Xray of Fracture of Medial Malleolus

Xray of Fracture of Medial Malleolus of Tibia

A malleolus is a projection of bone beyond ankle joint. The medial one is called medial malleolus. Other arising from tibia is called posterior. A counterpart called lateral malleolus is distal end of fibula.

A fracture is a break in the continuity of the bone and is usually caused by force beyond the strength of the bone.

Fracture of medial malleolus is a common ankle injury and following is an xray of fracture of medial malleolus.

Xray Ankle showing fracture of medial malleolus

 

The present xray shows a fractured medial malleolus.

Treatment of the fractured medial malleolus depends upon many factors. These are presence of concomitant fracture of fibula, amount of displacement of medial malleolus, age of the patient and demands of patient.

In nonoperative methods, patients are given below knee or short leg casts. SOmetimes the definitive cast needs to preceded with a temporary slab to reduce the swelling. It is mostly done in cases of undisplaced fractures or patients with very low demands.

Surgical treatment of medial malleolus fracture aims at anatomical restoration and holding the fractured fragments at that anatomical position by means of screws, Kwires or tension band wiring.

A fractured medial malleolus would take around 4-6 weeks to unite.

Xrayof Fracture of Medial Malleolus Fixed With Malleolar Screw

 

Xrayof Fracture of Medial Malleolus Fixed With Malleolar Screw

Xray of Fracture of Medial Malleolus Fixed With Malleolar Screw

The xray in picture is of 27 years old male who fell after his ankle got twisted. He had a displaced fracture of medial malleolus and the fracture was fixed with two malleolar screw.

 

 

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  • medial malleolus fracture recovery time (4)
  • Lateral Malleolus Fracture Recovery Time (3)
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Comments

  1. stan jones says

    i fratured my ankle a year ago,and iam still having problems with it, swelling burning sensation and on cold days it gets real bad for me.i fractured the medial malleous bone in my left ankle.

  2. Dr Arun Pal Singh says

    It is not clear why but some people continue with these kinds of symptoms long after their injury has healed. If you had been treated promptly and adequately, these would fade with time and might disappear too.

    Take preventive measures to protect yourself from extremes of temperature.

    Raise your foot intermittently to avoid swelling.

    Take care.

    Arun Pal SIngh

    P.S. Do take care about your footwear. It should be comfortable.

  3. Robyn says

    Dr Arun Pal Singh, I fractured my ankle in 1999. It was in 2 places, the lower fibula and right across the lateral maleolus. I had surgery to repair it and 6 months later to remove the hardware. At the time I had problems with circulation and it continues to this day . Pressure builds up and I have to elevate my leg. I can't stand for any length of time. When I sit, I have to elevate the leg. I even drive with my left leg with the right leg on the passenger seat. I lost my insurance after the injury and have not had any since then so cannot see a doctor to find if there is anything that can be done. Do you have any thoughts on this? Thanks!

  4. Dr Arun Pal Singh says

    Robyn,

    If problem is persisting with this intensity then you must see a doctor to rule out the cause.

    You would need to be investigated in my opinion before pronouncing the causative factor.

    There could be other causes of swelling as well.

    It is unfortunate that you cannot see a doctor at this moment.

    Though I am not aware of your health care system but at least I can stress the need.

    I hope you understand.

    My best wishes,

    Arun

  5. Felicia says

    Dr Arun,

    I had a fibula fracture about 3 years ago. I had to have a surgical procedure to fix the bone and have a metal plate and screws put in. I then healed and had a gap in the ankle. Therefore, I had to have another surgery where the bone was then broken once again and the hardware was then replaced in my leg. I am now 3 years later and have a very deformed looking ankle and have never stopped having swelling. My question is what is the cause of the burning sensation in the area of the leg that was broken coming from? I also damaged my muscle and tendons in my leg with the break and now if i do a long period of standing i develop muscle spasms in the leg and foot and it gets stuck and i have to pull it out or stand to make it go away. What may be the cause of that? I hope to hear back from you soon.

    Thanks,

    Felicia

  6. Dr Arun Pal Singh says

    Felicia,

    I need to know more.

    What do you mean by gap in the ankle?

    What is deformity in your ankle?

    Was the implant removed or you still carry it?

    Could you let me see xrays of yours immediately after your injury, before and after second surgery, and the last xray done on you.

    Please send the answers to my questions and pictures to contact at boneandspine dot com and I would try to do my best.

    Take Care.

    Arun

  7. Kez says

    I broke my ankle in two places 4 weeks ago. I was not offered an x ray on the day and was told it was a sprain. three weeks later i was told it was broken – i have seen a condultant who offered an operation or a cast. He explained the operation was tricky but said the cast may result in me having arthritis. The x ray after the cast showed that it had been reposition but the joint had a 1.4 mm gap. I choose a cast but am wondering whether i made a wrong choice?

  8. Dr Arun Pal Singh says

    Kez,

    I am sure you must have discussed your options well with your treating physician. The information you have given me is not enough for me to comment upon.

    However, if you are unsure you can visit your physician again and discuss the options, risks and possible outcomes again.

    That would be the best approach.

    If you want further information, you can use Contact Form on our website to provide your case history in detail including your pre and post reduction radiographs.

    Arun Pal Singh

  9. David says

    I suffered an injury to my left medial malleolus.

    I can push what I think is a large chunk of bone around the peak of the malleolus.

    Does this require a cast or can the chip simply be removed.

    It is not painful expect when pushed and there is no noticeably instability.

  10. Dr Arun Pal Singh says

    David,

    I need to look at xray before I can give any advice.

    You can use contact form to send an xray.

    However, you would be better served by a doctor whom you can see personally.

    Also please let me know how old is the injury.

  11. janine says

    this morning i really banged my ankle hard and now across the malleolus it is swollen and really painfull! my whole foot and leg is aching. Could i have broken the thing?!

  12. Dr Arun Pal Singh says

    Janine,

    After trauma it is always wise to consult a doctor, get an xray of the area and confirm or rule out injury.

    It is difficult for me to say that you do not have a bony injury.

    I hope you would understand.

  13. jo says

    i went to the hospital yesterday for an xray on my ankle, as i fell down a pot hole and my ankle made a nasty popping sound and is now very swollen,

    i did this to my right ankle and its very swollen on the right had side of my ankle by where that bone sticks out, but when they took the xray they took it from the front of my foot and the left side,

    why is that, why didnt that xray the side that is swollen and hurting, could they have missed something,

    please help it hurts

  14. Dr Arun Pal Singh says

    Jo,

    Usually two views in perpendicular directions are taken to assess the bony injury. One is anteroposterior and other is lateral.

    From your text it seem both have been taken for your ankle.

    A lateral view can be done from either side and both would be able to reveal the injury if present.

    I hope that helps.

  15. Dr Arun Pal Singh says

    Kevin.

    Here are the problems that I have noticed in the xrays.

    1. The radius has migrated proximally. As a result the ulnar styloid is a a lower level then radial styloid [That is why there is a deformity]

    2. There appears a dissociation of proximal radioulnar joint. If you see xray of elbow you would notice that radius and ulna are a bit apart than usual. If you cannot appreciate, get an xray of the opposite side.

    This means radio ulnar joint tissues are not competent enough to hold the bones together. This is probably responsible for allowing extensive proximal migration.

    3. The migrated radius strikes the humerus in flexion. This might be responsible for pain and/or loss of range of motion.

    In such a situations, the choices are limited and they are not absolute. That means every surgery would provide a solution but would also take away some price.

    Let me know if you have not understood anything.

    I deliberately have not listed options as my suggestions are based on xray only. One needs to examine the patient and then individualize the treatment.

    Her physician would be a better person to tell you.

    But if you still insist, let me know.

  16. Butch says

    I fractured my left distal tibia in 1965! I have had pain off and on now steady pain! I have developed a hole in that bone the diameter of my thumb! Whats going on?

    • Dr Arun Pal Singh says

      Butch,
      What do you mean by the hole. Did you consult any physician?

      Please let me know about your problem in detail.

  17. Tracy says

    i broke my tibia medial malleous identically to the x-ray you have pictured on site(feb 08). This happened 9 weeks ago i was senthome from hospital with a sprain, however i returned 3 weeks later to be told that it was broken. I had a cast for 4 weeks and was told that i would be x-rayed with cast off at follow up appointment and if not healing i would need surgery. Also i would have to wear a removable cast for a while. At follow up appointment i was seen by a different doctor who never x-rayed or offered cast and referred me for physio. I told him what other doctor had said and he just said i didn't need x-raying the bone has had time to heal. I am worried that the bone may not have healed properly as firstly i was walking on it for 3 weeks before casting and now without x-ray unsure if healing properly. I still have swelling and pain in the bone and also on other side which i presume is torn ligaments and am being woke in night with pain in my ankle broken bone side. Is this normal after 9 weeks , i had cast removed 10 days ago and go for physio in 3 days time.

    • Dr Arun Pal Singh says

      Dear Tracy,

      In a normal course, nine weeks is the ample time for a fracture of medial malleolus to unite but every individual behave differently. In doubt it is always the best to get an xray. Because you have pain on walking as well as rest, I think xray would help us to rule out if the origin is from fracture or the ligaments around.

      If xray shows a united fracture in normal and acceptable position then the pain would arise from soft tissues. Because you did not provide rest to your your joint for initial period [though there is no fault of yours], it would take a longer time for soft tissue pains to go away.

      Discuss it with your doctor if your pain is troubling you. Firstmost priority in your case should be establishing that facture has healed in acceptable position. Only xray can tell that.

  18. Vicky says

    Hiya,

    I fractured my ankle on the 14th December '08. It was only the fibula and was a non displaced fracture. Basically from what the Doctors said, a simple fracture not needing surgery.

    Well, I'm still in an aircast boot, have already spent 6 weeks in a fixed cast and it still hasn't healed!. Do you know why?. I'd be grateful for any information you can pass on to me.

    Also, once it has finally healed and I'm allowed to weight bear on it, how long before the leg muscles return to a state that allows me back to work?.

    Thank you in advance.

    Vicky.

    • Dr Arun Pal Singh says

      Vicky,

      From your description it is not clear at what level you have a fracture. Fracture of fibula usually heals without any problem if it is in upper and middle part of leg. If it is near ankle joint then problems may arise but are manageable.

      Why do you say it has not healed?

  19. Vicky says

    The fracture is on/just above the ankle.

    It's still uncomfortable and tender to touch. I thought it would have healed enough by now that I would be back at work. Is it usual for a fracture to keep you off work for so long?.

    • Dr Arun Pal Singh says

      Vicky,

      Tenderness is of concern. Have you been xrayed recently. What did it say about fracture healing?

  20. Vicky says

    I have an appointment on March 11th. I've been xrayed every time I've been to the hospital. The Doctor doesn't appear to be worried about the fracture. It just seems to be taking longer than anyone else and I don't understand why.

    Thank you for your replies Dr Arun Pal Singh.

  21. mohammed ibrahem says

    i was have Fracture of Medial Malleolus of Tibia like this Xray and made surgery assemble four bolt or nail

    now after 6 weeks i removed gypsum now i feel pain and can't move instep to the end and have pain in it

  22. vincent says

    i've fractured my ankle 2 years ago but never had any problems but now i've sprained my ankle just two weeks ago and it seems like my medial malleolus is caught under my ankle, restricting some range of motion. can that happen? will i have all my range of motion back? i skate and i would really appreciate it if you reply. thank you =)

  23. Vicky says

    The hospital has all my xrays.

    Maybe you could advise me as to what questions I should ask at my next appointment?.

  24. Dr Arun Pal Singh says

    Mohammed,

    Would you please elaborate more on your exact diagnosis and treatment done. Also, let me know your problem in detail. You need to pass on the information so that I am able to build upon that.

  25. Dr Arun Pal Singh says

    Vincent,

    I need to the problem. I am not able to undertand the meaning of the term "medial malleolus is caught under my ankle".

    If you just have sprain then your bones must be intact. After sprain there is restriction of motion for some duration.

    You need to provide rest to the ankle and take analgesics under medical supervision.

    From your statement it seems that you have not consulted a physician.

    I would suggest that you do.

  26. Dr Arun Pal Singh says

    Vicky,

    After a fracture the prime concern is following. This is one needs to know.

    1. Has the fracture united. Is it evident on xray?

    2. Is the bone united in correct position. It may not be anatomically perfect but should be within the range of acceptability.

    3. If it has united why is it tender.

    4. If everything is fine is there a specific cause for the pain or or it is a vague pain following trauma.

    Take care and do let me know of your progress.

  27. Vicky says

    Hiya :)

    I had another xray done today, the fracture is still quite clear to see, that's why it's still tender to touch. The registrar said it's not healed as well as it should have given the amount of time it's been broke although it should be fine to walk on using the crutches then gradually without. He'll refer me for physio.

    He said I'd be able to go back to work once I'm fully weight bearing, which he thinks should be within 2 weeks.

    Thank you for your help and advice, you've been very helpful :)

    Vicky :)

  28. says

    Hello Dr Arun,

    A bike accident 2 days back left me with pain in the lower right ankle foot.

    To my dismay I do not have a scanner or digital X-Ray image to email you the same.

    However the Xray report says —

    "Fracture of the lower end of fibula and anterior tibial condyle noted."

    I did meet 2 independant practising Ortho. Surgeons yesterday. I do not doubt their competence given that one of them has huge many years of experience. Yet mixed opinions left me doubting about whether I can avoid a sugery in this case.

    Also right now I am on antibiotics and painkillers.

    One of them told me that a plaster / cast with repositioning may work but could lead to minor nonhealing of the fracture in some cases and ideally a surgery would be better. Although I am not afraid of undergoing a surgery (no fobias of any kind) I would still prefer if a non-invasive procedure such as a Cast could really do the job of healing. What are the chances of a Cast failing to do the job?

    Pardon and correct me if I may have used wrong terminology anywhere.

    Please suggest what is the best way for going about with this. What are my choices if any?

  29. Dr Arun Pal Singh says

    Asim,

    Every procedure stands risk of failure.

    Another point is that there could be multiple modes of treatment for each injury.

    Sometimes patient is given choices of treatment along with pros and cons of each and asked to make a decision.

    Nobody can say in advance that a particular method of treatment would fail. But likelihood can be told.

    Because yo have had two different opinoins, I presume that your fracture can be treated either way.

    To put my comment on that, I need to see the image.

    Are you sure it is tibial condyle? You said you have injury in ankle. The condyle is in the knee. Plus is there a wound?

    Why have you been put on antibiotics?

  30. says

    Thank you very much for your response Doctor.

    My Consultant Doctor's Written Diagnosis Report Says,

    Pott's Fracture Rt. Ankle —>

    # Med. mall. – Transverse#, displaced;

    # Lat. mall. – verical, intraarticular#

    in position

    The medicines are – Tab. Chymoral Forte – 3 times per day

    Tab. Voveran Plus – 2 times per day

    Tab. Triples -A Cal – 1 daily.

    These from what I understand are my latest prescription drugs which I am taking.

    I understand these as 1st an enzymatic drug, the other a pain killer, the third a calcium supplement.

    The initial x-ray report was dictated on phone to me, due to my inability to go there personally and get the report collected ( me being alone for the next few days ). We better safely ignore my initial posted report as I might have noted the report wrongly. It's hard to understand why our local path labs dont provide Adobe PDF reports inspite of having digital imaging machines. I have even noted that 2 path labs within a 24 hr period provide different reports and interpretations/terminology.

    Thank you again. I am opting for bone reset with help of Plaster Cast initially and going in for a new x-ray after 1-2 week to see how things progress. Will try arrange for a scanned x-ray image from somewhere to be sent to you if provided your email id.

    Please post your opinion again based on my consultant doctor's findings.

  31. says

    Forgot in the previous post.

    Yes there is a superficial wound and also internal haemorrage for which my local physician had gave me the antibiotics initially perhaps after doing the first aid.

  32. Dr Arun Pal Singh says

    Asim,

    You have got broken medial malleolus and lateral malleolus, commonly called as bimalleolar fracture or Pott's fracture.

    # is the sign commonly used to denote a fracture.

    In your case, medial malleolus is displaced. That means it is no more in the position it is normally.

    Lateral malleolus is not displaced.

    Any treatment, whether non operative or operative, should bring medial malleolus back into position while maintaining position of lateral malleolus.

    Our aim is not only union but union in sound and acceptable position.

    Earlier these fractures were being treated with manipulation and non operative treatment but in case of displaced fractures, nonoperative method may not bring as accurate positioning especially when other side is not displaced.

    Surgery, on the other hand has its own risks like Incision scar, risk of infection etc.

    As you have already been given cast, you can get another xray to see position of displaced malleolus. If it is not corrected, you need to get surgery.

    If your superficial wound is big and comes in way of your surgical incision, it is best to postpone to surgery for some time as it would increase the chances of infection.

    If you wish to send me the images, you should send me one before and one after the plaster.

    You can find email id in "Contact" page.

  33. Tracy says

    Dear Doctor,

    It is now 4 weeks since i last posted, thankyou for your reply on 21st February. Just to recap, i broke medial maleolus 13 weeks ago, was misdiagnosed and after 3 weeks returned to hospital who re-x-rayed my ankle and discovered it was broken. I have had cast off for 5 weeks now and been having physio for 4 weeks. I have not been re-x-rayed after cast removal but my physio says the medial maleolus feels to be in the right place. I still have pain which she says is ligament pain and after being on my feet for an hour or two my ankle swells a lot. I am still walking with a limp which gets worse throughout the day and as i work in a cafe which means being on my feet all day, i still can not return to work. Also i can't walk upstairs without holding onto banister as my foot is weak and ligaments damaged. I do have a lot more movement in my foot with doing physio but still restricted movement from side to side. How long does it take to strengthen foot and ease pain from ligament damage as it seems to be going on forever? Thanks in advance for reply

  34. Dr Arun Pal Singh says

    Tracy,

    First of all it needs to be confirmed that your medial malleolus has united and is in acceptable position. A clinical examination can indicate but to be fully sure, it needs to be xrayed.

    There is no harm in getting an xray done even if somebody feels that everything is right on clinical examination. Please note that I am not contradicting anybody, I am just suggesting that a simple investigation would guide us for the treatment much better.

    Please see your doctor if your problem is continuing.

    If xray comes to be as normal/acceptable, then the problem is in soft tissues which in your case might trouble you little longer as they did not get adequate rest after the injury for initial 3 weeks (I assumed this from your post, correct me if I am wrong)

    Let me know how do you make a proress.

  35. Isaac Motau says

    Dear Doctor

    I fractured my right medial maleolus at soccer practise about 7 weeks ago (just like in the picture) and it was surgically fixed that same week since it was also displaced they had to put in screws 2 of them and i was on a cast for about 5 weeks. The doctor said it was not fully united when I last went for my appointment 2 weeks ago and he said I should apply pairtial weight bearing for 2 weeks and by then I'll be able to walk again but now the problem is my foot swells up when i walk and there is pain, I was wondering where the pain comes from or if i should be woried with the fracture itself because it has been 7 weeks since it was fixed and almost 2 weeks since the doctor said I can start to progresivelly walk again

  36. Daniel says

    How long does residual swelling typically last after surgery for a medial malleolus fracture? Injury 2/21, 2 screws put in 3/10, out of walking boot 4/10. My foot still has residual swelling on both sides of the ankle. Feels fine to walk, but cannot jog yet. Foot is very tight when trying to stretch with toes toward knee (calf stretch). I'm eager to run and play soccer, but doc says to not exercise until swelling goes down.

  37. Kelly Ritchie says

    My Daughter has a tibia fibular fracture (Also detached ligamnent from ankle) like your one shown and the orthopedic surgeon has back slabbed it and sent her for an MRI scan, he want’s to put her an an air walker boot cast, will this need an operation or will it just heal itself? I am concerned because she has Ehlers Danlos Syndrome hypermobility type.

    Kind regards

    Kelly

    • Dr Arun Pal Singh says

      Kelly Ritchie,

      Ehlers Danlos Syndrome can delay healing. My first choice would therefore be non operative treatment if possible. If the fracture is not amenable to non operative treatment, then surgery is the logical option.

      I hope that helps.

  38. Jim morasky says

    I broke my leg 3 years ago and had a plate with 9 screws insatlled. I still have swelling and a lot of pain. Would it help to get the plate removed?

    • Dr Arun Pal Singh says

      Jim,

      If the fracture is united one can go for plate removal if there are persistent symptoms.
      Yiou would need to protect your leg in plaster/brace after removal though. the usual protection is for 6 weeks.

  39. Dr Arun Pal Singh says

    Isaac Motau,

    The cause of pain needs to ascertained. Check out with your doctor whether your fracture has united or not. If fracture has united the cause of pain would be soft tissues which also get injured during trauma.

    Raise your feet intermittently to avoid dependent postion for long to avoid swelling.

    I hope that helps.

  40. Dr Arun Pal Singh says

    Daniel,

    your injury is behaving very well. Concentrate on physio and your ankle should become near normal. Swelling would go with time.

  41. Kelly Ritchie says

    Dr Arun

    Thankyou for your response i got the letter from the orthopeadic surgeon saying that Katie's injury is Diastasis injury with a fracture to the distal tibiofibular joint??? I have no idea what this mean's can you advise??

  42. Dr Arun Pal Singh says

    Kellly Ritchie,

    Welcome.

    Diastsis literally means separation. If you see the anteroposterior view on right half the image on top of the present page, you would see that in lower part tibia and fibula form an inverted U shaped cup in which foot bone is articulating.

    This inverted U is formed by tibia and fibula together. These two bones are connected with each other with tibio-fibular ligament.

    in case this ligament breaks, the bones move apart a little than normal anatomical position resulting in widening of U.

    This is called tibio fibular diastsis. This injury is generally associated with fractures of ends of tibia and fibula. Very rarely it can happen in isolation without any fracture.

  43. Kelly Ritchie says

    Dr Arun

    Thankyou i now understand, so is this good news and will it heal itself?? Do you think Air cast boot will be sufficent to heal it?? how long will recovery take??

    many thanks you have been very kind with the information you have provided

    kelly

  44. kelly ritchie says

    Dr Arun

    Thankyou for your response, is this good news? does this mean it will fix itself? how long is recovery??
    thank you for you responses thay have been most helpful.

    Kelly

    • Dr Arun Pal Singh says

      Kelly,

      As i am not aware of severity of injury, it is difficult for me to comment on these queries. You would be better served by treating physician on this issue.

  45. Jodie says

    Hi Dr Arun,

    I slipped at fell at a train station 3 days ago and was taken to hospital for an x-ray to be done. The x-ray showed a medial posterior malleoli fracture on my right ankle.

    I have a back slab and have been told that I will not be able to weight bear for at least 6 to 8 weeks and will have to use crutches during this time.

    I am not very stable on crutches and would like to know if it is correct that I should not weight bear at all for at least 6 weeks as the fracture does not look that bad.

    Having said that, I had severe swelling and paid on the left side of my ankle (opposite side to the fracture) prior to the plaster cast being put on. I assume this would be ligament and/or muscle damage? How long do ligaments and muscles take to heal?

    I have images of the x-ray's but am not sure how to send them to you?

    Your help and feedback would be greatly appreciated.

    Regards

    Jodie

    • Dr Arun Pal Singh says

      @Jodie,

      If you have a fracture around ankle, no matter what configuration bearing weight would put undue stresses and may worsen the fracture. That is why non weight bearing till fracture heals.

      Ligaments and other soft tissues usually heal within 2-4 weeks depending on severity of injury.

      I understand that crutch walking is not comfortable but it is to make you mobile while you keep your foot off the ground.

      As you get better control on your gait, you would feel a little better.

      Take care.

  46. Teresa says

    Dear Dr.

    My mom is 77 years old and has been having pain below her ankle join (sometimes on the right or at times on the left side of the joint). However, this week, she had a major episode that she is unable to bear weight or is painful with walking. The swelling is minimal, slight ( very slight) warmth and no redness and pulse is present. Is this a form arthritis? Thanks

    • Dr Arun Pal Singh says

      @Teresa,

      Arthritis can be one of the reasons but it is important to find the cause of arthritis. The list of the causes quite long and in her age it is even more important to investigate.

      I think you should take her to a physician.

  47. Katie says

    Hey,

    i have a previous brake to my lateral malleous and i still have problems with both ankles, i can put them into weird positions and make the bones look as if they are popping out of place, i can also make them click alot whenever i want to, very strange :) its just a weird thing and i was wondering if theres anything i could do to stop straining it,

    thanks x

    • Dr Arun Pal Singh says

      @Katie,

      Was previous injury in both your ankles?

      If not, then it might not be because of injury.

      From your description it seems that your joints are lax. If the problem is not affecting your functions, just keep a watch over it and if it worsens or starts affecting your activities, see a physician.

      I hope that helps.

  48. Laurent says

    Hi,

    I had surgery for my open tibia and fibula fracture last 21st october 2008, during which I had bone crafting of my tibia and insertion of a nail , but my fibula bone was sectioned to prefect uneven union, according to docs and therapists the fibula is of lesser importance. My problem and worries are that since mid march I am walking normally without crutches.and x-ray showed good recovery. Doc said I could resume normal life. But then start of this june 2009, I am going to the gym to exercise and tone the whole body. so far I had 3 sessions. Prior to that I had no pain at all. But lately i am feeling weird sensation of swelling and a little pain . Is it due to the exercise ? or is it normal residual swelling, and some pain of the soft tissues and muscles ? that is making me feel odd about it, shall I stop exercises.? I really don't know …. although my training are none intensive and focus more on the upper body than the tibia and legs. the swelling isn't that much but i don't know, I am also a very busy 3d artist and am always working till late.. so could it too much sitting after the workout… ? cause I really didn't sleep that nite I came back from workout… :(

    • Dr Arun Pal Singh says

      @Laurent,

      You did not mention it but I hope your fracture has united. if the fracture has united, the pain would be from surrounding soft tissues.

      In that case, you might want to continue exercises within limits of your pain and tone up your muscles.

      Things should settle with time. But do ensure that you have a sound union of fracture. Because if it is not then the course of events should be different.

      Take care.

  49. Carl Glaser says

    Hello Dr Arun Pal Singh,

    I have been told that I have a non-displaced fracture of the medial malleous, however it is not very visable on the x-ray. I told the Dr. that I had a previous break 20 years ago in the same spot. Recently I attempted a back flip and under-rotated, thus causing a sprain ankle and suspected fracture. It has been 6 days now and I just started walking with crutches since I was told to keep weight off. I have an air cast since 4 days ago. My question is: Do I need to stay on crutches for 4-6 weeks? I am able to walk on my foot with very little pain and the swelling if 80% gone. My achilles tendon is sore still and swollen, but it works fine. Is it possible that the image showed an OLD fracture? I really don't want to use crutches for the next 4-6 weeks.

    Thanks,

    Carl

    • Dr Arun Pal Singh says

      @Carl Glaser,

      Crutches are advised to provide rest to the joint. Even if the fracture is undisplaced, there would be associated soft tissue injury which needs to heal.

      It may not be as long as 4-6 weeks though if it is undisplaced injury.

  50. Grant says

    I fractured my ankle 6 weeks ago and had 3 screws inserted but still have swelling and cannot put weight on it, as i get a shooting pain in my heel. Is this normal?

    • Dr Arun Pal Singh says

      @Grant,

      Make sure you do not have an injury to the heel bone and work on putting your weight gradually on that foot.

      Sometimes soft tissue may cause this pain but it is necessary that we rule out a bony injury because that would require your foot off the ground for some more time.

  51. Heather Gammage says

    Okay,

    I have a question. I broke my medial mallelous last september. According to the doctor that I was seeing it healed. I have had problems with it since then with swelling and being uncomfortable. On tuesday of this week i slipped rolled my ankle and broke the same bone. Not to the same severity but enough to cause discomfort, swelling and pain.

    From what the xray tech told me he said that it was just a little fracture. (i am still waiting to see the ortho)

    Will they cast me?

    THank you,

    Heather

    • Dr Arun Pal Singh says

      @Heather Gammage,

      If you have a fracture, even of the undisplaced variety, it is always advised to immobilize the part with cast or other type of splint.

      A broken bone (even a crack) needs protection.

  52. Whittle says

    I fractured my ankle at the malleolus lateralis fibula and malleolus tibia bones 4 weeks ago and had surgery – 6 small screws inserted into a plate along the fibular and 1 large screw across the tibular.

    I do not have a caste, it seems to be healing ok so far, i'm wondering what is the best next step for a speedy recovery – a boot? (where best to find in Singapore please) and when i can begin to put more wieght on this foot?

    Thank you very much,

    Whittle

    • Dr Arun Pal Singh says

      @Whittle,

      Keep your body health, have nutritious diet and follow your doctor's advice. No external agent can hasten the recovery.

      I do not have an idea where yiou could find the boot in Singapore.

  53. jasmina says

    I have a dislocated fracture of the medial malleolus that also rotated 180 degrees & slide up 8mm. My surgeon had never seen it before along with three other orthopedic surgeons. I had surgery with one screw putting things back in place. My tibia/fibula were never harmed during the accident. What is my best way to recover. Will I be on crutches for six weeks. :(

    Thank you,

    Jasmina

  54. Sathish sabu.t says

    I have fractured my medial malleous and was in plaster for 6 weeks.now after 4 months there was an incomplete union seen in x ray. My ortho doc says it is due to periostum /soft tissue laying between bones causes the delay in union what is u r openion?IS surgery required?

    Thank you
    Sathish sabu.t

  55. Tracy says

    Hello Dr Arun Pal Singh

    I last posted on here 0n 18th March 2009. My ankle is making progress but i still have pain and swelling , by the end of the day, mainly on the outside of my ankle which i presume is soft tissue damage. I have seen a consultant and had an x-ray and he is satisfied that the medial malleolar fracture has united. I just have a few questions if you could please help me with, on my medical report he has stated that the new xray shows a congruous ankle mortis – what does this mean? He also states that i am looking at next spring before i will have made a full recovery which by then will have been 15 months from the date of injury, is this normal and why is it taking so long?

    • Dr Arun Pal Singh says

      @Tracy,

      That is a good think to have. that means your ankle joint is restored anatomically.

      Fractures unite early but the minor swelling persist for a long time.

      They do go away eventually in most of the cases.

      And everybody has a different severity of injury and capacity to heal.
      Al these might cause differences in the rate of recovery.

  56. Selvan says

    The medial malleolus bone in ankle was broken, As per the Doctor for a speedy recovery they have joined the ankle medial malleolus bone with a screw. As this is a new experience.

    1) Kindly let me know Is this a critical issue or I can take I lightly,

    2) what all precautions should be taken?

    3) Later once the screw is removed how long will it take to fill or join the gap of screw in ankle medial malleolus bone?

    4) Please let me know if you have any more information on broken ankle medial malleolus bone

    • Dr Arun Pal Singh says

      @Selvan,

      1. A fracture that needs surgery should not be taken lightly.
      2. Please follow your doctors advice regarding weight bearing.
      3. Removal does not cause any problem per se. The gap is too small to be worried about.
      4. Please let me know what information do you want?

  57. Ryan S. says

    i have fractured my medical malleous and i had surgery 4 weeks ago. i have put some pressure on it, is there any way that the screws will come loose? i have been worrying about this. sometimes in my cast i have like an akward feel where i broke it and it feels like the pins are like loose where my ankle is

  58. Selvan says

    It is six week running after the operation in medical malleous ankle, the broken medical malleous is fixed by a single screw. In sixth week I still feel some kind of pain. Taken a X-ray and In X-ray I can see a joining line of the broken bone. Kindly let me know How do I know if a bone is healing. Dr. said that I can partially put wait on my leg. Is it okey to put wait on legs when there is line seen in bone joint.

  59. Raja says

    Dr Arun, The ankle medial malleolus bone was broken and its operated and fixed with a screw. Now it is 6th week, broken joint is visible, there is no swelling,

    As the broken bone is fixed with screw, is there a possibility of dislocation of the broken bone?

    Broken joint is visible in X-Ray in 6th week and there is no swelling in ankle, can I put partial weight on the leg. Will there be any issues later as the joint is visible now.

    Broken joint is visible in X-Ray in 6th week, when will the joint be seen as a natural bone or when the joining of broken line will disappear and seen as a natural bone? How can I send you the Xray for your reference?

  60. Chantel says

    I broke my medial malleolus on my left foot about 3 weeks ago and I was told by my ortho doctor that I will beable to put weight on it by the middle of December. I was not told that I would be going to pt so I was wondering if there are any suggestions on how I should go about my own physical therapy at home?

  61. Selvan says

    Dr Arun Pal Singh,

    The ankle medial malleolus was broken and a screw is fixed. Now it is 9th week running, I started walking (limping) now. Still there is some pain in the ankle joint, I cannot move the foot to upwards. I feel a stiffness in ankle But I can move the ankle in all angle except upwards movement.

    The ankle upper skin is sensitive

    Should I have to consult the doctor or it is a known symptom?

    How long the pain will be there?

    Can I start putting normal weight and walk as usual walking or should I have to limp and walk for some more days.

    Can I do the exercise on ankle movement?

    • Dr Arun Pal Singh says

      @Selvan,

      The duration of pain varies in different individuals. It is always better to consult the treating doctor if you have a concern.

      Exercise and weight bearing advice would be best given by the treating doctor.

  62. Chantel says

    I was operated on, the screw is not going to come out. Right now I am in a moon boot. After 12/11 i was told i can start putting pressure on it to walk. I was wondering if there were any physical thearpy ideas I could use.

    • Dr Arun Pal Singh says

      @Chantel,

      After surgery any physical therapy should be done with consent of treating doctor as he is fully aware of your condition.

      And it should be under supervision of physiotherapist.

      I advise you to pay a visit to your doctor and ask him/her directly.

  63. D K Sarkar says

    I suffered from an accident on August 27, 2009 in which the front wheel of a car ran over my right ankle. My orthopaedic doctor after examining the X-ray report told that there is a fracture in the lateral malleolus and a crack on the body of talus. There was a plaster for a month. Now, I am able to walk without much problem. But there remans some uneasiness and pain at the time of walking. Besides, I am not able towalk as fast as I used to do earlier. I dont fnd much problem in climbng up the stair case. But at the time of climbing down, I feel a little nervous and stop at each step without a continuous walk over the steps. I am undergoing physiotherapy for the last 10 days and taking electrical stimulas, Infra Red light and sometmes wax treatment. Will please suggest me something more, particularly some exercises?

  64. Alexander says

    12/19/09 (saturday) I 'cracked' my right ankle coming off ski lift (some 3 hours away from home), several hours later, arrived ER to get Xray and had to wait till the next business day (monday) to see foot doctor.

    12/22/09 (monday) – went to foot doctor with the Xray, results shows a broken Medial Malleous; I was told if the fracture is 2mm more, they would need to put pins. They wrapped my right foot from 4 inches below knee, with some kind of wrap that becomes hardened overtime.

    I noticed the top and bottom of it are not tight (I can shove my whole hands from top) and few fingers from the bottom hole (where the toes are sticking out). Is this normal ? Its been like this since day 1 of cast. I thought it should be tight from top to bottom ?

    I also noticed that I always have to have my foot up, otherwise it will feel puffy and will turn purplish if laid it down (or standing up) for x minutes.

    Question #1: when I put my foot up, where should the contact point for resting be ? right on the heel (with the rest of the cast not touching the pillow) ? or should the resting point be equally distributed (so the whole cast will be rested )on the pillow ? I feel #1 makes me feel more comfortable.

    Question #2: when I put my foot up, should I let the toe be point straight up all the time ? or can i also turn it like 45 to 80 degree ?

    Question #3: whats the maximum duration that I can put my foot down ?

    Thanks and happy December to all :)

    • Dr Arun Pal Singh says

      @Alexander,

      1. Whatever way you feel comfortable
      2. Toe movements are encouraged to avoid stasis of blood flow.
      3. You would be guided by your own symptoms. Generally, prolonged dependent position should be avoided.

  65. Joe Sparks says

    Dear Dr.

    It was recently discovered on an X-ray of my daughter's spine that her ribs are not connected to the vertebrae in the normal manner. The head of the ribs has a tube-like piece of cartilage connecting them to the vertebrae. There are also 2 sinous processes on each vertebra instead of one. And two vertebrae in her neck are fused. Have you had any experience with such anomalies and is there any possible harm that could come from this condition?

    • Dr Arun Pal Singh says

      @Joe Sparks,

      I do not see if it could cause a major problem. But you should get her checked for any other anomaly in any other system.

      A paediatrician would be of help.

  66. Alexander says

    Hi Dr Singh,

    I'm Alexander from the Dec 26,2009 posting. Thanks for the reply :)

    I got cast on 12/21/09 to treat my Medial malleolus fracture. 2 weeks and 3 days later, I still have the same experience –> whenever I put my foot down for over 1 minute, my feet turns red-ish slowly with pressure starting to build (thus making my cast feel tight).

    Is this normal ? being 2 weeks and 3 days with cast. My cast is due to be off on 1/13/10 + further diagnosis.

    Thank you sir !

    • Dr Arun Pal Singh says

      @Alexander,

      Did you talk this to your doctor. Usually this should not occur within one minute.

      Tomorrow when your cast is removed, let your doctor know about this.

      Only thing I can think of is that cast is bit tight

  67. Alexander says

    Hi Dr Singh,

    Thank you so much. I had my cast removed and xray indicates that no surgery is needed. I was given an Ossur Air Walker. I found several wounds on my calves probably due to the tight cast.

    From time to time the air cast feels tight so i simply loosen the velcro.

    I have few last questions for you, if you don't mind, sir :

    1) How tight or loose should I set the Air Walker velcro ?

    2) Do I sleep with it or do I take it completely off to sleep (and elevated) ?

    Thank you sir :)

    • Dr Arun Pal Singh says

      @Alexander,

      1) It should snug but should be comfortable. Adjust accordingly without making it loose to toggle.
      2) I do not think you need it during the sleep. As per your information almost a month has passed since injury.

      However you need to protect your limb when you bear weight. That mean walking and standing.

  68. Ian says

    Hello Dr Singh,

    I broke my Medial malleolus on 19-Dec-09. I was cast on 22-Dec-09. There was no dislocation (movement) of the malleolus and no surgery was deemed necessary. It has been monitored by X-ray on a weekly basis. It seems to be healing well and the joint position is good. I am still in a cast (due off 27- Jan-09). I am not experiencing pain of any consiquence.

    Clearly, I will need my doctors own advice on weight bearing etc. based on my specific injury. However, what would the generally expectation be for the amount of time in weeks (from injury) before one might be expected to (1) bear full weight on the leg/ankle and (2) be able to downhill ski – given that the ankle/malleolus is held within a ski boot?

    Many thanks

    Ian

    • Dr Arun Pal Singh says

      @Ian,

      There is no specific answer to your questions but I will try to give you an idea.

      After fracture has united and you are off the cast, you would be asked to bear full weight on your limb in graduated manner.

      Your gait would not be normal immediately after the cast as the joint had been immobilized for so long and would need practice and physio to come to previous position.

      This time varies with age and persons. Usually range from 2-4 weeks.

      After your joint is normal, you are free to do anything including downhill ski.

      But it must be borne in the mind that your bone may not be strong enough to sustain minor traumas that may occur with forceful use of the joint.

      Therefore it is prudent to wait for a few weeks more and then graduated practice can be begun.

      Some people face a swollen foot after exertion. This can continue for some more months and usually if not insulted again does go away.

      But this does not occur in all the people.

  69. moe says

    On Dec. 13, 2009 I fell off a 4ft ladder while hanging a xmas wreath(wreath never got hung). From the fall I sustained an open fractue of my right ankle. Upon x-rays they find fracture of medial malleolus and tibia in addition to severe bone loss(about 1") of the fibula. I also have loss of cartilage and tendon & ligament damage. I had a 3 hr surgeon to put me back together again plates, screws and wires. To make matters worse I am a marathon runner!! I am in a cast currently and I am a healthy 44 y/o

    My questions. 1. How long does it take for bone to regrow, there is a plate along the fibula in hopes it will grow in order to avoid bone grafting.

    2. I am just looking for an honest opnion regarding ever running again, all the docs are beating aroung the bush.

    • Dr Arun Pal Singh says

      @moe,

      1.) Fractures usually take between 6-12 weeks to heal. The time frame is different for every individual.

      2.) No body would be able to tell you that right now so it is better not to ask that question.

      When you ask running again, I think you mean running like you use to before.

      No body would be able to tell you that.

      If your fractures heal well and and you get your joint motion back I do not think there should be problem in running.

      So! It is wise to wait for the outcome. Let your fracture unite and see how does your joint behaves.

      All the best.

      Let me know how did it go?

  70. Alexander says

    Hi Dr Singh,

    Thank you for the reply from Jan 19. I became comfortable with my Ossur Air Walker in about 5 days and I have another doctor appointment on Jan 28.

    I have another question for you if you don't mind :

    1) how long do we usually have to wear the Ossur Air Walker ? Mine will be 2 week on Jan 28.

    2) after the Ossur Air Walker, do people usually need Physical Therapy ?

    3) usually, how many more weeks before people can drive ? (mine being on the right foot).

    THanks again Sir :)

    Alex

    • Dr Arun Pal Singh says

      @Alexander,
      1. 3-6 weeks should be sufficient in my view but that is not ask your doctor to be sure in your case.

      2. It would depend how your joint behaves.

      3. same as in 2. You need better control on your foot when you drive. So drive only when you are very sure.

  71. Ian says

    Hello Dr. Singh,

    I posted a comment on January 18 above. I broke my medial malleolus on 19-Dec-09. I was cast on 22-Dec-09. There was no dislocation (movement) of the malleolus and no surgery was deemed necessary. It was monitored by X-ray on a weekly basis. According to the doctors at the fracture clinic, It healed well, the joint position is good and so the cast was removed on 27-Jan-10. As expected, there is still some stiffness and mild pain (enough to slighty impact my gait). The pain and stiffness are reducing gradually.

    However, there is quite a lot of swelling and fluid around the joint and for a few inches up my leg. Is this normal or should I get it checked out?

    Many thanks

    Ian

    • Dr Arun Pal Singh says

      @Ian,

      Yes! That can occur for some time especially if you keep your feet hanging.

      Take frequent breaks and raise your foot intermittently.

      if it persists beyond few weeks or you have some additional symptoms, consult your doctor.

  72. Alexander says

    Hi Dr Singh,

    wow I and Ian have the same injury and on the say day too ! Anyways, I want to thank you for your assistance – its really nice and uplifting to talk to good-hearted doctors like you :)

    I'm on the same boat with Ian – my cast is off ( I was wearing the boots for 3 weeks) and now I'm wearing my regular sneakers but my ankle gets swollen and changes color to red when I put my foot down for over 1 hour. I have not attempted to walk on it yet ( I still am using crutches); I'll wait until next week's Physical Therapy session – I'll let them decide what i need to do next.

  73. Evan says

    I was in a Car accident on 2/25/10. The ER xrays said that I had 'chipped' my ankle bone and was reffered to an ortho. The ortho did more xrays and stress test xrays. He said I had a Medial malleoulus fracture. He then put me in an air cast (kept me on crutches said 6-8 weeks) and sent me for a CAT scan to "see if we need to do surgery." Ive gotten my CAT scan but I cannot get another appointment until 4/1/10. Do you think I will need surgery? Isn't it a problem that I am waiting for so long to see if I need surgery if I infact do? If I have surgery how long does it take until the screws can be removed? Once they are removed how long until I can get off crutches? Thanks so much for your help!

    • Dr Arun Pal Singh says

      @Evan,

      In my practice, I prefer to decide early if patient needs surgery or not. That saves a lot of morbidity for the patient.

      I am not familiar with your medical system but you have to be treated within that.

      I cannot tell you if you need surgery. Only your treating doctor can.

      Screw would be kept for long time in spite of union. Usually it takes about 6-8 weeks for a fracture to unite.

  74. Evan says

    to follow up on my comment. My swelling has greatly gone down and is now only on the inside ankle and a small part of the outside one. There is very little to no pain and nothing looks out of place.

  75. Alexander says

    Hi Dr Singh :)

    Just dropping-in to give you an update :)

    I went for a 1-month of physical therapy, 8 sessions of light stretch exercises and 1 session of strenght training. My doctor wanted me off the crutches even before my first physical therapy session, but my physical therapist didn't want the aggressive approach so I got off the crutches just recently – on my last session (1 week ago).

    I have been walking (slowly) now even though my ankle are still swollen and reddish. The angle (range of motion) are getting better but far from my normal range of motion. That means I'm unable to walk down stairs because I can't bend my injured ankle good enough for my good foot to touch the next step.

    I'm due for doctor's visit / xray tomorrow though.

    Can I get your opinion on the following:

    1) do I need to extend my physical therapy session ? or can I do the exercises myself ?

    2) what types of exercises do you recommend ?

    3) do I still need to ice my ankle at the end of the day /or after exercises ?

    4) how long will the swelling and redness go on ?

    5) should I stop doing stretch exercises and just do the strenght exercises ? or should I still do both ?

    6) for both stretch exercises / strenght exercises, can I overwork it ? or should I still treat it like a baby ?

    7) should I wait until my ankle can do the normal range of motion before I can drive again ?

    Thanks for your assistance :)

    Sincerely,

    ALexander

    • Dr Arun Pal Singh says

      @Alexander,

      1. If you know what you do you can do it at home.
      2. You need to talk to your doctor.
      3. I do not think there is any harm though I do not think there would be any benefit too.
      4. The redness should not be there. You can show it to your doctor to know if something is wrong
      5 Both would help you
      6. Try doing bit more everyday. The idea is to go slightly further than the limit.
      7. Driving with a foot with poor control is out of question

  76. Shweta says

    Hello Dr,

    My name is Shweta.

    I had closed tibia stable spiral fracture due to twisting of my foot.

    The doctors have put me on a long leg cast. It has been eight weeks

    in full leg cast and I have two weeks more for my next visit to the doctor.

    After seven weeks the dr said the fracture looks good but did not mention

    if it was healing.How long does it usually take to heal for this kind of

    fracture and how can I know looking at the x Ray if it is healing ?

    Kindly advice.I am 37 year old.

    Regards and thank you.

    • Dr Arun Pal Singh says

      @Shweta,

      I think what your doctor meant was that union is in progress.

      Please discuss your queries with your treating doctor and he would be able to tell you better.

      To know whether your fracture is uniting or not, you need to train your eyes first to see the stuff and with plaster on it becomes even more complex.

      Either talk to your doctor or if you wish, you can send me an xray so that I am able to visualize.

  77. liam says

    my 10 y.o. son has just cracked his medial malleolus. it is a small non-displaced translucency on x-ray distal to the growth plae which appears unaffected.he was put in a back slab cast to be removed and re-evaluated by an ortopod in 1 week. what is the best case scenario for a speedy recovry time,what can we expect the next step with the orthopod to be?

    • Dr Arun Pal Singh says

      @liam,

      If it is a non displaced and stays non displaced, I think it should be treated by non operative means.

      All the best.

  78. Kenton says

    Hi Dr Singh

    Yes my son part from the protrusion of his medial malleolus, also has pain, we have an X-ray taken and the radiologist who review the x-ray says its just ossification of the tip of the bony prominence of the tibia of the Medial Malleolus. there was also the presence of growth plate at the site. this is part from the normal growth plate at the epiphysis. from observation the medial malleolus is becoming more prominent and that is my worry for my son.

  79. Kenton says

    Yes i have discussed with my orthopedic Surgeon, he said that it is common with kids who are hyperactive, and it is an area of increased ossification, commonly results from Avulsed fracture which happens overtime. my son is 10 yrs and will grow and overtime this protrusion will remodel by the time he is 16 or more.

    • Dr Arun Pal Singh says

      I have not come across this kind of query before and I could not find much on this issue.

      A condition called bursitis has been reported in athletic children but otherwise!

      Keep a watch on it. If it does not increase in size or prominence, it could be a a normal variation.

      You would be better guided by someone who can examine the child too.

  80. vasudeo says

    i have medial malleolous tibia undisplaced closed fracture.

    doctor had done a fibre caste .&was asked maintaine for 6 weeks.

    after removal of plaster there is no proper healing acording to doctor by x ray exam.

    inbetween i walked with one leg with the help of walker.

    now he asked to increase pressure on affected foot slowly day by day 10 kg/day.

    will it be recovered or should i do according to u?

    thanks..

    • Dr Arun Pal Singh says

      @vasudeo,

      If it was undisplaced it would have been healed. An xray would revel if it is united.

  81. Shweta says

    Hello Dr ,

    I had posted following query some 2 weeks back.

    ————————————————————————————————

    I had closed tibia stable spiral fracture due to twisting of my foot.

    The doctors have put me on a long leg cast. It has been eight weeks

    in full leg cast and I have two weeks more for my next visit to the doctor.

    After seven weeks the dr said the fracture looks good but did not mention

    if it was healing.How long does it usually take to heal for this kind of

    fracture and how can I know looking at the x Ray if it is healing ?

    Kindly advice.I am 37 year old.

    ———————————————————————————————————

    I visted the doctor again at 10 weeks of fracture.The doctor removed the full leg cast and checked by pressing at the fracture site.I did not feel any pain at the fracture site, but there was pain when he presses at the ankle bone.So he put me on short leg cast and has advice me to use walking boots on the cast and walk.

    Also, he said the fracture was still seen in the x-ray.I am not sure what is the progress of the healing .

    Also, due to stiffness in long leg cast, I am finding it difficult to move my knee.Do I need to go for a physical theraphy or it will be alright by exercises at home.And what kind of exercise can I do at home for knee movement.

    Regards and Thank you,

    Shweta

    • Dr Arun Pal Singh says

      @Shweta,

      You must have been told exercises. Usually these are range of motion exercises for knee and quadriceps strengthening exercises.

  82. Joe says

    Dr Singh,

    I’ve been reading the various reports of ankle injuries herein with great interest. On March 17th I managed to break (separated the lower portion) my left ankle’s medial malleolus. It was apparently a pretty clean break, according to my doctor and the xrays I was able to see, and due to its nature the orthopaedic surgeon I saw immediately declared that it needed surgery to restore the bone’s full integrity and how it mates with the talus beneath it.

    I had the procedure on March 26th, having two screws inserted through the displaced portion up into the tibia. The surgeon said it was a very good fit and should result in proper union of the bone. I go back on April 6th for a follow up, xrays to check the fit, etc.

    I’m presently in a half-cast thing that goes under my foot, up my left calf, and partially wraps the entire ankle on both sides. It’s held in place by elastic bandages, which allows me to ice it and flex my toes nicely. I still get a little numbness in my foot if I don’t elevate it for a while, which I credit to the wraps being a little snug. I haven’t loosened them myself because I feel I shouldn’t monkey with something they did at the hospital.

    If, in fact, my malleolus heals as nicely as my surgeon seems to indicate it will, can you gve me a ballpark idea of how long I might be off of it. I’m a 61 year old male, and I was a very active golfer until this happened. I’m concerned because a sturdy left leg and foot are pretty important to a proper golf swing. In addition, there’s a lot of twisting of the left foot & ankle at the finish of the swing that I fear may be compromised by the repair of my ankle.

    Also, in a couple of the earlier comments from patients, they asked about having the screws removed from their repaired ankle bones. Is that commonly done? Is it at all necessary, or can the screws remain in place to help the structural integrity of everything down there? Would the screws pose a problem in my later years regarding pain, stiffness, arthritis, etc?

    • Dr Arun Pal Singh says

      @Joe,
      A fracture usually takes 6-12 weeks to heal and after that usually 2-4 weeks of physiotherapy are required.

      That enables the patient with a united fracture to move around without support.

      Fro a sports related activity you would need to train for ankle strengthening exercises and it might take a bit longer. How long would depend on your progress.

      No! The screws do not cause any harm per se. THey can be left as such if the.re is no problem

  83. Shweta says

    Thank you Dr for your reply.

    I have started to walk with shoe on cast with partial weight bearing.My knee is still stiff.The doctor did not recommend any particular exercise for stiff knee.He said as I walk, the knee will loosen up with time.

    If there is no pain does that mean the bone has united, but not completely ?

    Thank you,

    Shweta

  84. Crystal says

    Hello Dr.,

    I had an X-ray done and i have a crack on my medial malleolus. I have a walking cast on for four weeks. Do you think I will need it longer? About how long until I can walk regular? Because right now I cannot put any weight on it. I have been using crutches. I am also on cheer and was wondering will I be able to tumble/flip again (that is how I broke it) or will my ankle be to weak. Is there any way to make it heal faster? And also my toes get numb when I have it evelated for a long time is that normal?

    Thank you.

    • Dr Arun Pal Singh says

      @Crystal,

      Healing does take time. Your fracture would heal within 6-8 weeks, sometimes longer.

      After that you need to train your joints and muscles and things would get better gradually.

      Take a good diet. That is only you can do to heal aat normal pace.

      Till now external measures that could expedite healing have not been discovered.

  85. Kalani says

    hey doc

    i have a small chip at the end of my fibula about 1 eighth inch and its displaced bout quoter inch. i am not in a cast and am wondering how long i should keep off it. i can put all my wight on it with hardly any pain. will the chipped of bone dissolve

    thanks doc

    Kalani

    Aloha

    • Dr Arun Pal Singh says

      @Kalani,
      If the chips is small enough and you are not exeriencing any pain it is better to leave it like that.

      Yes! With time it might

  86. Strike says

    Hi Dr Singh,

    Im quite impressed with your responses. I dont have a broken ankle but a broken wrist *unshifted*. I hope you could answer some of my doubts.

    I had a cast for 6 weeks but the doctor said that the bones are still not united. Im asian and living in Austria, could it be that for asian it takes longer to unite. The Doctor said that normally it takes four weeks before a broken wrist gets united again. Im on my second month now but mine has not reunited yet. I now have sort of a gloves to protect the wrist but is it ok that my healing process takes so long?

    Thanks for any advice.

    Best Regards,

    Strike

    • Dr Arun Pal Singh says

      @Strike,

      Yes! Your question is at wrong place but I would answer it anyway.

      I am not aware of any study that says Asian unite slowly.

      Sometimes, people do hel slowly for no apparent reason.

      Take another xrays after 8 weeks and most likely it would unite.

  87. Joe says

    Dr. Singh,

    Thanks for your kind reply earlier to my questions regarding how long I might expect to recover and whether the screws in my medial malleolus would present a problem if left in place. I have one other concern regarding the swelling in my foot & ankle that persists still.

    I have had my lower leg hard cast replaced by a walker boot that I can remove and typically don't use when I am just sitting in my home or sleeping. In fact, I rarely use it at all since my ortho surgeon has thus far prohibited me from placing any weight on my left leg other than to provide balance if I should stand for any reason. I still occasionally ice my ankle/foot, and take low doses of ibuprofen to combat the swelling but I see no noticeable progress in reducing it.

    Is persistent swelling typical, or should I contact my orthopedic clinic and have this looked into? I have a regularly scheduled follow-up appointment with them on April 27th, another 9 days from today, and will wait until that if you think I am not experiencing anything unusual. But I believe the swelling should have abated by now. But then again, I've never broken an ankle before, so I have nothing to compare this to.

    • Dr Arun Pal Singh says

      @Joe,

      There is a severe delay in my reply and I am sorry. I hope your visit went fine and your queries have been answered.

  88. reid says

    i fractured my medial malleolus in a lax game and am have pins put in it tomorrow i would like like to know what the time will be untill i can walk again.

  89. Donna says

    I have a question. I am a 44 year old female. On March 6th (7 weeks ago this Saturday), I was thrown from a horse and fractured the spinous processes on my T3, T5, T6, T7, T8, and T9 vertebrae. Not sure how my T4 managed to stay intact, but it did!

    Follow up xrays on the 24th of March showed that I am apparently healing without any problems.

    I am moving much better and am slowly returning to my normal life. However, I still experience considerable pain (particularly after being on my feet or walking a lot) and do not feel comfortable driving yet.

    Is this fairly normal for this sort of injury? On average, how long does it take for full recovery? Specifically to be without pain.

    Thank you. And by the way….I have decided to "retire" from riding horses.

  90. Alexander says

    Hi Dr Singh,

    Just dropping by to say hi and thanks for your kind assistance :)

    Anyways as of my last session of physical therapy (March 19), I've been walking and driving since then with no problem or pain.

    The redness has diminished (but not completely), but the swelling hasn't gone away …is it true it will take up to a year before the swelling to completely go away ?

    I have been walking a lot more (2 hours or more at the park) but I tend to get lazy so I haven't been doing the stretch exercises. Does walking for 2 hours good enough ? or should I still do the stretch exercises ?

    And from my hours of walking the past month, I noticed that purple-colored tiny veins are showing on my ankle area, in addition to the visible green colored veins – are these normal ? The flexibility range-of-motion (toe pointing toward me and against me) isnt like the other yet (does this take up to a year to become normal again ?)

    And my last question : how long more do you think I should wait until I can do stuffs like surfing, etc ?

    Thanks again :)

  91. sumana says

    I have a question. My husband recently suffered a tibial bone fracture and had to be corrected surgically.On the same leg he had an ACL reconstruction 6 years back.Anyhow post surgery he still complains of numbness in the foot even after 36 hours. I would like to know why?

    • Dr Arun Pal Singh says

      @sumana,

      I hope I do not have enough information from your side to answer that.

      It would be better if you ask this the treating doctor.

  92. Miller says

    I fractured my medial malleolus in my left ankle(non-displaced/clean). This happened 3 weeks ago from a fall. My doctor has been monitoring with X-rays and the week 3 X-ray showed there is a clear callus forming, to the point where the fracture is hardly visible. I have read in a number of places that early weight bearing is the key to no physio and I have to this point been putting at maximum 50lbs. on my left leg. My doctor says that this will cause the bone not to heal but based on the latest x-ray and the fact that I have been weight bearing to some degree the whole time I disagree. I plan to be full weight bearing at 4.5-5 weeks and my cast doesn't come off until the 6th week. My question is, What is the timeframe for a the spongy soft callus to become a hard callus. I believe it is 4-6 weeks, but I'm not sure. I am a police officer and want to return to full duty sooner then later. I think the Doc has alterior motives with the physio, if I could walk his buddy wouldn't get his money after the bone healed. Maybe I am way off base. Thank you for your consideration.

    • Dr Arun Pal Singh says

      @Miller,

      You are right about timing of the callus but you are wrong in not following your doctor's advice. You might have some beliefs but they contradict with laws of science.

      When a joint is injured as in your case, it is in the best interest to keep the limb of the ground so that joint can heal properly.

  93. marie says

    I broke my rightmeidal mal…It happened may 28 2010…its now aug 8th 2010…

    i started therapy 1 month ago i get so much pain at the mis day..i cant waer my shoes with out my ankle swelling over my shoes…I had 2 screws put in…

    i tell my theripst whats happening i feel like im being ignored

  94. geoffrey says

    Dr. Singh.

    I injured my ankle and medial maleoulus fibula 11-17-04. My ankle swelled and I iced and rested it. However I could stand and still walk. So I never went to a Doctor. My ankle is now completely useless and I have trouble standing and walking. What should I do?

    • Dr Arun Pal Singh says

      @geoffrey,

      You should see a doctor who can examine and diagnose your problem. Then you can be offered the treartment based on your diagnosis.
      I hope that helps.

  95. Mike says

    Hi, it's been 24 days since I broke my ankle and fractured the fibula about half way up my leg. I'm still in a fiberglass splint and was to have surgery 3 days ago, day 21. They aborted surgery because of a potential heart condition that was caught in the surgery prep. I don't have any pain right now, it subsided about 7 days ago, I have reduced my pain meds, I keep it elevated for about 16 hours per day, swelling is now greatly reduced. I have not or will not put any weight on it. My diet is very good

    My question- given the CAT data below, is surgery mandatory for me? Will I be able to function at some point without surgery? I feel neglected, should things take this long?

    Thank you

    TECHNIQUE: Spiral CT imaging was obtained in contiguous 3 mm segments through the ankle

    and proximal foot. These images were reviewed on standard axial imaging on soft tissue and

    bone settings as well as three dimensional surface rendered imaging and parasagittal and coronal

    reconstructed studies.

    FINDINGS: The patient shows presence of a comminuted distal tibial fracture. There is both a

    fracture through the medial malleolar area which is comminuted but non-displaced with fracture

    margins at less than a millimeter of separation. The fracture also extends posteriorly involving

    the posterior component of the tibia including approximately 5% of the articular surface. Again

    the widest gapping of the fracture occurs at the level of the posterior tibial articulation and this is

    measured at 2 mm. The remainder of the fracture margin shows good apposition of less than a

    millimeter distraction. There is relative gapping of the distal tibia and fibula with slight lateral

    subluxation of the talus suggested. This is estimated at approximately 1-2 mm and most likely is

    associated with some ligamentous injury of the medial collateral area of the ankle joint. On the

    axial images, there is a small curvilinear 2 x 0.5 mm calcification interposed between the distal

    fibula and the distal tibia along its anterior margin. This most likely reflects a small cortical

    avulsion injury associated with ligamentous trauma. Evaluation of the tarsal bones shows a small

    sclerotic bone island within the calcaneus. The talus is intact including both the anterior and

    posterior subtalar joints. No fractures of the navicular or visualized portions of the cuneiforms

    are noted. There is soft tissue swelling of the joint commensurate with fracture injury.

    IMPRESSION:

    1. Comminuted distal tibial fracture including the medial and posterior components of the tibia.

    Overall alignment and apposition of the fracture margins is fairly well-maintained as discussed

    above.

    2. Findings also suggest slight lateral talar subluxation of a few millimeters, most likely

    consistent with some disruption of the medial collateral ligaments of the ankle. Given these

    findings I would be considerate

    • Dr Arun Pal Singh says

      @Mike,
      There is nothing as mandatory. Choice of treatment is greatly affected by patient's condition and his demands.

      From your findings, it seems that you have a fracture which is comminuted but not displaced much.

      So non operative treatment should also provide satisfactory results.

      All the best and let me know how did it go.

  96. says

    I fractured my lateral malleolus in my right ankle, i was in the cast for 2 weeks after removing the cast i walked for 2 days again swelling and pain started. Doctor put me another cast for 6 weeks yesterday there removed that but little swelling is there and also some offen i will get pain on injured area…is it common or else do u have any advise….

  97. Saj says

    Hi Dr,

    I had a rhinoplasty about 9 months ago, the hump on my nose was filled down and then my nose was broken to reset the bones. I could feel a little gap where my nose was fractured from, will bone regrow and close this gap?

    Regards,

    Saj

    • Dr Arun Pal Singh says

      @Saj,

      I cannot advise you on this issue as ENT specialist is the right person to talk to. Discuss it with your doctor please.

  98. Lisa says

    Dr. Singh,

    I found out from my podiatrist today that I have a bone chip at the end of my medial malleolus. It's been there since I have ankle joint replacement revision surgery almost a year ago. (doctor removed bone growth in the ankle and replaced the poly liner). My podiatrist wants me to wear a CAM walker with orthotic for 6 weeks to allow the bone to heal. What other things can I do to heal the bone faster and help with the pain and inflammation? Thanks in advance!

    • Dr Arun Pal Singh says

      @Lisa,
      Anti-inflammatory medication would take care of pain and inflammation.

      Take good diet and follow the advice of your doctor. Bone healing takes time and as such there is no method to expedite the process.
      You can only ensure that you provide the optimal environment by following whatever your doctor advised.

  99. Chantal says

    I fractured my right ankle at the end of April (not sure of the medical term however it is the inside bone) I did this simply by walking and my ankle gave out. I was told there could have been a previous fracture as well. The diagnosis was a fracture and torn ligaments. Was put in a walking cast for 3 weeks and told there were no limitations with the cast. Upon return to the hospital the specialist who had first seen me was unavailable. The new specialist said there was no way that it could be healed x rayed and said another 3 weeks. Cast was removed precribed a brace and I went to physio told only to come back if I got bad pain. I returned to the specialist because I still have pain. The are requesting an MRI. My questions is that I do not only have pain on the bone but under it and along the inside of my foot there is even a little bone on the inside of the foot that hurts. Any ideas? I'm uncertain that the doctor made the right diagnosis the first time. A little insight would be appreciated.

    Thank-You

    • Dr Arun Pal Singh says

      @Chantal,

      I am sorry but I cannot comment on your problem with the information you have provided.

      Can I have look at the xrays! What does MRI say?

  100. Chantal says

    I got the MRI results and they say that the fracture has not healed and a ligament on the opposite side of the ankle is completly torn My doctor says I need to have a screw put in but that the ligament will heal on it's own. Is that true?

  101. Cheryl Bourgeois says

    I sprained my ankle on October 9, 2010 and it was getting better. I sprained it on the outside, but now the inside of my ankle hurts. I have been walking on it very gingerly and had been feeling better. I walked on the treadmill for 30 minutes at 1.5 on October 23, 2010 and now my ankle has sharp pains on the inside. Have I further injured myself?

  102. Nick Romac says

    My 16 yr old son refractured his medial malleolus. First time summer 2009(twisting his foot on a basketball court), wore a cast for 6 wks, seemed to heal without problems. August 2010, playing soccer, slid into another player, broke again. His orthopedic surgeon placed 3 screws this time. It is now 4 months since surgery, very little discomfort, going to physical therapy, but has not been released for sports yet. He has had monthly x-rays which appear to show healing according to my radiologist friend and is the consulting m.d. But he has also had 2 C.T. scans which do not appear to show complete healing. The orthopod told us he would check again after the first of the year, but now told us he won't see our son for another 2 months, because he doesn't want to keep radiating him with the C.T. scans. Questions, shouldn't this be healed by now with fixtures in place? Could there be another reason for imcomplete union? Should we have a blood test? Lastly, how dangerous is a C.T. of the ankle? Is a monthly C.T. too much radiation? My son if flipping out with this situation and wants us to take him to another doctor. We don't know if we should get a second opinion. Thanks for your help.

    • Dr Arun Pal Singh says

      @Nick Romac,

      The dictum is – if you are in doubt or are not satisfied, get a second opinion.

      It entirely does depend on you and your situation.

      I am not sure why CT is being done if xray is showing union. Most likely it is not.

      CT per se is not dangerous and I do not think that repeated CTs for short duration are cause of any concern.

      But it is generally not done to find union.

  103. selvan says

    My ankle was fractured and a screw was fixed in the molecule bone , now its one year completed, whenever I happen to walk on cold weather there is a slit pain, and when roll my hands on the ankle molecule I can feel the nervous and it is tickling. Is it good to removed the screw now ?. And now I am in USA, will it be expensive here to remove the screw.

    • Dr Arun Pal Singh says

      @selvan,

      If the fracture has united and screw is giving trouble, it should be removed after passage of sufficient time.

      You would need to find out the cost yourself though.

      I hope that helps.

  104. Carly Munro says

    I had a trimalleaolar ankle fracture on 2 August 2010, which required open reduction internal fixation.

    I went to see my consultant on 10th January and have been told that the posterior malleolus fracture is not fully united and the lateral malleolus fracture shows there is still a fracture line seen proximally. The medial malleolus fracture is the only one fully united.

    Is this normal to not be fully united 5 months on? It is now 6 months and still experiencing a lot of pain. When walking it gives way and very painful, also clicks. If it doesnt unite itself will it require surgery again or be left?

    Thank you.

    • Dr Arun Pal Singh says

      @Carly Munro,

      No! It is not normal. The further treatment would depend on fracture types and status of union.

      Did you talk to your doctor about it?

  105. says

    Some couple of weeks ago, I developed sudden pain in my medial side of the lower end of tibia (malleolus).I cant recollect injuring myself.When walking, I get pain over the lower end of tibia but hardly if any in the ankle joint. I had AP and lateral views xrays, I am on valsartan 80mgs.odfor my blood pressure control.It as you know have effect on renal funcitons, pp creatinine, urea and not sure about uric acid. Creatinine is 2.21mg/dl, urea 49.3 mg/dl and uric acid of 7.7 mg/dl. Xray is reported normal.In view of these findings, Gout is possibility and started on Colchicine. It is the localized tenderness over the mid portion of the malleolus.. I propose to have MRI scan. In the mean time, I take analgesics (paracetamol, diclophenec, ibuprofen jel for local application. I shall appreciate your advice.I am a retired GP and 73 yrs.

    old.

    • Dr Arun Pal Singh says

      @Dr.Harendra Vyas,

      Yes! MRI is the next investigation but you should first consider consulting an orthopedecian in person.

      All the Best.

  106. Amit Bhomle says

    Hi,

    I have fractured my right leg near the ankle area in an accident from bike. On inspection doctor detected right medial malleolus fracture which then fixed with malleolar screws. After surgery doctor advised me to take the bed rest and not put any weight on that leg for 6 weeks. So please let me know what time it will take to cure it and whether it will cause any pain in future.

    Also please let me know the adequate diet for it.

    Thanks in Advance!!!!!!

    • Dr Arun Pal Singh says

      @Amit Bhomle,

      Please follow your doctor's advice. He would be in better position to guide you.

  107. Vikas Gupta says

    i had fracture left medial malleolus on left leg.I had the surgery on 9th may 2011.and operative procedure was ORIF with 2K-wires(TBW).I have continous pain from that day,but it is tolerable and i have no fever from surgery day.I want to know in how many days i can be all right like before completely and in how many days i can walk by taking pressure on my left heel.what is problem in this type of fracture?Please also tell me that Can i move my toe or not now?

    Please help as I found u very good in replying.

    • Dr Arun Pal Singh says

      @Vikas Gupta,

      You can move your toes, those are not going to affect your fracture.

      Your doctor would be a better guide for instructions on bearing weight.

      It generally takes 6-8 weeks for fracture to unite and it is folloeed by few weeks of physiotherapy to regain full function.

  108. Dr. Amit says

    Dr. Singh, my father had a medial malleolus fracture and it has been repaired by screw fixation.

    However the lateral X-ray is showing screw protruding out of the posterior cortex. i can see atleast 3-4 threads.

    1. Is that right or the surgeon has used a longer than required screw size. The surgeon is saying it is alright.

    2. Will it require a re-surgery.

    3. Will there be any complications if left.

    Kind regards

  109. says

    Dr. Singh

    I recently fractured my medial malleous in the region closest tibia,where it curves down. The Doctor placed screws in there. I wondering what affects this will have on my ability to stand up for long hours, as i work on my feet alot. Will bicycling be an effect motion enhancer and rehab? Also… They induced me with nerve blocks to manage the post procedure pain…12hrs later, no feeling has been restored to my leg below the knee level, my toes are numb-tingling, and the temperature of my -numb-tingling toes- is considerably much more warm.

    What is going on?:)

    CG

  110. Rajkumar says

    Dr. Singh

    I fractured my tibia during an accident in march 2011 hospitalized for 2 days and the doctor has put 2 malleolar screws 4.5 cm each. Upon seeing the x-ray after 3 months now, he has told its healing perfect and has told me that he will remove the screws after a year.

    My question is, should the screws be removed ? what will happen if they remain there itself ? I am very much averse to getting hospitalized for another 2 days.

    Please advice

  111. Siddharth singhal says

    I have got fracture in my Medial Malleolus .

    doctors have done srugey of 2 screws. the scerws are in slant position .

    i have consulted to another doctor he has created a cofusion in my mind that scerw are never in slant position .i should have another surgey.

    pls guide me to a point .

  112. bhupesh kr. sharma says

    While playing football, I injuired my left knee and after diganosis by the doctor and as per X-ray report it was found that a "Chip fracture seen at lateral condyle of upper end of the left tibia" , joint space though looks normal.

    Now what kind of fracture is this????

    And what is the right treatment for the same for speedy recovery and can I play football again or not???

  113. says

    my name is fatai, i had an accident, a proved frm d x-ray showed a slant fractured. With a traditional healing d man said is going to be o.kay. What can i do

  114. Rajkumar says

    I had malleolar screw fixation in my left tibia last year and the doctor had told me that the screws should be removed after a year. But now I am feeling very comfortable and very confident with that leg while walking and it never occurs to my mind that there are screws in my leg. Should I still get them removed ? Can't i just continue with the screws inside ? Further if the screws are removed won't it not lessen the strength of my ankle

    Please advice.

  115. Rajkumar says

    Sorry Doctor.. I had asked the same question to you last year.

    I forgot and asked you the same now.

    thanks for your patience

  116. Essa says

    I had Medial Malleolus fracture and operated with screws and plate. It passed almost a year and I have pain when I was walking. I can see my Tibia bone is outward (not much) and fuss limited to go upwards.

    I also feel pain (upper part of Tibia,) I feel also my became (after the operation) flat foot.

    Almost 70% of action can do (rotation, flex ion and extension) compare with other leg.

    In x – Ray – bone healed

    please advice what course the pain.

    • Dr Arun Pal Singh says

      @Essa,

      Cannot be said on this interface. Please seek an opinion from your treating doctor.

  117. Raj says

    I had Fracture on Medial Malleolus. Now its 3 years since it was operated and I still have the screw inside. Yes, some times the nerves running over the screw, gives pains but not always. Can I get the screw removed now ?

    Do I have to undergo some medical tests.

  118. selvan says

    My ankle was fractured and a screw was fixed in the molecule bone , now its three year completed, sometime I can feel a pain on the nervous which is near the screw head. Is it good to removed the screw now ?.

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