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Painful skin after broken ankle + surgery.

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Hi there,

My boyfriend dislocated and broke his ankle playing baseball two weeks ago. I believe it was a bimalleolar fracture (ie: the ends of both leg bones were broken). He had surgery the day after the injury to repair the damage with plates / screws, etc. We didn't get to speak with the surgeon afterwards, so we're not sure exactly what they did.

He is now in a fiberglass cast up to his knee. At first, we had a lot of problems with it swelling (even though he was keeping the leg elevated). The cast was really tight and his toes and upper leg were practically bulging out. We went back to the hospital and they recommended ice and Advil to decrease the swelling. The next morning, the swelling had decreased significantly. It still swells up a bit if he gets up and moves around for a while, but nothing like it was.

Now that the swelling and the pain from the actual ankle is under control, he has a new symptom: the skin on the top of his foot / toes is painful and very sensitive. He says it feels like it is burnt / stinging and even the lightest touch hurts. It's not excruciating, but very annoying and uncomfortable.

I looked closely at it and the skin seems slightly red and hot, but otherwise normal (ie: not raw or broken). He has also developed some bruising around the big toe, but I assume this is from the injury.

I check his temperature regularly, and he is not running a fever, so I don't think this is from an infection. He still keeps the leg elevated as much as possible and ices it regularly. We have also been applying Cortisone cream a few times a day, but it doesn't seem to have helped much.

Is this a normal part of the healing process? Any thoughts on what could be causing this?
Thanks in advance!
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replied July 13th, 2011
Especially eHealthy

The bruising around the great toe is normal. Bone is very vascular and bleeds a lot when injured. Bruising will follow gravity, so because he has had his foot down in a dependent position, the blood will flow in that direction.

There is a lot of edema and blood in the soft tissues around the ankle and foot right now. The area will appear very inflamed, red and warm, for quite awhile.

He should still keep the ankle up, above the heart, not just on the couch in front of him. Elevated means, he is on his back, with the foot way up on the back of the couch. It really is hard to elevate a foot above heart level. But, by doing so, the edema and blood in the soft tissues will be resorbed back into the body.

I know, I know, it's hard to keep the foot up that much. But, whenever possible, get it up!!

However, if the elevation doesn't take care of the irritation or it gets worse, contact the orthopedic surgeon. Pain under a cast has to be taken seriously. There are many horror stories of patients being blown off, and ending up with a hugh sore under the cast. So, if it doesn't get better, contact the surgeon.

Good luck.
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