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Broken leg/ankle recovery--regaining ROM?

Riders with Health Issues
#1

About five weeks ago, I broken my leg and ankle (specifically, I broke the tibia (and maybe fibula? I forget) where they come into the ankle–those bumps on either side of your ankle). Now I have roughly equal amounts of bone and titanium in my leg, and screws in my tibia.

Anyhow, I’ve been cleared for “weight-bearing as tolerated”, and am relearning how to walk. The biggest problem is that I have very little range of motion in my ankle, which makes walking really hard. I’m not sure if it’s stiffness from not moving it much for five weeks, or if maybe the screws are getting in the way.

Does anyone have experience with this kind of injury? Tips for getting motion back? My surgeon didn’t say anything about PT, and I don’t go back to him for almost two months. Would heat help? I’m thinking about using Thermaflex liniment and wrapping it or something.

#2

My mom had a break in a similar area, and I’m REALLY REALLY surprised you didn’t get any kind of referral to PT, because she went to PT for quite a while to work on getting some range of motion and to make sure she wasn’t over-compensating and thus putting excess stress on the other leg. (And even with all of that, she never did get back to the full range of movement that would be normal.)

Admittedly, my mom’s break was REALLY bad (any worse and they would’ve seriously been talking amputation) but the ankle is so important to our ability to walk and balance that I’d probably call up the surgeon’s office and go ‘hey, what about PT?’ - maybe he assumed your GP or someone would take care of that?

Assuming you’re hoping to get back to riding, also - once you get a PT, if they haven’t helped equestrians before, you might want to take in some good video of someone riding your discipline of choice that shows the general range of movement needed in the ankle, so they know what to be working towards. (Again, you might not get all the way there, but I messed up my ankle worse when I sprained it once because the doctor said riding was fine if it was wrapped and it turned out the doctor had No Clue what was involved and would never have cleared me for riding if she had. So I wouldn’t assume they knew automatically.)

#3

GO TO PT!!! Oh my gosh, don’t even mess around with not going! I shattered both sides of my ankle as well, and dislocated it and it’s a long, road. It took like a year to feel normal in the saddle again, and it still aches quite a bit. Good luck-it will get better

#4

Call your surgeon’s office and ask for a referral to PT. If that doesn’t work, call a PT in your area and make an appointment. I cannot imagine having hardware installed after a break like that in a joint and NOT having PT post-surgery. They have something called “gait training” for people who have to relearn walking. I had bunion surgery and was referred to PT. Good luck. You might not regain full ROM, or you might need the hardware removed (I’m having screws removed from my shoulder due to lack of ROM).

#5

[QUOTE=horsechick;4945018]
GO TO PT!!! Oh my gosh, don’t even mess around with not going! I shattered both sides of my ankle as well, and dislocated it and it’s a long, road. It took like a year to feel normal in the saddle again, and it still aches quite a bit. Good luck-it will get better[/QUOTE]

Seriously, I think my mom was, all told, in PT for a year and a half or something. (The first part of that was body strengthening for pushing herself in a wheelchair, and then using crutches, though, because she was supposed to completely avoid putting any weight on it for a while to start with. It was a REALLY nasty break.)

In addition to the PT sessions, she still has exercises to do at home, too - stretching and range-of-motion stuff, mostly, and a few things involving those stretchy resistance bands. And her break was 6 or 7 years ago now. I think it’s just an on-going thing to keep things from stiffening up. (She did lose some sensation in her foot/ankle due to nerve damage from the break, too, so that might be part of it also. She can’t feel as well as someone else can if her ankle is tightening up on one side or whatever.)

#6

Right after surgery, the surgeon more or less said that I wouldn’t need PT. Which… huh? He did a good job reassembling my leg, but otherwise, I’m very dissatisfied. At my appointment Friday, he just looked at my leg and told me I could start bearing weight. Mind you, I was initially told 6-8 weeks non-weight bearing, and I’m at 5 weeks. Then he realized that he didn’t have x-rays… sent me for x-rays, got back in the room, and the nurse told me I could leave. Um, what about the x-rays? Oh, they’re fine. I had to specifically ask if the x-rays confirmed that I can start bearing weight and she had to go find the doctor and ask… because heaven forbid he pop back into the room for literally a minute to tell me everything is good. No one said a single word about PT, and I’m not going back to see him for two months. WTF? My broken FINGER got more attention.

I won’t even get into how he didn’t know about the MRI that was ordered in HIS name and never bothered to read the report that he got confirming my torn ACL in the other leg… the leg that the doctors at the hospital assured me was perfectly fine.

Calling the office about PT would be a waste of time. The receptionist is the biggest bitch on the face of the planet, and I can guarantee her response would be “you can discuss it with the doctor at your appointment in August.”

Not a happy camper :mad:.

#7

[QUOTE=amastrike;4945070]
Right after surgery, the surgeon more or less said that I wouldn’t need PT. Which… huh? He did a good job reassembling my leg, but otherwise, I’m very dissatisfied. At my appointment Friday, he just looked at my leg and told me I could start bearing weight. Mind you, I was initially told 6-8 weeks non-weight bearing, and I’m at 5 weeks. Then he realized that he didn’t have x-rays… sent me for x-rays, got back in the room, and the nurse told me I could leave. Um, what about the x-rays? Oh, they’re fine. I had to specifically ask if the x-rays confirmed that I can start bearing weight and she had to go find the doctor and ask… because heaven forbid he pop back into the room for literally a minute to tell me everything is good. No one said a single word about PT, and I’m not going back to see him for two months. WTF? My broken FINGER got more attention.

I won’t even get into how he didn’t know about the MRI that was ordered in HIS name and never bothered to read the report that he got confirming my torn ACL in the other leg… the leg that the doctors at the hospital assured me was perfectly fine.

Calling the office about PT would be a waste of time. The receptionist is the biggest bitch on the face of the planet, and I can guarantee her response would be “you can discuss it with the doctor at your appointment in August.”

Not a happy camper :mad:.[/QUOTE]

Oh, you have one of THOSE doctor’s offices. (I hate calling my GP. HATE. I’m on immune-suppressing medication for an auto-immune problem, which means I’m more at risk of serious complications even for stuff like a cold. So if I call the doctor because I’m sick, I really need to SPEAK TO THE DOCTOR so he can decide if I need antibiotics or antivirals or if he wants to see me in person, etc. Inevitably I go through a whole song and dance where the receptionist passes me to a nurse, who asks my symptoms and then tells me the standard song-and-dance about rest and fluids, and we then go back and forth for several minutes before they clue in that NO REALLY I am not a normal case and the doctor needs to be involved in the decision making process, since he can look at my most recent bloodwork results and so on. I’m thinking of, next time I go in for an appointment, demanding an email address for him I can use instead, because dealing with his office is exhausting.) (Not to mention the one time the RECEPTIONIST wanted my dad to give HER a full rundown of his medical history and why he was called. Wtf? A. None of her business B. He’s in their system and has been for years so anyone who needs to know in the office should have access to everything and C. Quite frequently they call BACK to demand this sort of information, and do not apparently care that you might be out in public somewhere where, you know, you don’t really want to be talking about your medical business! If you ask them to hang on a moment while you find someplace private like going back out to your car, they get in a huff and say they’ll call back later. So heaven forbid you should have a problem that might need more immediate attention. ARGH.)

(Ahem. Sorry. Apparently I had a rant simmering on the subject of crappy doctor’s offices. :slight_smile: )

Anyway. Can you get a second opinion or self-refer to a PT? I think it’s bizarre that he’s being so hands off, and honestly I would probably hold off on putting weight on it until I got a second opinion, Just In Case. Doctors do make mistakes, and you really don’t want to mess up the healing process, you know?

If you have health insurance, there might be someone at the insurance company you can call to help you figure this all out - it’s less cost to them if you get PT now and everything heals properly than if it gets messed up and they have to pay for more surgery and then PT after THAT. So they should help you figure out if PT is covered on your plan, and how to go about getting it.

(BTW, you might as well ask for a copy of all of your scans and x-rays now. That way you’ll have them if you want to go see anyone else, and won’t have to wait to get them or for them to be transferred.)

#8

GO TO PT. I wiped out the whole tibial plateau, In the hospital for 3 weeks. - they started in home PT as soon as I got out of the hospital, and now 7 mos later, I have about 98 degrees AROM, and 102 total. Enough to ride had I not developed lymphedema. working on that now. I was told 4-6 mos in a wheel chair initially, and went to partial weight bearing at not quite 3. Had a great in home therapist. Wouldn’t be half as far along if he hadn’t pushed me. Yes, it hurts. Just do the weight bearing incrementally – and get a referral to PT. If the surgeon won’t do it get the GP to do it.

#9

As a separate reply rather than adding to my already long-winded post:

I talked to my mom a bit, and she said that it might just be too early to start PT on your ankle, or he may not feel it’s necessary from the way the break is healing. She did agree that it makes sense to make sure that he (and any other medical professionals involved in your care) understand the range of movement you require for riding, though, since a lot of people DO think riding = sitting there like a sack of potatoes. (My mom’s seen me ride dressage, so she at least knows it’s more work than that. :slight_smile: )

Anyway, she says that you should definitely try to ask him about it specifically, just to clarify what’s going on. But apparently PT is kind of going the way of the dodo a bit. (Which makes no sense to me, but what do I know?) (My mom is a nurse, btw, so that’s why I asked her about it, not just because she also broke her leg. :slight_smile: )

(I personally would probably go for at least one PT session at some point, even if I had to pay out of pocket, and take my chart and scans and everything along with me, so that I could get help designing an exercise/stretching plan that was suitable with hopefully less chance of doing something stupid and damaging myself trying to figure it out on my own.)

#10

amastrike… get a second opinion… and NOT one from the same group of docs.

#11

Wow, I agree. Get a second opinion.

I was pretty dissatisfied with my doctor too when I broke my ankle, but one of the other guys in the office was really good and I was able to bounce opinions off of him. My doctor took the do-nothing-until-you’re 110% approach. The other doctor tempered his advice by saying to do whatever I could until it caused pain. I’m thinking I still need to get another opinion since my doctor didn’t want to try to get 2 of the screws out and they’re really bothering me now (and after the barbaric way he pulled the first two out there’s NO WAY I’m going back to him!).

Satisfied or not, though, both suggested PT. I broke the tip of my ankle off (non-medical term, lol!), broke my fibula, and shredded the tendons across the front of my ankle and ended up with surgery to pin everything together (except for the fibula break, which was essentially ignored the whole time).

I started riding the day my cast came off and rode without stirrups for a few weeks. I added the stirrup back in slowly, but I would say that was my most effective PT. By the time I made it in to my PT’s office I had probably 75% of my ROM back. The exercises she had me do definitely helped, but the riding ended up being the big thing for me.

Anyhow, I would definitely get a second opinion, and if you’re not comfortable doing that I would head directly in to a PT to see what they tell you.

Good luck!

#12

I went to an ortho yesterday about my knee… He’s an awesome doctor, and it’s just SO much better than the broken leg ortho. No three hour waits, no waiting rooms full of really, um, ghetto people, staff who aren’t rude and impatient, actually seeing the DOCTOR… The list goes on.

Anywho, he feels it’s not advisable to fix my torn ACL until the broken leg is more healed. And he was pretty surprised that broken leg ortho doesn’t want me back for two months… apparently, compound fractures require more monitoring as the risk of infection lasts a while. So he’s going to keep an eye on that for me, too. He took x-rays and actually let me see them! It’s actually kind of scary… the breaks are still clearly visible, so basically I’m walking on a titanium rod and some screws. I try not to think about it. So I’m sure he’ll get me set up with PT when the time comes. I’m going back to him in about 3 weeks, and hopefully we’ll be able to schedule surgery then.

I’m going to see about firing broken leg ortho and sticking with super nice ACL ortho for everything.

#13

JMHO…

5 weeks out is way, way, way too early to be worrying about ROM return and PT - IMHO!! You need to heal, heal, heal first. Take your time. Maybe the 1st ortho didn’t want you to do any PT until 2 mos out. But go forth with someone you like better. Your injury is serious and will take a long time to get better. Be patient!
And ACL too? sheeesh! Do you have a “KickMe” sign on you!!?? :winkgrin:
Wait several months before doing your knee please!!

#14

About 9 years ago I had a bad ankle fracture, Tib, fib and Talus(sp?). I had surgery and now have a pin, 2 plates and 4 screws.
The surgeon had a family member who rode, might have been his daughter, not sure. But he was familiar enough with riding to understand ROM needed. Post surgery he was very clear that I’d need PT.

At 5 weeks I still had a cast and used a walker although I could start to put some weight on my leg. Xrays showed definite healing. So 5 weeks is probably too early for PT.
At 8 weeks the cast came off. Xrays were great.

Two weeks later I had my first PT appointment. I think I had 30 appointments over a 12 week period and regained almost full ROM. Actually better than the surgeon expected. But that would not have happened without PT.

#15

Wateryglen, for now, I’m mostly thinking about ROM because it’s really hard to walk when I can’t really bend my ankle. First ortho was an obnoxious jerk. I can see not wanting to put me in PT for a couple months, but he didn’t even MENTION it. And I need to be seen more often than once every two months. Grrr, I can’t stand him. LOL, I must’ve had a kick me sign! And of course I had to injure BOTH legs… wouldn’t want me to have any good legs, after all. I’m going to get the ACL done as soon as the ortho is willing. I really need to be able to get back to life ASAP. I go back to college at the end of August, and I really don’t want to be dependent on crutches or a wheelchair when I have to walk all over campus. It’s pretty much a guaranteed minimum 10 minute walk when non-crippled…

PTF, my new ortho said his daughter has ridden, so I guess he knows a bit. But I’ll probably do what I’ve seen many people suggest, and bring in video of me riding to the ortho and PT when I finally go so they can see what I need to be able to do.

#16

My story

When I broke my leg, tib fib way down at the bottom. I wasn’t allowed to put ANY weight on it for a long time. I broke it on July 19th. I put weight on it for the first time in PT in OCTOBER.
I never had a cast, but I wore a walking thing that I could take off for whirlpool time) although I didn’t use it for walking. I have a plate and HAD many screws that have since been removed ( still have the plate though).
They told me I couldn’t put weight on it because the original screws when thru both the tib and fib in sort of an x pattern and if I had any movement between them and broke the screws then they would be harder to take out. They took those out right before PT started and then took out a few more screws about a year later because they were bothering me.
I do not have full ROM despite alot of PT, I cannot put my heel down like before and I can’t get into boots without zippers. It still hurts most days and I broke it in 1999.
I wouldn’t wish it on my worst enemy. I hope you get a good ortho person and do get your ROM back, but despite my good ortho and great PT I got what I got.

#17

First: OWWW!!!

Second if you want the nice doc to take over treatment of your broken leg, you need to make it official. Otherwise you put your ACL doc in a difficult position. Tell his office you want to transfer your case from Dr X. Chances are you can sign some forms authorizing them to get your records and they can do that between offices. Keeps you out of the mix and away from dealing with the difficult office. I would do that ASAP since it might take a while as the old doc’s office wont be highly motivated.

#18

oh yeah, btdt

And… it sucks. My surgeon (good guy) brought me back into the office every two weeks for 8 weeks to re-cast my leg. both lower leg bones broken, ankle looked like Barbaro’s. The ankle bones were in 27 pieces. Ugly. Pins, plates, screws, surgery.

He asked me a question when he found out I rode. “Do you want to be able to ride well, or continue to wear 4” stilletto heels (I was doing some modeling). No hesitation, fix me so I can ride. He recast my leg so my foot ended up in the “heels down” position. So, some 18 years later, the good news is, I can pull my toes up like a Big Eq rider, but I can’t point that toe down like a ballet dancer any longer, and haven’t been able to since the break. It’s a trade off.

That ankle works fine, but still hurts every hour of every day. Sometimes a lot.
You get used to it.

#19

What did knee ortho say about weight bearing? The fact that you can still see the breaks would concern me.

FWIW I had a tri malleolus fracture 5 years ago.

I was NOT allowed to let it touch the ground until the breaks were healed on xray, 11 weeks. I was told not to even wiggle my toes.

My doctor told me that if i followed his instructions I WOULD get full ROM.

Once I was cleared for PT I put my good foot on the floor, brought my knee in front of my toe and told the therapist “I need to be able to do this” I can also straighten my ankle about 180 degrees(think gymnast)

She gulped.

I had about 5 months of PT, starting with warmup on an exercise bike, picking up marbles with my toes,progressing to resistance exercise with Therabands and calf lifts. She would manipulate my ankle, producing interesting cracking (and crying)noises.

Most sessions ended with ice.

It was NOT pretty but I do have almost full ROM. It also hurts to a greater or lesser extent more or less constantly.

#20

Get a second opinion from an ankle specialist. I am 4 1/2 months post tib/fib break. I was non weight bearing for 8 weeks, then in a boot only 30% WB for 4 weeks then allowed to gradually progress to FWB. At 3 months an MRI was done because the fracture was still very very visable in the oblique fibula fracture and as it turns out there is a bunch on soft tissue damage and a non-union of the fibula (not healing). I am riding and have full ROM back but it was due to riding without stirrups for months and constantly working the joint. I use SURPASS when the pain is bad and am going for a second opinion on the 8th. You really shouldn’t be WB if the fractures are still very visible. Sounds like your ankle guy is an idiot IMO!

Good luck with healing

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