Severe pain after surgery for Trimalleolar fractures

Bones, joints and muscles
1

Hi everyone,

I am a 59 year male. I broke my ankle severely whilst playing tennis with my wife. My foot was a complete 180 degrees round the wrong way and kind of lying on its side. Instinctively I immediately grab it and pulled it back to the 12 o’clock position and held it there was sitting on the hard court telling my wife to call 999. Surprisingly I was not in much initially. Whenever I let go of my foot it would just flop back down. It was clear to me that I had completely broken my foot off my leg. Waited 1 hour and 15 minutes before ambulance arrived. When I got to A&E they took an X-Ray and it was confirmed as a Trimalleolar fracture but they would need to put my foot back into alignment without anaesthetic !!! The pain by now was pretty high so they gave me fentynal to do the procedure. I came around and was aware that my foot was already in a cast and I was transferred to a ward to await surgery. I had wait 11 days for surgery, just waiting in the ward with a badly broken ankle. After the surgery (5 and half hours) I woke up in recovery, literally screaming with pain. Yes the incisions on both sides of ankles were painful but no where near as the pain in my foot. The only way I can describe this is that it is as if someone has tied a piece of cord around my foot, just below the toes and is pulling it as hard as they can. It’s an incredibly sharp, tight, burning pain. The top of my foot and toes is completely numb and the skin is hyper sensitive and feels burnt. Coupled with this I also am dealing with the sensation that someone pulling cheese wire hard down through my toes. My foot is swollen like a balloon. Two and a half weeks post surgery I am still writhing in agony. The pain team prescribed me with Pregabalin and oxycodone for the pain but it does not help in anyway and I am due to run out of these very soon. The pain is all consuming and relentless. I think that the surgery either damaged a nerve, irritated a nerve or cut through a nerve due to the numbness and tight sensation and also the skin sensitivity. Has anyone else here experienced this pain ? Am I the only one that has had this post surgery ? I woke up after the operation in a cast but they cut it open all the way from top to bottom due to the swelling. I was discharged 3 days after the operation and then 2 weeks later I had an appointment with the orthopaedic team. Doctor took an X-Ray and said everything looks fine and put me in a Airwalker Boot. He said I should be on 600mg of Pregabalin as he thinks I have sensory nerve damage. Then pain team overuled him and put me on 300mg. I feel like I am fighting a tiger with a tissue, the meds they are giving me to fight this pain are ridiculously low dosed and are a waste of time. So here I am, my next appointment is month away and I am losing the battle against this pain. It’s so intense I just wish they would amputate my foot, I am still literally crying out in agony. It has been constant since I woke up from the operation 2 and a half weeks ago. I feel that I have been abandoned and left with little to no support to fight this pain moreover nobody seems to know for sure what is causing this pain. I am extremely worried that if it is not diagnosed early then it maybe that I have to live with this forever as it was diagnosed too late. There is no way on this earth that I can live with this. The tightness and burning sensation is too much to bear. If you have been in a similar situation post surgery please let me know, did the pain finally go away, are you back to normality ? I really am at my wits end and cannot cope with this pain for much longer.

2

I turned 54 a week after breaking my ankle in the same way except my dislocation was 90 degrees to the left on my left ankle. I waited a week for an external fixator, and 2 more weeks for the internal hardware. You are describing my pain to a T. My second surgery was on Friday, 10/3. How long did it take for your pain to normalize? I wish they had taken off my foot too. The surgeon told me my nerves were very stretched but had not snapped. In the US, docs will prescribe pain meds, just not strong enough, apparently. I’m taking 300mg gabapentin every 8 hours, 5 mg of oxycontin every 4 hours. I am also a chronic pain patient, so I do have a long acting oxycodone. I have Ehlers-Danlos and Mixed Connective Tissue Disease which is an overlap of Lupus, Rheumatoid arthritis, scleroderma, polymyositis. I cannot sleep because the pain is unrelenting. How is your ankle feeling now?

3

Hi K_B

Gosh, it sounds like you are dealing with a lot and wish you a speedy recovery.

Since writing on this forum i have been diagnosed with CRPS - Complex Regional Pain Syndrome that was either caused by the trauma of the injury, surgery, where they have damaged a nerve during the procedure, or both. Either way this is what accounts for my disproportionate pain.

The surgery incisions re still healing (scabs etc) almost 3 months post surgery. The pain from the surgery is thankfully reducing but as soon as i get up from my bed after elevating my foot all night, i am in a race against time as my left and ankle foot will begin to swell almost immediately. If i sit at my computer in a normal seated position for a few hours then my left foot will be like a balloon. So my main issue at the moment is controlling the swelling and the flare ups from the CRPS.

This is why i felt incredible tightness and burning sensation on the skin on top of my foot. This is the symptoms of CRPS. Unfortunately, it is not a very well understood condition in the medical world. It is treated with a multi disciplinary approach. Physio, Pain Management and Psychology.

I am still on 300mg of Pregabalin a day and 10ml of Morphine when required.

I have found that putting socks and slippers on the foot has helped with my pain, i think its the constant pressure around the foot helps to distract your brain from the injury. Apparently this has a lot to do with CRPS, so i am trying all sorts of different techniques including Mirror Therapy.

I have also began to walk / hobble around our house without crutches and i am sure this helping reduce my pain too as it reminds the ankle what it should be doing and also helps the damaged nerves regenerate.

It’s a long road recovery, my surgeon has told me that i will be looking at a year minimum before things are back to any kind of normality.

I need to reduce this time frame by half as i need to get back to work and start earning money as soon as possible as my company sick pay has run out so i receiving zero salary at the moment. So i am pushing hard and fighting my way through the pain to try and get up and running asap.

Its not easy and when the injury happened i did not think in a million years that all this lay ahead of me. I truly believed they would patch up my ankle and i would be back to normal within a couple of months. I have broken bones before but that was maybe 30 years ago so i guess you heal much quicker when you are younger. This is my problem. I still think i am 25 in my head and can run around like i did back then. Playing tennis at nearly 60 years old probably was not the best thing to do. Time to face reality that i am not a spring chicken anymore and this injury has most definitely shown me this.

To conclude, the pain from the surgery has reduced significantly but it took a long time, almost 3 months before i came out the other side. The pain from the CRPS is severe when it flares up and that is random at the moment. I may go 3 days pain free then suddenly boom, its back and i need to hit the morphine and lay down and deal with it until its done. Good days bad days is my routine at the moment but slowly, things are starting to improve.

I truly hope you begin to feel better soon, its going to take time as this type of injury is bigger than we think. But you will get there. I agree the pain relief the hospital and doctors provide is pretty much ineffective to the type of pain we have been experiencing. In truth i doubt there is much available to deal with pain at these levels.

Time is the greatest healer and our bodies are amazing at repairing themselves, they just need the time.

I wish you well my friend and hope you can come through the other side of this soon.

4

Wow, that’s a lot to deal with. I hope you are able to get back to work soon, and have relief from your pain. I have a friend suffering from a recent CRPS diagnosis and it is debilitating. I do not know the prognosis of CRPS. Is it something that can be resolved, or reduced over time?

My husband had a tibial plateau fracture at age 50 while kicking in a martial arts class. He was immobilized for a few months. He was active duty military at the time, so time off was not an issue for him. He never made it back to 100% in that leg, but at least he has accepted that certain activities may not be optimal after a certain age.

I woke today with a bit of a fever and chills. My surgeon called in an antibiotic, and I slept off and on all day. I am feeling a bit better and my pain seems a little better as long as I stay on top of my medication schedule. I found an app to remind me of everything. I have also noticed that my pain increases when I keep my leg elevated for too long. I have to alternate between what the doctor recommends and a more neutral position. My thigh also hurts a lot from the tourniquet.

I too had broken bones when I was younger, and had two knee surgeries for a femur fracture in my early 20’s, yet recovery seemed almost instantaneous. Those days are over, apparently.

Did I mention that my injury was far less impressive than your tennis injury? I was standing in my hummingbird garden. My right ankle began to turn over and my left decided it was not going to be outdone this time around.

My name is Kelly. Thanks for your help and willingness to respond so quickly to my questions.

5

Hi 1Gazindo,

deine Geschichte hat mich echt mitgenommen. Eine bekannte von mir hatte sowas ähnliches. Nur dass der Unfall gar nicht so dramatisch schien am Anfang. Sie ist beim treppen steigen umgeknickt und dann nahm das Drama seinen Lauf. Die Schmerzen wurden immer stärker, ein durchgehendes Brennen im Fuß, jede Berührung schmerzte, der Fuß schwoll an und änderte sogar seine Farbe. Sie ist zu vielen Ärzten gerannt bis schlussendlich ein Arzt Morbus Sudeck oder CRPS diagnostizierte. Hört sich an wie bei dir. Vll ist es ja sowas?

6

Oh sorry sehe grade dass bereits geantwortet wurde. Ich bin neu hier :slight_smile: Welche Behandlungen wurden bei euch durchgeführt?

7

Hi Kelly,

A hummingbird garden sounds fabulous !! What a terrible thing to happen to you in such a tranquil setting. You would not think such a severe injury could happen whilst strolling around a garden.

My surgeon was shocked when I told him that it was caused whilst playing tennis. He said the severity of the injury is more associated with road traffic accidents.

Like you, I find elevating my leg/foot for too long seems to make the pain worse. I now sleep in my usual position, flat on my back with both legs flat.

It’s amazing, I wake each day and my left foot is back to normal size, swelling gone and I can touch it without any nerve pain. However, as soon as I rise the swelling starts and the nerve pain slowly creeps back in. I try many different exercises throughout the day to try and regain as much mobility as possible but by lunchtime my foot and leg are extremely swollen and painful so it’s back to lying in bed with my leg raised on 3 pillows.

This pretty much has been my routine for the past 2 months. It’s really slow progress but at least I am inching forward bit by bit each week.

CRPS is a difficult one. Some people recover, or go I to remittance. Others have suffered it for over 25 years. Generally speaking, the medical industry dont really understand it. They believe the trauma to the ankle, whether that be from the injury, the surgery or both makes the brain go overboard, sending pain signals along the nerves from the base of the spine, down the leg to the trauma site. They believe the brain needs to be re-trained, or given some kind of reassurance that everything is okay.

Easier said than done, but I do believe this theory has some merit. If I hold my foot between my hands, one on top of my foot and the other on the underside, it’s strange but all the nerve pain disipates immediately. My foot feels secure, almost envelopes it with good vibes. It is bizarre and when I remove both hands the nerve pain returns. I’m not very flexible anymore so holding my foot in this position is not possible for long periods.

I am hoping that the majority of my nerve pain is being caused by the swelling, compressing the nerves.

As I said, when I wake each day my left foot looks and feels almost normal apart from the two large incisions either side of my ankle.

I believe the metalwork is also causing me a lot of discomfort. I have a long metal plate on the outer side. Maybe 4 to 5 inches long and held in place by 12 screws. On the inside I have 2 long screws and 1 short one then to the rear they have fixed a smaller plate with 4 screws. When I lay my foot on the pillows I find it almost impossible to get a comfy position without feeling the uncomfortable feeling of metalwork digging in.

How long ago did you sustain your injury ? Have you found any ways of relieving your pain, other than medication ?

I am now 3 months into this, I broke my ankle on 8th July 2025 and the various levels of pain I have experienced are immeasurable. Honestly, I have never experienced pain like this in my life.

But as I said before, day by day, week by week, month by month, slowly I am starting to experience some improvements. Minimal, but improvements all the same. I truly hope your recovery journey takes the same path, and i am sure it will.

This type of injury, especially for us over 50’s is a long, slow road. Even for those who are younger, the recovery time for a Trimalleolar fracture is several months. According to my Consultant Physiotherapist, it is not uncommon to suffer swelling for well over 6 months.

So it looks like we really have no choice but to suffer the consequences of our injuries, quite literally.

My name is Gary and it is a pleasure to meet you, even in our unfortunate circumstances.

Remain positive, find a way through the pain and keep moving forward. We cannot change what has happened but we can make a difference going forward.

Wishing you a speedy, pain free recovery.

Best wishes.

Gary.

8

Hi Zindaag,

Thanks for your message.

Please read my latest response to another member on here. I cover pretty much most of your questions regarding CRPS.

It can be permanent for some, others go into remittance only for it to return and a small percentage recover completely, over time.

It is by far the most intense, relentless, inescapable pain i have ever experienced. Tight, burning sensation with hyper sensitive skin in the affected area. Just a tissue being wiped across my foot would make me scream out in pain.

The medical industry does not fully understand this phenomenon so they take a multi discipline approach, physio, pain management and psychology.

I sincerely hope your colleague does not suffer this affliction for long as it truly is the most debilitating of conditions to experience.

Best wishes.

Gary.