, this all depends on the individual and the extent of the injury. Your doctor and other healthcare professionals will help to assess and reach the level of activity that you will be able to obtain. Lastly, depending on the severity of the injury your ankle joint might see damage to the cartilage. This could lead to the onset of arthritis in the future. However, there are conservative and operative techniques that could be employed to take care of arthritis should symptoms arise.

 

Disclaimer: The information compiled in this guide was taken from sources made available to the public and from consultation with orthopedic surgeons. We are not medical professionals and do not regard ourselves as experts. Always listen to the instructions given by your doctor first and foremost. However, we encourage patient education and recommend that you research your injury further. Your medical institution website may have further useful information. Otherwise please check our list sources for more detailed reading.

Sources

1.)   http://www.hss.edu/condition-list_foot-ankle.asp

2.)   http://www.footeducation.com/foot-and-ankle-conditions

3.)   http://orthoinfo.aaos.org/menus/foot.cfm

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