Broken Ankle (Fracture) Facts

Article Featured on eMedicineHealth

What Is a Broken Ankle?

Ankle injuries are among the most common of the bone and joint injuries. Often, the degree of pain, the inability to walk, or concern that a bone may be broken is what usually causes people to seek care for an ankle injury. The main concern is whether there is a broken bone vs. an ankle sprain. Frequently it is difficult to distinguish a fracture (broken bone) over a sprain, dislocation, or tendon injury without X-rays of the ankle.

  • The ankle joint is made up of three bones that fit anatomically (articulate) together, the tibia, fibula, and talus (some medical experts also include the calcaneus bone and label the joint as the subtalar joint and consider it part of the ankle):
    • The tibia, the main bone of the lower leg, makes up the medial, or inside, ankle bone.
    • The fibula is a smaller bone that parallels the tibia in the lower leg and makes up the lateral, or outside, ankle bone.
    • The far ends of both the tibia and fibula are known as the malleoli (singular is malleolus). These malleoli are the lumps of bone that you can see and feel on the inside and outside of the ankle. Together they form an arch or mortise (a recess) that sits on top of the talus, one of the bones in the foot.
  • A fibrous membrane called the joint capsule, lined with a smoother layer called the synovium, encases the joint architecture. The joint capsule contains the synovial fluid produced by the synovium. The synovial fluid allows for smooth movement of the joint surfaces.
  • The ankle joint is stabilized by several groups of ligaments, which are fibers that hold these bones in place. They are the capsule ligament, deltoid ligament, the anterior and posterior talofibular ligaments, and the calcaneofibular ligament. Some of these ligaments may be disrupted if the ankle is fractured.

What Are the Signs and Symptoms of a Broken Ankle?

Signs and symptoms of ankle injuries and ankle fractures tend to be obvious.

  • Pain is the most common complaint.
    • Sometimes the pain will not come from the exact area of the fracture.
    • The person may experience associated foot fractures (especially on the side of the small toe) or knee that also cause pain similar to ankle pain.
    • It is usually pain in the ankle that stops individuals from walking.
  • Swelling frequently occurs around the ankle.
    • Swelling suggests either soft tissue damage with possible blood around the joint (hemarthrosis) or fluid within the joint itself, most likely blood.
  • A person may see bruising around the ankle joint, although not immediately. The bruising can track down toward the sole of the foot or toward the toes.
  • In severe fractures, there may be obvious deformities of bones around the ankle.
    • Skin may be stretched over an underlying broken bone.
    • Bone may be exposed.
  • If the ankle joint is dislocated, the foot and leg bones will be misaligned and will appear deformed.
  • If people injure nerves or blood vessels that supply the foot, there may be more pain along with pale skin in the foot, numbness, or an inability to move the foot or toes.

What Is the Difference Between Ankle Sprains and a Broken Ankle?

The difference between a broken ankle and a sprained ankle is that a fracture or break in the bone is necessary to have a broken ankle. Any crack, break, or chip in the anklebone is considered a fractured ankle. A sprained ankle is an injury where there is tear or disruption of the ligaments (the fibrous tissue that holds bone to bone in a joint). A severe injury to the ankle can consist of both a fracture and a sprain at the same time. Depending on the type and severity of the fracture or the sprain, the prognosis of a sprain may actually be worse than a fracture.

What Causes a Broken Ankle?

When a person stresses the ankle joint beyond the strength of its elements, the joint becomes injured.

  • If only the ligaments give way and tear, the damage is a sprained ankle.
  • If the ligaments that stabilize the joint are completely disrupted, the bones can come apart and the ankle can become dislocated.
  • If a bone gives way and breaks, the damage is an ankle fracture.
  • Fractured ankles can occur with simultaneous tears of the ligaments. This can happen in several ways:
    • Rolling the ankle in or out
    • Twisting the ankle side to side
    • Extreme flexing or extending of the joint
    • Severe force applied to the joint by coming straight down on it as in jumping from a high level

What Are the Types of Ankle Fractures?

The type of ankle fracture classification depends upon the location of the fracture and which bones of the ankle are fractured. There can be one bone injured, or multiple bones injured. The type and severity of the fracture will determine the treatment by the orthopedic surgeon; a classification list is as follows:

Lateral Malleolus Fracture

  • The lateral malleolus is the bump on the outer part of the ankle and is made up of the fibula bone.

Medial Malleolus Fracture

  • The medial malleolus is the bump on the inside of the ankle and is made up of the tibia bone.

Posterior Malleolus Fracture

  • The posterior malleolus is the bony prominence on the back side of the tibia, and is rarely injured on its own.

Bimalleolar Fractures

  • “Bi” means two, so two bones of the ankle are fractured with a bimalleolar fracture.
  • Most commonly the lateral malleolus and the medial malleolus are the bones that are fractured.
  • Bimalleolar fractures often make the ankle joint unstable.

Trimalleolar Fractures

  • “Tri” means three so in a trimalleolar fracture, all three malleoli (medial, lateral, and posterior) bones of the ankle are broken.
  • These are unstable injuries often caused by a large amount of force, disruption of the ligaments, or a dislocation.

Syndesmotic Injury

  • Also called “high ankle sprains.”
  • Usually a result of ankle eversion (outward twisting of the ankle joint).
  • May or may not be associated with an actual fracture of the bones of the ankle, but is often treated as a fracture.
  • May involve fracture of the fibula (outer bone in the lower leg) higher up in the calf near the knee (proximal) in severe ankle sprains, also called a Maisonneuve fracture.

There are other names for ankle injuries; however, most will fit into the general types listed above.

Which Type of Doctor Treats a Broken Ankle?

A broken ankle may be diagnosed by a general practitioner (family doctor, internist, pediatrician), or an emergency medicine doctor in a hospital. The patient may be referred to a podiatrist (foot specialist) or an orthopedic surgeon for the care and further treatment of the broken ankle depending on the severity of the injury or the need for possible surgery.

When Should You Call a Doctor If You Think That You Have A Broken Foot?

If a person has injured an ankle, contact a doctor or go to an emergency department. Seek medical treatment for an ankle injury in the following situations.

  • The person cannot bear weight on the ankle.
  • The pain remains intolerable despite using over-the-counter pain medications.
  • Home care fails to reduce the pain.
  • The foot or ankle becomes numb, partially numb, or pale.
  • A gross deformity of the ankle bones is present (this may indicate an ankle dislocation)
  • Open wound or bleeding over the injured area
  • Bones or bone fragments visible outside the ankle skin
  • Inability to move the toes
  • Inability to move the ankle
  • Cold or blue foot

How Is a Broken Ankle Diagnosed?

A doctor will evaluate the ankle to determine if there is an ankle fracture or if the joint has been damaged sufficiently to become unstable. Joint instability often suggests multiple fractures, a fracture with a ligament injury, ligament injury alone, or dislocation.

The doctor will seek a history of the injury and will ask questions to determine the possible fracture patterns.

  • Where does it hurt now?
  • How long ago did the injury happen?
  • Does the knee, shin, or foot hurt also?
  • How did the injury happen?
  • Did the ankle turn in or out?
  • Did the person hear a crack or a pop?
  • Was the person able to walk immediately after the injury?
  • Can the person walk now?
  • Does the person have any new numbness or tingling in their leg, ankle, or foot?
  • Has the person had previous ankle fractures, sprains, or surgeries on the injured ankle?

The doctor will perform a physical exam, looking for:

  • Evidence of bruising, abrasions, or cuts
  • Swelling, bleeding, and tissue damage
  • Pain, deformities, and the grinding or movement of broken bones of the knee, shin, ankle, and foot
  • Pain, excess looseness of a joint, or complete tear in ligaments
  • Fluid in the joint and joint stability
  • Seeking a pulse and looking for injured arteries
  • Testing sensation and movement in both the ankle and foot
  • Ankle X-rays if a broken bone is suspected; some doctors may try to avoid unnecessary and costly X-rays by following certain guidelines such as the Ottawa ankle rules (see reference 2)
  • X-rays of the knee, shin, or foot depending on where pain is; children may get a comparison X-ray of the uninjured ankle to see subtle changes in growth plates due to injury.

What Home Remedies and First Aid Methods Treat a Broken Foot at Home?

If a person suspects an ankle fracture, call a doctor or go to a hospital’s emergency department immediately. Until a person can get to a hospital or doctor’s office they may try the following:

  • Stay off the injured ankle to not to injure it further.
  • Keep the ankle elevated to help decrease swelling and pain.
  • Apply cold packs to the injured area to decrease swelling and pain. Do not apply ice directly. Cold packs are effective for the first 24 to 48 hours.
  • Ibuprofen (Advil, Motrin, etc.) is ideal for ankle injuries because it acts as both a pain medicine and a medicine to decrease inflammation.

What Is the Treatment for a Broken Ankle?

  • Doctors usually place a splint on the injured ankle for a few days to 2 weeks until the swelling decreases around the joint. The type of fracture and the stability of the fractured joint will determine the type of splint (cast or walking boot) that will be used, or whether surgery is needed.
  • Some minor ankle fractures do not require a splint or cast. In these cases the fracture will be managed as an ankle sprain.
    • Because these fractures are very small, they heal well with this management.
    • With any injured ankle, however, a person should not bear weight until advised to do so by a doctor or orthopedist.
  • After the swelling decreases and the patient is reexamined, an orthopedic doctor or a primary care doctor may place a better-fitting cast on the ankle. Depending on the type of fracture, the patient may be placed in a walking cast, which can bear some weight, or the patient may need a non-weight-bearing cast that will require the use of crutches to assist with walking.
  • Depending on the degree of pain, the doctor may prescribe pain medication. The patient should use the pain medication only as needed. Do not drive or operate heavy machinery while using these medications.

When Is Surgery Necessary for a Broken Foot?

Fractures that are severely displaced or may involve a dislocation will need to be realigned (reduced) in the emergency department. If the realignment is incomplete or if the underlying injury is severe, surgery is usually needed. If the fracture breaks through the skin (compound fracture), it will usually require surgery to clean the area thoroughly and limit the chance of infection.

Do You Need to Follow-Up with Your Doctor After the Ankle Has Been Treated?

Follow-up care for an ankle fracture depends on the severity of the fracture. Consultation with an orthopedist is recommended for most fractures. In some instances, a surgeon may need to be consulted, especially if there is any vascular compromise or deformity due to the fracture.

  • The patient may need emergency surgery, next-day follow-up, or follow-up in 1-2 weeks with an orthopedic doctor.
  • The patient may require follow-up with a family doctor.
    • If the patient’s injured ankle was splinted on the initial visit, he or she will probably need to have a cast placed on the ankle during the follow-up visit.
    • Recovery time varies depending upon the type of fracture or need for surgery. The average fracture requires 4-8 weeks for the bone to heal.
    • With severe ankle injuries, the doctor may recommend physical therapy for rehabilitation after the acute phase of healing.

What Is the Recovery Time for a Broken Ankle?

Most simple fractures heal well with immobilization and non-weight-bearing activity. Complex fractures may have good to fair outcomes, depending on the severity of the fracture(s), the effect of rehabilitation on function and the development of arthritis.

  • Patients can expect recovery from most ankle fractures, depending on how severe they are, to take 4-8 weeks for the bones to heal completely and up to several months to regain full use and range of motion of the joint.
  • More severe fractures, especially those requiring surgical repair, will take longer to heal; some may need implanted supports (metal rod or plate and screws) that may be removed later or left in place.
  • Fractures of any type increase the likelihood of developing arthritis in the affected joint. The more severe the fracture, the higher the risk of developing some degree of arthritis.

How Can a Broken Ankle Be Prevented?

Preventing ankle fractures can be difficult.

  • Many occur as “slip and fall” incidents. Being careful in activities is the best prevention.
  • Proper footwear when participating in sports also may reduce ankle fracture risk.
  • Splints, braces, or taping of a previously injured ankle may decrease the possibility of further injury or fracture.
  • Maintenance of strength of the muscles that stabilize ankle is an important part of prevention of ankle injuries.

 


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Do you need bunion surgery

Do you need bunion surgery?

Article Featured on AAOS

Most people with bunions find pain relief with simple treatments to reduce pressure on the big toe, such as wearing wider shoes or using pads in their shoes. However, if these measures do not relieve your symptoms, your doctor may recommend bunion surgery.

There are different types of surgeries to correct a bunion. Bringing the big toe back to its correct position may involve realigning bone, ligaments, tendons, and nerves.

Are You a Candidate for Surgery?

In general, if your bunion is not painful, you do not need surgery. Although bunions often get bigger over time, doctors do not recommend surgery to prevent bunions from worsening. Many people can slow the progression of a bunion with proper shoes and other preventive care, and the bunion never causes pain or other problems.

It is also important to note that bunion surgery should not be done for cosmetic reasons. After surgery, it is possible for ongoing pain to develop in the affected toe — even though there was no bunion pain prior to surgery.

Good candidates for bunion surgery commonly have:

  • Significant foot pain that limits their everyday activities, including walking and wearing reasonable shoes. They may find it hard to walk more than a few blocks (even in athletic shoes) without significant pain.
  • Chronic big toe inflammation and swelling that does not improve with rest or medications
  • Toe deformity—a drifting in of the big toe toward the smaller toes, creating the potential for the toes to cross over each other.

Photo and x-ray of foot deformed by a bunion

(Left) A bunion that has progressed to deformity with the big toe crossing over the second toe. (Right) An x-ray of the same bunion shows how far out of alignment the bones are.

Reproduced from Wagner E, Ortiz C: Proximal Oblique Sliding Closing-wedge Osteotomy for Wide-angle Hallux Valgus. Orthopaedic Knowledge Online Journal: Vol 12, No 4, 4/1/2014; Accessed December 4, 2015.

  • Toe stiffness—the inability to bend and straighten the big toe
  • Failure to obtain pain relief with changes in footwear
  • Failure to obtain pain relief from nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen. The effectiveness of NSAIDs in controlling toe pain varies greatly from person to person.

Deciding to Have Bunion Surgery

After bunion surgery, most patients have less foot pain and are better able to participate in everyday activities.

As you explore bunion surgery be aware that so-called “simple” or “minimal” surgical procedures are often inadequate “quick fixes” that can do more harm than good. Although many bunion procedures are done on a same-day basis with no hospital stay, a long recovery period is common. It often takes up to 6 months for full recovery, with follow-up visits to your doctor sometimes necessary for up to a year.

It is very important to have realistic expectations about bunion surgery. For example, bunion surgery may not allow you to wear a smaller shoe size or narrow, pointed shoes. In fact, you may need to restrict the types of shoes you wear for the rest of your life.

As you consider bunion surgery, do not hesitate to ask your doctor questions about the operation and your recovery. Some examples of helpful questions to ask include:

  • What are the benefits and risks of this surgery?
  • What are the possible complications and how likely are they to occur?
  • How much pain will there be and how will it be managed?

Be sure to write down your doctor’s answers so you can remember them at a later time. It is important to understand both the potential benefits and limitations of bunion surgery.

Surgical Procedures

In general, the common goals of most bunion surgeries include:

  • Realigning the metatarsophalangeal (MTP) joint at the base of the big toe
  • Relieving pain
  • Correcting the deformity of the bones making up the toe and foot

Because bunions vary in shape and size, there are different surgical procedures performed to correct them. In most cases, bunion surgery includes correcting the alignment of the bone and repairing the soft tissues around the big toe.

Your doctor will talk with you about the type of surgery that will best correct your bunion.

Repairing the Tendons and Ligaments Around the Big Toe

In some cases, the soft tissues around the big toe may be too tight on one side and too loose on the other. This creates an imbalance that causes the big toe to drift toward the other toes.

Surgery can shorten the loose tissues and lengthen the tight ones. This is rarely done without some type of alignment of the bone, called an osteotomy. In the majority of cases, soft tissue correction is just one portion of the entire bunion corrective procedure.

Osteotomy

In an osteotomy, your doctor makes small cuts in the bones to realign the joint. After cutting the bone, your doctor fixes this new break with pins, screws, or plates. The bones are now straighter, and the joint is balanced.

Osteotomies may be performed in different places along the bone to correct the deformity. In some cases, in addition to cutting the bone, a small wedge of bone is removed to provide enough correction to straighten the toe.

As discussed above, osteotomies are normally performed in combination with soft tissue procedures, as both are often necessary to maintain the big toe alignment.

Foot x-rays showing a bunion corrected with osteotomy

X-rays taken from the top and the side of the foot show a bunion corrected with osteotomy.

Arthrodesis

In this procedure, your doctor removes the arthritic joint surfaces, then inserts screws, wires, or plates to hold the surfaces together until the bones heal. Arthrodesis is commonly used for patients who have severe bunions or severe arthritis, and for patients who have had previous unsuccessful bunion surgery.

X-rays of an arthritic foot before and after arthrodesis

The x-ray on the left shows severe arthritis of the MTP joint. After arthrodesis (shown on the right), the entire foot is realigned. An advantage of arthrodesis is that no additional procedures are necessary to correct the bunion.

Exostectomy

In this procedure, your doctor removes the bump from your toe joint. Exostectomy alone is seldom used to treat bunions because it does not realign the joint. Even when combined with soft tissue procedures, exostectomy rarely corrects the cause of the bunion.

Exostectomy is most often performed as one part of an entire corrective surgery that includes osteotomy, as well as soft-tissue procedures. If a doctor performs exostectomy without osteotomy, however, the bunion deformity often returns.

X-rays of a bunion before and after exostectomy

The x-ray on the left shows a mild bunion bump before exostectomy. After the procedure (right), the bump has been shaved but the toe deformity remains and is actually worse; the big toe drifts closer to the other toes and the metatarsal bone sticks out further.

Resection Arthroplasty

In this procedure, your doctor removes the damaged portion of the joint. This increases the space between the bones and creates a flexible “scar” joint. Resection arthroplasty is used mainly for patients who are elderly, have had previous unsuccessful bunion surgery, or have severe arthritis not amenable to an arthrodesis (see above). Because this procedure can change the push off power of the big toe, it is not often recommended.

X-ray of a failed resection arthroplasty and photo of a shortened big toe

This x-ray shows a failed resection arthroplasty. Although the damaged bone of the MTP joint was removed, scar tissue did not fill the space between the bones. The bone edges are still in contact. The photograph shows that without the needed scar tissue, the big toe is shortened. This makes it more difficult to push off while walking.

Preparing for Surgery

Medical Evaluation

Before your surgery, you may be asked to visit your family doctor for a complete physical examination. He or she will assess your health and identify any problems that could interfere with your surgery. If you have a heart or lung condition or a chronic illness you will need a preoperative medical clearance from your family doctor.

Medications

Tell your doctor about any medications you are taking. He or she will tell you which medications you can continue taking and which you should stop taking before surgery.

Tests

You may require several preoperative tests, including blood counts, a cardiogram, and a chest x-ray. You may also need to provide a urine sample.

To help plan your procedure, your doctor may order special foot x-rays. These x-rays should be taken in a standing, weight bearing position to ensure your doctor can clearly see the deformity in the foot. These x-rays assist your doctor in making decisions about where along the bone to perform an osteotomy in order to provide enough corrective power to straighten the toe.

Your Surgery

In planning your surgery, your doctor will consider several things, including how severe your bunion is, your age, your general health and activity level, and any other medical issues that may affect your recovery.

Almost all bunion surgery is done on an outpatient basis. You will most likely be asked to arrive at the hospital or surgical center 1 or 2 hours before your surgery.

Anesthesia

After admission, you will be evaluated by a member of the anesthesia team. Most bunion surgery is performed with anesthesia that numbs the area for surgery but does not put you to sleep.

  • Local anesthesia. An ankle block numbs just your foot.
  • Regional anesthesia. A popliteal block works for a longer period of time compared to an ankle block and numbs more of the leg. The numbing medicine is injected behind the knee.
  • Spinal anesthesia. This injection will numb your body below your waist.
  • General anesthesia. This form of anesthesia will put you to sleep.

The anesthesiologist will stay with you throughout the procedure to administer other medications, if necessary, and to make sure you are comfortable.

Procedure

Depending upon your bunion and the procedures you need, your doctor will make an incision along the inside of your big toe joint or on top of the joint. In some cases, more than one incision is needed to correct the bunion deformity.

Surgical photo of an osteotomy

This surgical photograph shows a saw cutting the bone to perform an osteotomy.

The surgical time varies depending on how much of your foot is malaligned. Surgery will take longer if your deformity is greater or if more than one osteotomy is required. Every bunion correction is a little bit different, and there is no reason to be concerned if your surgery takes more time.

Afterward, you will be moved to the recovery room. You will be ready to go home in an hour or two. Be sure to have someone with you to drive you home.

Photo and x-ray of a foot after osteotomy for a bunion

(Left) The bunion that was shown at the beginning of this article as it appeared immediately after surgery. (Right) An x-ray showing the bones in alignment after surgery. Osteotomies were performed on both bones; screws and plates hold the bones in place. Reproduced from Wagner E, Ortiz C: Proximal Oblique Sliding Closing-wedge Osteotomy for Wide-angle Hallux Valgus. Orthopaedic Knowledge Online Journal: Vol 12, No 4, 4/1/2014; Accessed December 4, 2015.

Complications

As with any surgical procedure, there are risks associated with bunion surgery. These occur infrequently and are usually treatable — although, in some cases, they may limit or extend your full recovery. Before your surgery, your doctor will discuss each of the risks with you and take specific measures to avoid complications.

The possible risks and complications of bunion surgery include:

  • Infection
  • Nerve injury
  • Failure to relieve pain
  • Failure of the bone to fully heal
  • Stiffness of the big toe joint
  • Recurrence of the bunion

Recovery at Home

The success of your surgery will depend in large part on how well you follow your doctor’s instructions at home during the first few weeks after surgery. You will see your doctor regularly for several months — occasionally up to a year — to make sure your foot heals properly.

Dressing Care

You will be discharged from the hospital with bandages holding your toe in its corrected position.

Because keeping your toe in position is essential for successful healing, it is very important to follow your doctor’s directions about dressing care. Do not disturb or change the dressing without talking to your doctor. Interfering with proper healing could cause a recurrence of the bunion.

Dressing applied to foot after osteotomy

Legend: Your doctor will apply your dressing in a specific way to keep the bones in correct position.

Reproduced from Hirose CB, Coughlin MJ: Proximal and Distal First Metatarsal Osteotomies for Hallux Valgus, in Flatow E, Colvin AC, eds: Atlas of Essential Orthopaedic Procedures. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2013, pp 535-539.

Be sure to keep your wound and dressing dry. When you are showering or bathing, cover your foot with a plastic bag.

Your sutures will be removed about 2 weeks after surgery, but your foot will require continued support from dressings or a brace for 6 to 12 weeks.

Medications

Your doctor will prescribe pain medication to relieve surgical discomfort. The most effective medications for providing postsurgical pain relief are opioids. These medications are narcotics, however, and can be addictive. It is important to use opioids only as directed by your doctor.

As soon as your pain begins to improve, stop taking opioids. Talk to your doctor if your pain has not begun to improve within a few days of your surgery.

In addition to pain medicine, your doctor may prescribe antibiotics to help prevent infection in your wound for several days after surgery.

Swelling

Keep your foot elevated as much as possible for the first few days after surgery, and apply ice as recommended by your doctor to relieve swelling and pain. Never apply ice directly on your skin. It is common to have some swelling in your foot from 6 months to a year after bunion surgery.

Bearing Weight

Your doctor will give you strict instructions about whether and when you can put weight on your foot. Depending upon the type of procedure you have, if you put weight on your foot too early or without proper support, the bones can shift and the bunion correction will be lost.

Some bunion procedures allow you to walk on your foot right after the surgery. In these cases, patients must use a special surgical shoe to protect the bunion correction.

Many bunion surgeries require a period of no weightbearing to ensure bone healing. Your doctor will apply dressings, a brace, or a cast to maintain the correct bone position. Crutches are usually used to avoid putting any weight on the foot. A newer device called a knee walker is a good alternative to crutches. It has four wheels and functions like a scooter. Instead of standing, you place the knee of your affected foot on a padded cushion and push yourself along using your healthy foot.

In addition to no weightbearing, driving may be restricted until the bones have healed properly — particularly if the surgery was performed on your right foot.

No matter what type of bunion surgery you have, it is very important to follow your doctor’s instructions about weightbearing. Do not put weight on your foot or stop using supportive devices until your doctor gives approval.

Physical Therapy and Exercise

Specific exercises will help restore your foot’s strength and range of motion after surgery. Your doctor or physical therapist may recommend exercises using a surgical band to strengthen your ankle or using marbles to restore motion in your toes.

Marble pick-up exercise for foot

Specific exercises such as the marble pick up exercise will help restore full motion to your foot.

Reproduced from JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010.

Always start these exercises slowly and follow instructions from your doctor or physical therapist regarding repetitions.

Shoe Wear

It will take several months for your bones to fully heal. When you have completed the initial rehabilitation period, your doctor will advise you on shoewear. Athletic shoes or soft leather oxford type shoes will best protect the bunion correction until the bones have completely healed.

To help prevent your bunion from recurring, do not wear fashion shoes until your doctor allows it. Be aware that your doctor may recommend that you never return to wearing high-heeled shoes.

Avoiding Complications

Though uncommon, complications can occur following bunion surgery. During your recovery at home, contact your doctor if:

  • Your dressing loosens, comes off, or gets wet.
  • Your dressing is moistened with blood or drainage.
  • You develop side effects from postoperative medications.

Also, call your doctor immediately if you notice any of the following warning signs of infection:

  • Persistent fever
  • Shaking chills
  • Persistent warmth or redness around the dressing
  • Increased or persistent pain, especially a “sunburn” type pain
  • Significant swelling in the calf above the treated foot, especially if there is a “charley horse” pain behind the knee, or if your develop shortness of breath.

Outcomes

The majority of patients who undergo bunion surgery experience a reduction of foot pain, along with improvement in the alignment of their big toe. The length of your recovery will depend upon the surgical procedures that were performed, and how well you follow your doctor’s instructions.

Because a main cause of bunion deformity is a tight-fitting shoe, returning to that type of shoe can cause your bunion to return. Always follow your doctor’s recommendations for proper shoe fit.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Ankle sprains: what's normal and what's not?

Ankle sprains: what’s normal and what’s not?

By Alexandra E. Page, MD | Featured on AAOS

Ankle sprains are the most common sports injuries, with an estimated 25,000 occurring every day in the US.

Sprains can happen with any sport, including just walking across the yard! Ankle sprains are most common in ball sports such as basketball, soccer, volleyball and others.

What happens? The ankle is designed to have much more motion with the foot turning in, which is how sprains usually happen. The term “sprain” refers to any ligament injury. Ligaments are the tough fibers that connect bones to each other to give the skeleton strength while still allowing joints to move.

The most common ankle sprains involve tearing of the ligaments on the outside of the ankle. The ligament tearing leads to bleeding deep inside, which you see as bruising on the skin.  Fortunately, your body is designed to heal injuries, so these ligaments will almost always heal on their own.

As with any injury, your body quickly sends blood to start the healing process, which leads to the swelling. Remember: your heart is the pump and it is a long way to pump the blood back up from the ankle. For many people, some swelling will continue long after the sprain has “healed” and you are back to activities. This is, again, due to the distance from the ankle to the heart. At night, the swelling gets better but, with activity during the day, the fluid from normal blood flow leads to gradual swelling.

Rest, ice, compression, elevation, known as RICE, is a good way to treat an ankle sprain. This decreases the swelling, lessens your pain, and allows your body to heal the injury. Studies have shown that the sooner you return to activity, the better and typically the faster you will recover.

If pain allows, start moving the ankle early.

When to seek care: If it hurts too much to put any weight on the ankle and you can’t walk, seek treatment immediately. Depending on the amount of injury to the ligaments, it may be days, weeks, or even months to return to high-intensity sports. Sometimes recovery may be slow but, if it gets better day by day or week by week, you are on the right path.

If the ankle seems to stop improving and you just can’t get back to your activities then your orthopaedic surgeon can help.

Prevention: It is always better to avoid the sprain in first place! Remember to stretch before sports to prevent ankle and other injuries to all your bones and joints. Some studies show that taping or an ankle brace can help avoid repeat sprains if you have had sprains in the past.

Don’t let fear of an ankle sprain keep you from your sport. Your orthopaedic surgeon wants you to stay in motion to stay healthy!


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

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