BIMALLEOLAR AND TRIMALLEOLAR FRACTURES
Tid Bits of Info
- The most common group to suffer these injuries are women over the age of 60.
- Surgery is needed to “set” the bones after a bi or trimalleolar fracture occurs.
- A period of non-weight bearing that lasts 2-4 months will be required to allow the bones to heal properly.
- Bearing weight too early on the involved leg can lead to a premature onset of arthritis in the ankle/foot complex.
- Seek the advice of a Physical Therapist for the proper rehabilitation treatment program.
Fracturing any bone can be painful and take time for recovery, but fracturing an ankle is particularly challenging. While high impact sports accidents can cause ankle fractures, so can simple falls. The type and severity of fracture will determine both treatment and length of recovery. A bi or trimalleolar fracture is extremely severe and will incapacitate a person for an extended period of time. A formal physical therapy program over long period of time is vital to recovery.
The Difference Between Bimalleolar and Trimalleolar Fractures
On the distal end of the Tibia and Fibula a “lump” of bone develops into a malleolus or malleoli (singular). These bony projections are used by tendons to create a pulley effect, enabling them to generate the greater force required to move and control the ankle/foot complex. This is an area that acts as an anchoring location for the ligaments that are the static stabilizing structures of the ankle/foot complex. There are two very noticeable malleoli and a third that is not recognizable without the use of an x-ray. The Tibia has the medial and posterior malleoli and the fibula has the lateral malleoli. If two of these are involved in a fractured ankle, then it is labeled a bimalleolar fracture and if all three are involved then the diagnosis becomes a trimalleolar fracture.
Treating Bimalleolar and Trimalleolar Fractures
The treatment for a bi or trimalleolar fracture begins immediately. The ankle should be stabilized, and the person should be transported to the emergency room. Surgery is required to “fix” these fracture sites. It involves re-positioning the bones to their normal anatomical alignment and holding them in place with screws and plates. Following surgery the patient will be completely non-weight bearing for a period of 2-3 months. The repaired ankle will be incapable of bearing any weight for a long period of time and doing so could shift the placement of the repaired bones. Any misalignment of the bones could predispose the patient to an early onset of osteoarthritis in the joints of the ankle/foot complex.
Bimalleolar and Trimalleolar Fractures can be accompanied by significant swelling throughout the ankle/foot complex. This swelling can be serious, and may even cause blisters (called fracture blisters) to form on the skin. Surgery is frequently delayed days or weeks if there is too much swelling. Severe swelling makes the surgery more difficult to perform. It can also increase the risk of infection and delay healing after surgery.
Physical Therapy for Bimalleolar and Trimalleolar Fractures
Most surgeons wait 2-4 weeks to start a formal physical therapy routine (but it begin immediately). The initial treatment is geared towards reducing swelling and pain and restoring the passive motion of any body part that is not in a cast. The patient can perform limited core, hip and knee exercises in an attempt to prevent excessive atrophy due to the non-weight bearing status. The atrophy is almost inevitable and will be one of the main reasons that the total time for rehabilitation following this type of fracture can last longer than one year!
Normally, the patient is approved to transition to full weight bearing the end of the 3rd or 4th month. While patients are usually hesitant to put weight on the involved leg, a physical therapist can help with the transition. The therapist can educate the patient on ways to transition from non-weight bearing to full weight bearing and answer any questions about the different sensations that will occur when the foot is placed on the ground for the first time following surgery. There will be pain, tingling, numbness in ankle/foot complex and a strong feeling of instability throughout the involved leg. The therapy will include strengthening exercises for the core and entire lower extremity. It will be a very long process to restore the strength, muscular endurance and proprioception throughout musculoskeletal system because the entire body is effected when there is a prolonged period of now weight bearing.
Bi and trimalleolar fractures are devastating injuries to sustain and the involved person’s life will be dramatically effected for several months. With proper rehabilitation, the patient can restore their full function within the involved leg albeit it will take the better part of 1 year or longer.
what does ODG say for post-op PT after ORIF for a tri-M Fx ?
read dozens of these posts
three weeks since initial break and 2 weeks post op they inserted screws and plates. have split and spend most days resting leg splint is terrible seems like it rubbing stitches and don’t sleep very well. I get up and move around but ankle begins to swell but not hurt so guess pretty lucky.
off pain meds 3 days after sugery nurses were impressed i was off of them so fast. two days get stitches out and get removable cast so i can start showers yeah. long way to go and reading the posts helped alot . i’m not going to rush it i want to completly heal.long slow process. i do have my knee cart that helps allot.
I’m 2 weeks post-trimalleolar fracture surgical repair. Just had the stitches removed today and a boot put on. The plaster they put on after the surgery was put on incorrectly, according to the PA-C as it was wrapped completely around my leg. The swelling had nowhere to go so it pressed into the plaster splint. Very painful. Initially I had no pain besides at the moment of break. The ER docs and nurses were dumbfounded. They had to reduce the fractures 4 times (and by the 4th time it was a little painful). Then no more pain until after surgery. They told me NO IBUPROFEN, but the other pain meds did nothing, so I’m taking ibuprofen anyway. The PA-C says it’s ok as long as it’s not around the clock. Supposed to be non-weight bearing for 2 months, but they might let me start trying at 6 weeks. I am now able to move my foot around without the boot on to get the range of motion back. Looking forward to being allowed to walk again. This has been really difficult to deal with, as I hate just sitting around and I don’t like relying on others to do for me. Can’t wait until this is all behind me.
thanks for the info i am 2 weeks post surgery and i understand about the splints they suck and hurt seems to rub all the time
i get stitches out in two day and get my removable boot hope it will be better good luck with your recovery
I stepped on a house shoe in our garage & down I went on my hands but had on heels causing both ankles to bend causing Trimalleolar left ankle fracture & a severe sprained ankle on the right on February 22, 2017, surgery was done to repair on March 2, 2017. No weight bearing for 2 months. I did work using a wheelchair until I was released to walk with a cane. I had physical therapy (which was very helpful) Went to the Grand Canyon on June 2nd for our 50th wedding anniversary (airports were great to provide a wheelchair & assist).
I had the typical swelling & pain and after 15 months, I still limp at times when first getting up from sitting very long and have some swelling and pain at the end of most days. I can not wear shoes with much of a heel. I use an AFO when outside working in the yard which helps support the ankle on uneven surfaces.
This has been a devastating & painful injury for me but I am thankful I can still walk, work and do nearly everything I did before.
Hi, I had Trimalleolar fracture on April 16th. Did the surgery and had an splint put on. I liked the splint because I was still able to use my toes but now the splint is off and the gave me a walking boot. The boot is very painful cause it puts pressure right where my ankle hurts. I stopped wearing the boot and just started limping around. Not very painful at all. My problem is now (my good ankle) and calf is in a lot of pain and my ankle is starting to swell. Not sure why.
Hi all. All the posts are very helpful…thank you.
I am a healthy and active walker/hiker, 66 yo who slid down two steps at the end of January 2018. Badly sprained right ankle, and a left leg Trimaleollar fracture of tib/fib, with tibia dislocation over the talus bone. ER tried to relocate the tibia, but only managed 2/3 repositioning. Had surgery two days later (4 plates, 20+ screws). Not too much pain, at the break or post surgery actually. (Although at the moment of the break and a few seconds after on the ground, I found I can actually bellow like a cow!) Home two days after surgery with the boot, no weight bearing for 10-12 weeks instructions. Kneeling scooter was a life saver after the first week and I could tolerate moving the booted leg. Gave me a little independence and could dump the “lady urinal”! Sleeping in the boot … ugh…but it’s usually short term I’m told, so just get thru it, right? I got allowed to take the boot off after three weeks, as long as I wasn’t moving around. Yea!!! Only put it on again when I had to go to an appt.
I’m approaching the 12 week mark, but got the green light to start light ROM p/t at 7 weeks. I was sooooo happy to get moving. Had been pestering the surgeon for weeks! I then got released to start partial boot wearing weight bearing. A week walking the halls in my house with crutches (that took practice!), and just got released to walk carefully outside…in the sun!! So with each new hurdle, I an uplifted. As of today I can walk slowly and carefully in the boot about a half mile with crutches, 50% weight bearing. Better than 3 weeks ago in bed! A little aches at the end…elevation and ice seem to help. I’m not a pain med kind of person, so I avoid all of it at all costs. The ibuprofen for 7 days at home, after what they gave me in the hospital really affected my kidneys!
The emotional struggle is rough. Loss of independence for many weeks or months, change I lifestyle, dependence, and on and on. It’s true…every part. I was not prepared. I seriously fell into the self-pity pit off and on every four or five days, based on the fear of losing full function. At my first pt appt, met a woman who recognized the signs of this break as her mom just suffered a bimalleolar, and asked how long I’ve been off my feet. She empathized as she was 8 months post pelvis break with 12 weeks in bed, no getting up! Very supportive woman and was up walking and driving! Hope!! Followed the same day by a late 20’s woman going thru cancer treatment saw me in the wheelchair with the boot and genuinely asked if it hurt a lot. That was the end of self pity for me! Yes, as you all know, but for a new people reading this…this is a complicated fracture, that may well impair our ability in some degree or fashion……but look around….it can be so much worse. Focus on the children who have disabilities they just ignore and muscle thru, the Special Olympic ATHLETES who manage to do way more than I will ever do, impaired or never hurt. Maybe that will help a little. It does not diminish the pain, inconvenience or loss…it just puts this into some perspective.
I can’t wait to keep going….but still have the fear of loss. I don’t want pain for the rest of my life, who does? My pt guy said it would be about 1-1/2years before I will “take a step and not remember that I broke my leg”. But he hoped it would eventually go away. (Great, I should be pain free by 68!!!)
I had a lot of very localized nerve pain on the inside of the foot at the arch (no break there) after a few weeks. That was unbearable. Doctors were worthless. I was resistant to begin seriously icky drugs. I began learning quickly about essential oils, acupuncture and massage. PT advised to “carefully manipulate” the incisions to get my skin as pliable as the other ankle, all those together helped relieve that pain to down to an occasional 1% of the 1000% it was at the outset. Anyone have any experience with that?
Swelling…I didn’t have a lot of post op swelling and when I got to pt, the therapists were amazed I didn’t have a lot more. I attribute that to keeping my leg up on the bed as much as possible 24 hears a day. I just didn’t think it was a good idea to “stretch” the blood vessels in my foot and ankle for any period of time. If it did turn dark burgundy (and navy blu on the sole, I would lift it above my head while back on the bed and watch the color drain out in a few seconds! Amazing to watch. Maybe this has helped. I will cont8nue this as I get walking more and re-awaken all those muscles in your calf that regulate the blood flow up and down and get them back to where they need to be…..I anticipate those painful toe raises in the future….anyone have tips?
Anyone have icky ugly scars? (My surgeon is apparently great, but not a great seamstress) I’ve been using a silicone strip (no medication or other ingredients) called Cica Care. Seems to be helping after two weeks….flatten and lighten the creepy parts. Hopefully it will return to skin color eventually. (2-4 months….quicker than I will be walking!)
Thanks again. This page has really helped.
hi kath, im kath too, i had trimallular fracture 9/27/17, (10 mos) surgery 9 screws/plate, cant remove hardware for a yr. im 68 now. 24/7 pain , arthritis and osteoporosis set in, wasnt there b4, active lifestyle ceased, have to use cane, i limp. depressed, and now catch 22, if surgeon removes hardware, none of them exray afterward i.e. 3 mos. time to see if HOLES filles in. they dont follow up. so with osteoporosis, i would think they use a bone cement to fill in holes, im going to ankle specialist next, i dont want fibula to crumble from holes not filled in but the pain of the hardware is awful, now recently, i have sprained ankle twice, unstable gait, unbalanced, etc. i pray u have better luck than me
I had a trimalleolus fracture & dislocation 9 mths ago. Surgery delayed 2 weeks due to swelling. I suffered Indescribable pre & post op pain, bored senseless during 4 mths of lying 23 hrs/day with ankle above heart to try to control huge swelling, reliance on others for shopping, house cleaning & transport etc., severe sleeplessness, etc etc etc.
I started daily Physio after 2 months & followed their instructions religiously exercising several times a day. After 6 months the physio said my ankle had the best range of movement they had every seen after a trimalleolus fracture so even though I thought my continued swelling, pain & stiffness was not acceptable, they didn’t.
Two months ago I had the tibial lag screws & the syndesmotic screws removed as they were causing significant pain with every step. Via an arthroscopy they also trimmed the scar tissue from the cartilage that joins the tibia & fibula resulting in a good improvement in range of movement.
I now have regained 80 to 90% range of movement, only mild swelling & occasional niggles if I walk too far.
My ankle was shattered & my life turned upside down but do what the doctors say, follow phyio’s instructions & do your exercises. Everyone’s fractures, dislocations, surgeries, rehabilitation & expected outcome will be different but unless you take control of your own destiny, always look on the bright side, & not think you know better than the professionals, your own outcome & it’s effect on the rest of your life will be worse.
I started reading this string a couple of weeks after my accident. It has been the best thing I did to understand that an apparent hiccough in your life will change it forever. To what extent is up to you.
52 yr. 230 lb. tri-malleollar fracture tripping backward over a sewer cleanout. Weird to describe myself as lucky, but due to bad swelling never had screws placed and lived with external fixators for 8 weeks. At first moving around on crutches made toes turn purple and I almost passed out a couple of times. Practically lived on my backside for weeks; tailbone still sore. Permission to place weight in boot after 10 weeks and try and walk after 3 months. 6 months next week and can walk without a limp if I concentrate. Have lost some flex; still working on it. Arch strength taking forever to come back. Can’t do one legged toe raises yet. Can walk faster, but not jog. Should also state that broken ankle had been sprained badly (week+ on crutches) at least twice previously.
I fell February 17, 2017 and sustained a tri-malleolar fracture. One year later, I still can only walk several yards without pain, with cane, can only walk without cane around my house. Pain is severe by 5 p.m. each day. Worst problem is EXTREME heaviness in legs and feet if I sit or lie for any length of time. Each morning can barely raise my legs out of the bed because they feel so “heavy.” I am 65 and have a slight case of spastic cerebral palsy. My doctors only say improvement will be slow, but it’s been more than a year. Does anyone else have this limitation in walking and this heaviness in legs one year after the tri-malleolar break, or have cerebral palsy?
I am 6 years in from a trimaleolar fracture and dislocation following a horse riding incident. I’m afraid to say that I still get swelling on a daily basis and it niggles and aches often. I have lost between 20 & 30% range of motion in that ankle which is now starting to cause issues in my knees and hips. Before the accident I was extremely fit but now I struggle to exercise without pain. This is an injury that you will never fully recover from.
Hi all.fixator-I have a trimalleolar open fracture with dislocated ankle. I fell in the dark,in a 7 ft empty creekbed,on the way down i got my foot stuck in a trees’ root-ball . My foot was snapped back and literally was hanging. The exposed bones were sunk in creekbed rock,dirt,leaves and whatever else was in there. This happened Aug.18,2017. I was put in the external fixator aug 19. Exposed bones were irrigated and an internal fixator was put on on Aug 22. Cast was removed before I went home on Aug 24. Returned sept 2 with infection. Did emergency surgery to clean out infection, and had propeller skin flap placed on inside part of ankle as the skin was damaged from infection. Sept 4 was put on IV antibiotics because of the blood infection I had developed. Was sent home Sept 11 with a Pick line to administer more antibiotics. Nov 11 yet another surgery,infection in bones,cleaned out infection and removed 2 screws that were also infected. Antibiotic beads were placed in or near infection site. I am going on 6mos.since injury, no cast,no splint,and no boot. The propeller flap wasn’t allowed any pressure on it as it is soft tissue and was taken from my calf and literally twisted down to cover area of ankle where skin is gone. The bones that broke, made up my ankle,those are missing and replaced with plates and screws. I have been to pt for a month now,doing the exercises,weight shifting,and movements. I am using a walker and wheelchair. My foot swells every day,elevation works for that. Dr says fwb, pain feels like major sprain when i apply pressure, and swelling is instant, going back on jan 30 to see dr,hoping infection is gone and I can finally give up antibiotics. Other posts are giving me hope. It’s a long journey that has made me think about life and how everyday above ground is a good day.
Hi. I’m 3 weeks post op on a trimalleolar fracture and also have Fibromyalgia. Went today and had my 3rd cast on but the pain of this one is awful compared to the other 2. I don’t know why, it’s shorter and seems to be rubbing at the ankle more, whilst little worms are gearing up in the bloodstream. I also get a twinge, y’know the twinge you get just before a muscle cramp comes on, did any of you feel this? So glad I found you lot, makes me part of a Tri(be)! The Trimalleor Tribe or TTT for short. 😉 Just thought I would pop on and see if anyone is about. Thanks, Deb, Belfast.
Wow this information has been so helpful. In October 9th I fell down some stairs and suffered a Bimalleolar fracture to my left ankle. I am in week 7 since the accident with 4 weeks after surgery. This injury has been devastating l because as many of you have said you’re life becomes so dependent upon people helping you. I lost my Job (but thank God I found a better one) and more than the physical pain emotionally this has been hard for me. I’m use to being the strong one and helping everyone else so having to depend On my family (who has been amazing) was a real adjustment. Thank you guys for sharing your stories of recovery. In my mind I feel like I’m going to be walking fine when I go back for my next appointment December 14th but the reality is I still have a long road of recovery ahead of me. For those of you who have the Knee Scooter…. it’s the best thing ever. If I had to relay on the crutches I would’ve been treated for a fractured right ankle too( I have no balance). Stay strong everyone, we will make it through this and thanks again for sharing your stories.
I wanted to share my story to give hope to anyone going thru this experience.
I am an active 64 yrs old never broken a bone until I walked off high curb on 8/5/17. had a Trimalleloar fracture R leg, bad sprain on L.
My timeframe-
Surgery 8/9/17. Severe pain and discomfort first 5 days. I was distraught with the severity of the injury.-didn’t feel well to do much, worried about future etc…
I was totally dependent on others, due to both feet injured. Total bedrest for 2 wks. with Soft cast on fracture and aircast on sprain. So difficult to sleep on back with legs higher than your heart!
Best purchase-portable wheelchair at Walgreens and a urinal! lifesaver!
8/22-2 wks post op, cast gone, given Boot and aircast on sprained foot. Was able to remove boot for sleep and if sitting.-huge relief! Still slept with feet elevated but could sleep on my side so finally able to rest.
8/22-2 wks post op- Started PT. I Feel early PT really helped move me on. I was in wheelchair so PT gave me ROM exercises that put me ahead of game and arm strengthening, which I sorely needed! I followed the plan religiously and still do RX exercises. Keep your toes and feet moving!
9/8-4 wks post op-use walker with 25% WB
9/21-6 wks post op- full WB with boot
9/27-7 wks post op-boot off and walking with walker. driving again!-freedom!!
10/1- Final PT. walking on own. tho not too far. still used walker for longer walks or shopping.
By end of Oct. able to walk 1-2 miles unassisted and at a slower pace than before injury but I was walking! Flew to Vegas for a well deserved R/R!
11/7- 12 wks post op-final visit with OS.- I am fully healed. ROM good but still limp if sore. working on that.
11/27- 15 wks post op- I still have swelling and soreness especially after walking a mile or so. Not limping as much. Wear tennis shoes most days and trying to find a comfy casual shoe. My fract. ankle is larger than my other so shoes don’t fit as well. I continue to do the PT exercises to gain strength back. I am able to do stairs one foot at a time.
So, 4 mos post op, I feel I am able to do nearly everything I did prior to fall. -albeit some at a slower pace. Every day gets better. When this first happened I couldn’t even think where I would be 4 mos later. don’t give up hope! you will get there too!
Ok i broke my ankle bimollear fractures at october 15 after 2 weeks i was able to do surgury at nov 1 8 screw and plate i have the same problem same pain like every one here . I was shoked how my leged looked i have no muscles my leg very week i hardly can feel it i will remove cast by end of dec i will let you how it goes .no weight bearing for 8 weeks .
Bad injury be patient. I had a rotation of therapists and always dreaded when the ex gymnast was up. Hurt like hell but he worked wonders. Home therapy on your own was also critical. Best for ROM was sitting in a hot bath several times a day and forming the letters of the alphabet using your big toe as the pen tip. Thera bands were great too. It did takes several years to be completely pain free. For a while everytime you would push to new limits of exercise the ankle would rebel. Rest it a couple of days then move on and up. I still have the eight pins and plate in place, no pain at all unless I hit the pins on something. Best to you all.
I had six oct 1 2017 after twisting my ankle at a wedding.Trimalleolar fracture, terrible. It is tough not being able to go out by yourself, drive yourself. Just took first shower. Amazing. I stopped the pain mess 4 days after sx take Tylenol now except sometimes to sleep need to take pain pill but do not take in the daytime. Swelling down after 2 and a half was. But will wait and see about that.Go to Dr weds will see when I can walk again. Very depressing time. Good luck to all
Now after reading even more – I guess I am extremely grateful that after only 3 months I am walking mostly without a limp and haven’t had a boot for almost a month. I can’t imagine still using crutches 5 months in. What a horrible “special fraternity” to be a part of
So many kindred spirits telling their stories and reading the encouragement for full recovery is great!
Had my accident July 5 out of state and due to some really extenuating circumstances didn’t get surgery until 5 days later (dislocated the whole time) It was diagnosed as a Trimaleoler but ended up being 4 breaks. Like many others, I ended up with 2 plates, 12 screws and 4 pins and no weight bearing for maybe 9-10 weeks.
Recovery has been steady but I do struggle with nerve damage and continual pain. For the most part I try and just ignore the pain and maintain a normal daily life. I teach college and work EMS so I am on my feet a lot during the day. I take NSAIDs when it gets to be too much but in a week I will be taking my students backpacking and I am worried for how well I will be able to keep up with them this semester. So many people want to tell you their story too but most of the time it’s very disparaging…”I still hurt after 20 years”…”It’s never gotten better”
The thing that gets me is my Dr. said no physical therapy. This seems odd to me considering I’m 51. How many others where told no PT either?
I will never take walking for granted again! (Or standing in a shower washing your hair, or getting in and out of vehicles and so on and I have learned a new empathy for individuals who are permanently handicapped!)
I want to thank everyone for sharing your experience, strength and hope. I’m now 5 months post op from a trimalleolar fracture. Finally out of the boot about 3 weeks ago and walking. My ankle still swells quickly with use and I find myself fearing it will never get better, but reading others’ experiences has helped me put it in perspective. In the case of these fractures the pun three steps forward and two steps back really does apply. My doctor did say it’s a long recovery that takes months. I’ve been fortunate that my office offers short and long term disability which was approved without issue. The issues I do find, (in addition to my wanting to be 100% right now), are friends and some family members that just don’t understand and say things that don’t help. Like “you’re not better yet?” Or “when I broke my foot it was all better by 6 weeks, you must have a low tolerance to pain”, or “you’re still not back doing everything yet?” Then others offer pity which I hate just as much. While no doubt I want to run through flowering meadows and walk my 5 miles a day, I have found other things to do. Some more productive than others. I went meticulously through a penny collection and found a 1943 steel penny, but in the end i had to admit to my husband that it was a waste of time because even if all the wheat pennies I found were worth 100% of their value it’s still just two cents. We did get a good laugh though. I finished writing a book I’ve been working on for ten years and it has some promise. This time off has been a blessing to have the luxury of time to devote to writing. I started cross-stitching a Christmas stocking. I sat on the floor of my closet with my ankle up using the crutch to pull things off hangers and shelves to finally purge my closet. I’ve ordered too many ‘good’ deals online for facial products and other fun things. And I try to resist gorging on the news of all the political craziness going on. I found though I’m having to rebuild the muscle in my leg, the muscles in my arm look really good after 4 weeks on the walker and have now started doing push-ups (using knees) to maintain my arms My patience is growing thin, but I’m grateful to read about others on the path of recovery from a trimalleolar fracture.
Thanks for the encouragement on this post. I was learning to roller skate on 6/17/17. I fell and broke my left arm and ankle. The ankle was a trimall fx with joint, ligament, and tendon damage, requiring surgery. The arm was a dislocated elbow with an ulna fx, no surgery was needed. I spent 4 days in the hospital and then transferred to a rehab facility. I spent 6 wks there. My surgery was on 6/30/17. It’s been a journey. My ankle stayed splinted two wks after surgery and then I got switched to a cast with suture removal. I go for a 6 wk post op follow up on 8/14/17. I’m hoping I can start wb with a boot. My arm was splinted for 3 wks and then removed. My arm is recovering nicely and I’ve gained 85-90% of my ROM in it. I’m hoping my ankle goes just as well even though it needed surgery. This cast is so uncomfortable though. I’m not in pain just a lot of discomfort. I rarely take pain meds anymore. Elevating it in a sweet spot is key. Everyone’s recovery is different but this gives me up. I’ve read that tendons, ligament, and joint damage prolong the recovery but I’m hopeful.
I am 5 months post surgery for a trimalleolar fracture. Plate with 7 screws. Have had Physical Therapy which did help. Have been walking without cane/walker for 6 weeks but still have a limp & swelling by the end of day is significant. I am thinking of having the plate/screws removed. Anyone else had this done & did it improve your ability to walk & flex the ankle?
I did a bi malleolar and spiral fracture of fibula 16 weeks ago when I had a fall in NZ. This article is the best I have read to explain the fracture and the recovery. I find it hard to explain to people why it is taking so long and I did not fully understand myself. I am still not back at work ,had surgery and could not weight bear for 14 weeks. Have a great PT but taking time to get my confidence back. Now I understand but it isn’t easy. I am an adventurous 58 yo and fit the category perfectly! But I am determined to get back to hiking as soon as I can.
I am now 10 weeks postop and the best part of the whole recovery is the mini milestones and the enjoyment that results.
I didn’t realise how good it would be to stand up-right and walk around unaided, to be able to stand up in the shower and not have your leg poking out the shower door, However the best feeling came from the first day I could get back in the car and finally have some independence .
I really get a buzz every time I stand and walk, even if it is a little slower at the moment
Thanks Joanne
I’m one month into this ordeal. Triathlete and RN. I have a knee scooter and can drive. No narcotics, but Advil, Tylenol,ice and elevation. Trying to stay positive, but continue to worry about my job and future fun. Haven’t started PT, thinking i should start my own program for at least the rest of my body. Should start regular PT in a few weeks. Thanks for the encouragement!
Hey Susan, As an athlete & RN you get it; tissue heals given good conditions. You WILL have future fun for sure. You may need to modify for a year or so. This is a tough break, literally & figuratively.
Exercising the rest of your body will help immensely, good idea to start at home, progress to a gym/pool when you’re more mobile. For me, walking was tough, the less weight-bearing exercise (cycling & swimming) felt best and I could work out hard those ways.
I took the down time to review my life goals, relationships, strategies. A big lesson was it’s okay to feel vulnerable in tough times and ask for help. That sincere introspection has changed me for good. Sounds corny, but true.
If I did it, so can you!
I hope my experience helps others early in the rehab process. I had right trimalleolar surgery May 11, 2016, 14 months ago. I was 60 years old. I was non-wgt bearing x 8 wks then gradually progressed to full wb by 12 wks. I stopped narcotics in the day by wk 2, completely by wk 4. Ice, elevation, NSAIDs & Extra strength Tylenol helped for months. Still taking meloxicam.
I live alone, friends helped with meals & errands. By wk 3 I started driving with left foot plus cruise control. My knee scooter saved my mental health, I used it to grocery shop, get safely thru my pool. My ortho MD ok’d swimming with very soft kick as long as I was safe getting in/out.
Ankle/foot swelling & stiffness persisted for months. Wearing a soft elastic support helped, I preferred a Malleotrain with its 2 crescent shaped gel pads behind the malleoli. By 3 months I could walk a half mile with no limp, ride my bike 5 miles, swim a mile. By 6 months, I could cross country ski 5k on flats, walk 2 miles fast on indoor track. Walking uneven terrain was still uncomfortable.
By 10 months, my swelling was mostly gone except after a hard workout. I had several “ankle pops” probably scar tissue letting go, not painful but weird. Each one seemed to improve my ROM.
Now, 14 months from surgery, I still have minor aches, I stretch my leg/ankle daily, resumed full gym & pool workouts, cycle 25 miles, dance in girly shoes(low heels).
I’m a retired rehab therapist, my training helped. My best advice: follow MD/PT instructions, stay positive, accept help where you need it but don’t baby yourself. Exercise your healthy parts daily, set realistic goals & celebrate achievements. This is a big hiccup but do-able.
Update- post- trimalleolar injury- 6 months: I know that immediately after my injury I wanted some sort of a timeline… so here I am at 6 months and I would say that I am 85% back to normal. My ankle still swells and I still ice it some but I have very little pain even after exercising. I still do the ankle exercises prescribed by PT and most days I do a 40-minute full body weight routine. I do squats and lunges and calf raises for my lower body without difficulty. I also do some balance work. I think that exercise is extremely important during recovery, I followed exactly what my physical therapist and surgeon told me to do. My doctor told me that I needed to continue to wear the air-splint (stir-up) when on uneven ground. Well, I live in a very remote area in the mountains, so when I’m just walking to my car I’m on uneven ground. I didn’t like the air-splint given to me by my surgeon (it rubbed on my medial screws) so I found a Zamst splint that he okayed and I wear that when I’m out and about. At home, I walk around barefoot without a limp unless I am tired. I can walk two miles and I am able to wear 2-inch heels.
This has been a long slow process but I’m getting there. By the way, my kids loved their “Netflix binging mom” for the first few months when I was NWB. I guess that I seemed much more relaxed (like I had a choice). So, I guess that there is an upside to everything!
Your 6-month update is VERY encouraging to me. Thank you very much for the share. I am trim-fracture/dislocation since 27 Mar 2017. I just had a 2nd surgery this past Wednesday 12 July to remove 4 of my 11 screws because they were too long and some were protruding into my joint. So far, I have much more swelling and pain then before this 2nd surgery and my limp is back with a vengeance. I’m hoping this is only temporary until the surgery settles in my ankle. I keep it raised above my heart and ice pack it. Per my Surgeon, no Physio for a fortnight but I still cheat at home to keep my range of motion hoping my stitches won’t break. I know I know. Just went back to gym today for 45min of upper body okay-ed by surgeon. So this is 3 1/2 months into it or so, so I’m hoping for better times ahead. Thanks again for the share!
Jodie, you poor buggar. I feel your pain.
You don’t HAVE to wait until August if you cast is hurting. Go back to the surgeon or ER & get it changed.
Day 2 post-op, I thought there was a 1/2″ wide length of plaster running directly along my suture lines. It was actually the ooze from the incisions into the combines that had dried as hard as a brick.
Lack of sleep & teariness is very, very common, as is the burning & numbness. That doesn’t help you at all but at least you will know that is “normal”. Like many people in this thread I got less than 4 hrs sleep a day for a month.
Despite your allergies there are pain killers you can take. Tell the doctor to prescribe them. If it is only nausea you get when taking some pain killers, take them with food &/or anti-nausea medication. Things are so much better when the pain is lessened.
Omg… bi surgery June 9th… casted June 26th… this is now my second cast… i don’t go back to be rechecked until Aug 1st which at the time i am supposed to get a walking cast or boot.. i can cry now at the drop of a dime.. i can’t do anything.. i have to wear a bit on my right leg because i severely sprained it at the time when i broke my ankle… my foot is constantly numb and burns.. now the inside of my left ankle is feeling like my cast is rubbing against my incisions on that side.. i can’t sleep because i can’t get comfortable.. i can’t take the pain medicine because i have an allergy.. I’m miserable!!!
I am 74 and while snow blowing my driveway, hit a patch of ice, went airborn landing on my twisted foot. Knew immediately it was broken but no pain. Just couldn’t move. Ambulance to hospital, x-ray showed a trimalleolar displaced fracture. Screw, pins and plates, 6 weeks no weight bearing in cast followed by 6 more weight bearing in a knee high boot. Had to hire some employees to rearrange my living area to first floor. No crutches while in cast. Straight walker to transition from transfer chair to shower seat, bed, recliner, etc. I went into a regular shoe after 12 weeks with PT twice a week. I can walk, but after about 5 minutes, the swelling starts and also the stiffness. Its been almost 5 months with 8 weeks of PT and I am still not walking without limping and swelling. My P Therapist suggested along with my regular exercises to try a hot/cold water treatment. I do 20 minutes twice a day using my handshower to fill two buckets, one with hot water between 98-110 degrees and the other in cold water, 50-60 degrees. I was amazed that the hot water in my shower registered 115 degrees, the cold water 57 degrees. I use my iPhone timer for four sets, 4 minutes hot water then 1 minute cold. Repeated 3 more times – hot to cold.
It has really helped. I guess it opens and closes the blood vessels around the injured ankle. I have an accurate thermometer which is important. Along with the exercises, elevation and ice packs, this treatment seems to lessen the stiffness & swelling. I try not to take those pain meds like Advil, Tylenol, etc. because taken over a long time is bad for your kidneys. I have been fortunate that I was able to get off all Oxycontin soon after I was out of the cast.
Hi Lily,
If the injury involves the ligament that joins the tibia & fibula near the ankle joint, the surgeon may need to insert a couple of syndesmotic screws I.e the long screws you see on some X-rays that go through the fibula AND tibia. These stabilise the two bones above the ligament whilst the ligament heals.
Those screws can often snap when people start to weight bear so are often removed prior to progressing to weight bearing. It is probably those screws to which people refer.
When not swollen, my ankle looks Frankenstein, the screws stick out. The doctor said removal is unwise because the bones now have holes from the screws and increases the risks for just another break. In addition I have very thin ankles. I had a trimalleolar fracture March 19th, surgery the next day. My hardware is exactly as in the picture shown in this article. I’ve read that some folks posting here are getting their hardware removed, I’m curious what other doctors have said. Also has anyone had issues with lack of healing?
Thanks,
I went Monday to get my stitches out & for X-Rays….my Dr told me that now I need these same 2 screws, so I’m going in the morning for this procedure. He said it should prevent me from having more problems & pain in the future. I injured & dislocated my ankle on May 29th. Had a previous post in June. Realizing more & more how serious this type of injury is…. just from stepping off a curb in a parking lot that was steeper than I realized & over a storm drain!
So glad to find all this info….first website that came up when I googled….healing from trimalleolar fracture…..I also dislocated my ankle on May 29th. I had surgery next day after injury & had an exterior fixator after the manual reduction didn’t work in ER after 2 attempts! Thank God I was out with something that caused amnesia! I had surgery 2 weeks later & have 2 plates with 14 screws. Go back in 2 weeks to get stitches out of 2 incisions, X-rays & cast back on for 4-6 weeks I’ve been told, & then a walking boot. All I have is a walker & a husband that has taken FMLA…..it is the worst losing all independence….I’m thankful for this blog to help me on this journey….the reality of a long healing process!
Anna, do not weight-bear before your doctor says it is ok. He knows the details of your fracture, not the internet. Plus he has a minimum of 15 yrs medical experience. Dr Google (& ourselves) is/are our biggest enemy.
I found hiring a knee scooter was my saviour. I could get to places that I hadn’t before.
The less impatient we are now will directly relate to the degree of long-term disability/arthritis we will end up with. Lol, that is the main reason why I am following doctors orders.
Good luck to all of us I reckon.
I am the worst patient! I’m following my doctor’s orders, but I’m also one of those that wants to speed things up and looks for reasons to do so. Let me explain…
I suffered a bimalleolar fracture on May 21, 2017. I had to wait 10 days for surgery as the swelling was too severe to operate (likely because my not-so-smart self tried to walk on the ankle right after the break…twice. SMH). My surgeon was pleased with my surgery on May 31, 2017 but did mention that the fibula was more “crushed” than he anticipated so he had to piece it back together and use a bigger plate than usual. I had my sutures removed and a cast put on June 9, 2017 and was told we would do more x-rays on June 30 to see how the fibula is looking. If all looks good, then I’ll be put in a boot and, a couple of weeks after that, will begin weight bearing.
Now, I know that my fracture wasn’t a textbook bimalleolar fracture (are they ever?!), but I came across this article, as well as a few others, that actually say that immediate weight bearing is preferred, leads to much quicker recovery times, results in less depression, allows return to work much quicker, and may reduce the likelihood of arthritis and other issues down the road.
I know better than to go against what my surgeon has said – I think he’s a fantastic surgeon! – but it’s tough not to want to put myself on my own recovery program when there is literature like this out there. I know that’s not possible as it would not be under a doctor’s supervision, but I do wonder why non-weight bearing is still the norm across the board.
As for my own experience, man this sucks!! I am a total workaholic and control freak. I’m lucky enough to be able to be working from home starting this week, but not being able to clean my own house, do my own laundry, etc. is driving me insane!! I’ve been extremely fortunate to have the help that I have had, but it’s still tough. Plus, I’ve only been able to visit my horse 3 times since the accident and I am missing her, and riding her, like CRAZY!! I’m just trying my best to recognize how far I’ve already come (heck, just 3 weeks ago, I was sitting on the couch with two broken bones just waiting for surgery, so things are definitely better than they were!), but it sure is daunting to think about how much more there is to go. It’s REALLY helpful reading success stories on here, so thank you to those who have posted. And, for those like me still on the road to recovery, hang in there. We can do this!!
Update: 19 June 2017: Went to Orthopedic surgeon-I am trim fracture dislocation 12 weeks in. Still have chronic pain-swelling-Doc said I need to lose the cam boot and try wearing shoes-once I can do this I can drive. Surgery scheduled for 3 July 2017 to remove 4 of my 11 screws-outpatient-Doc said pain and swelling will continue till about a year has lapsed since original accident. Rest of hardware to be surgically removed once fully healed(1 year).Will update how surgery goes-We are here to support each other-take care everyone.
Hi Stephen, I am curious, where did you have your surgery and what is the name of the doctor. I keep hearing people say that they are going to get the screws out. I am 7 months out from surgery. My doctor has not even offered that as an option. If anyone has any information about why it would be beneficial to have them removed verses leaving them in, I would appreciate hearing from you.
I had a tri-mal # and dislocation after a nasty slip on May 7 whilst walking down a 35 to 40° slope and slid on gravelly ground. Doctor told me my foot had sheared off my leg backwards and sideways. He explained that I was lucky because the cartilage slid on cartilage and there was little direct impact of both surfaces which would occur in the case of a car accident or landing heavily on the ankle. For this reason the chance of long-term arthritis is greatly lessened.
Although requiring hospitalisation for over a week to reduce the swelling pre-up I had the open reduction on the 24th May. (13 screws in all).
I am now 3.5 weeks post-op but have not required any painkillers for weeks & can tolerate the dog jumping on my cast and me accidentally bashing it into walls with no increased pain. The biggest cause of my pain pre-and post up was the casts. Altogether I went through seven different casts pre-op and two post-op. This was mostly due to the gross instability of my ankle so, either the swelling caused the pain or if it was not swollen, the ankle flopping sidewards within the cast caused even more pain.
The mechanism of the injury & degree of swelling will directly relate to the amount of pain we have and the instance of long term post injury pain. Just because we all have Tri-mal #’s will not mean we will have exactly the same Recovery story.
My biggest lesson from all of this has been to say yes when any help is offered. I have discovered a help network amongst my friends and family that I never realised I had. I am stoutly independent and have refused help my entire life but have found people enjoy helping you out when you need it. Let them help. It will lessen your depression too.
Good luck everyone.
Everyone heals at different rates and based on a lot of factors including age and how fit and active you are and your mental status. I am going on 10 weeks since my trimalleolar fracture and dislocation. I use crutches and am in a boot. I can walk with one crutch for a short period of time. Doing physio is really important but not easy, especially if you are having pain or your ankle feels like it’s in a vice or against a sharp blade. You have to take pain meds and medical cannabis to alleviate the pain and to help put you in a good mood. Getting out of the house is crucial. I go to gym 3 times a week and also do my physio at gym. It makes me feel so much better and accomplished. If you are not fully ambulatory you CANNOT drive and DO NOT attempt to drive in a boot! Until you can walk without aid and without boot and feel comfortable slamming your foot on the break really hard, you cannot drive.
Good morning!
i have been reading all the posts. And i am glad that you shared your stories. it has helped me understand what i am going through. i broke my ankle on March 7, 2017 hiking down Camelback Mountain in Arizona, the firefighters had to come rescue me. It was a big scene. I am from Oklahoma so i really had no idea about this mountain until i got to the hospital. the doctor told me i had a tri mal fracture and would need surgery the next day(Wed). i had surgery the next day. Thursday i was able to check out of the hospital with 6 screws, one plate and a big ole boot. Friday i had to fly back to oklahoma. its been 12 weeks since my surgery. i am still in my boot but i can walk with my crutches i am hoping my doctor’s appointment next week i will be done with my boot. my ankle is still healing but it doesnt hurt at all it just swells in the late afternoon when i am almost done with work. All i can say it gets better it just take time and patience with your body. Dont let the stress win. Stress is a healing blocker. I am still healing but i am better than i was yesterday. Make sure you eat healthier this helps the healing process. Dont feel bad to ask for help that was something i had a hard time doing. i still have a long way to go but i am ready. i hope everyone has an amazing day! and your ankle is healing!!
I am only 3 days post surgery trimaeolar fracture with dislocation. 9 screws and metal.mountaing biking accident and just overwhelmed with the different time frames everyone has. What are some things done in first phases that helped for quicker recovery. Exercises, etc
Hi I have a trimellior fracture from an obstacle race trying to be fitter lol. I am 4 1/2 weeks post surgery and agree with others being so dependent is awful had w weeks off work and have been very lucky with support from family friends and work colleagues but so bored of not being able to do simple things. Have kept moving toes and legs raises but hoping to have a boot instead of cast at week 5. Desperate to get air on my scarsvhave a plate and 6 screws. Now swelling reduced can feel a sharpness I that i think is tge metalwork is this normal. Glad to find other stories and experiences. Has anyone been driving in a boot ?
Keep your ankle propped up above your heart this really does help the swelling. and dont forget the ice packs. Eat healthy and drink your water.
I am almost 12 weeks post surgery and anticipate that at the next visit I will become fully weight bearing. I had a trimalleolar fracture on March 1 with surgery on March 2. Across the top of the ankle is very tight. Has any one else had that experience and, if so, what was done to alleviate the tightness?
we are almost the same time, i broke my ankle on March 7, i try to massage that muscle it seems to help and also i just stretch it out.
Oh so heartening to not feel so alone in this process . I slipped and fel on ice walking my poochl 4th march 2017 trimalleolar fracture and dislocation… emergency room at the hospital did a great job putting back in place and casting. I chose not to have surgery, so I was in the initial cast for 2 months, then recasted and my foot manipulated back to a neutral position then another shorter cast put on for another month. Today it was removed … yay, and all looks technically pretty good.. lots of therapy presctibed and a walking boot for another month … but so happy to be able to sit and sleep without it. Started PWB in cast a month ago … and now to start WBAT (as tolerated) a little apprehensive… and lots of excercises to do at home just to loosen all those tendons amd ligaments… but feeling grateful. I can say that the social isolation and lack of independence was and still is the most challenging. I say to myself in hindsight when feeling sad … it could have been much much worse. Chin up to all … stay strong … and Im 60 years old … and I know if I were younger the healing process would hve been shorter.. but pretty damn hapy with my body and its ability to heal xxx
Bi-malleolar fracture on 1Feb 2017. I had by syndesmodic fixation screws (2 off) removed last week and am able to apply full weight to ankle -at last! Walking with a limp because brain has been instructing body not to apply any weight to right leg for the last 3 months! Ankle still swells up everyday to the point of discomfort. Am now wearing a compression stocking which helps. I am advised that the swelling may last several months. Swelling seems to be the last hurdle in the recovery process. I will be embarking on physiotherapy to help rebuild muscle that has disappeared over the last 3 months. To everyone else out there with a similar injury, just keep fighting, it will get better and finally heal.
I fell and sustained a trimalleolar fracture and had surgery on April 12th. I am now almost 6 weeks post-op with no weight beating until June 8th appt. I still have a lot of pain and burning in the inner ankle and across the top of the ankle. I take 800mg of Ibuprofen but still require Percocet intermittently. I would appreciate any feedback on how long narcotic pain meds are generally used. This is a great website and has been helpful!
Traci: I take Tramadol 55mg during the day once, 1000 mg acetaminophen to help when Tramadol wears off. And 325 mg Hydrocodone at night. I also take 10 to 20mg THC in between when pain comes back. This is after 2mo.s since accident. The hardware is what hurts. I will be getting 2 or more screws removed next month since they are too long and protruding into my joint. I was apprehensive of this additional surgery but “Fab” has put my mind at ease. After physio, working out at gym, and at the end of the day when edema (swelling) is at its worse is when the pain bites. I keep my ankle raised above my heart and ice pack it. This helps a lot. I hope this helps. Cheerio love.
I had my surgery April 13th and started weight bearing June 5th. I’m walking without any aid, but have pain where the plate is on my outer ankle. I have a feeling of resistance in the front of my ankle when bending. No more pain medication needed anymore for me now. How has your progress going?
I fell badly in August 2016 and sustained a trimalleolar fracture at age 58. Could not believe the impact it had on my life and the frustration at not being able to do what you want. However it has improved a lot since then and 9 months on I can walk without any cane and yesterday was able to wear heels (sensible height) at work for the first time. To be honest the ankle is still sore and I need to rotate it regularly and stretch to exercise it but it does get better even though it seems an eternity. My best wishes to everyone in this situation – try to stay positive you will feel better but it takes a very long time.
I have a tri fracture that happened 5.6.17. These posts are going to help me through this ordeal as will of course hubby and PT. Was hoping for a short recovery and return to “normal” but doesn’t seem likely. I may need to find a new “normal”. My thanks to everyone for sharing their stories.
Update: Trimalleolar fracture and dislocation 27 Mar. Fibreglass cast removed 9 May. In boot. Hate it. Only wear outside. Still on crutches. Ankle was shaking violently out of cast but now OK. Right foot touching ground but no weight bearing till 24 May. Started physio but just ankle stretching. Still swollen but less pain. Skin peeling like crazy. Two of my screws are too long and are sticking into joint. Will need surgery to remove but not till I have full weight bearing and swelling subsides. I still do weight training on my upper body sitting down. I’m hoping the surgery won’t cause me to lose my small progress. This Injury so sucks!
I recently had a trimalleolar fracture in my right ankle. It has been so hard to see the positives, when my wedding is the beginning of september. My doctor said I should be walking by July which lands three months after my surgery. I just had my visit last Thursday with my doctor after being post surgery for two weeks. He said everything looks great and told me to start exercises, just flexing my foot back and forth. I was hoping I could be back at it soon as I am an avid lifter and now I can literally do nothing to work out for my upcoming wedding. I am devesrated to say the least but everyone keeps getting on me for being so depressed, saying that I have to be positive. But it is very hard to be when I have to depend on my fiancé for everything.
Alicia, I remember feeling exactly the way you do, wondering if I would be walking by our beach trip planned for the last week in May, after my injury in January. Well… I am at exactly 4 months right now and I am starting to feel like myself again. I started walking FWB around 9-10 weeks. I am able to walk without a limp now. I am able to do squats easily, lunges are still a struggle but I am making progress. You should be able to ride a stationary bike by 8-10 weeks and you should also be able to do seated upper body work. Go to physical therapy for guidance on your ankle and lower body exercises. Be patient, rest as much as you can, eat as healthily as possible and week by week you will see small improvements.
You are at a tough stage. And by the way, this injury really does suck and it is unfair that any of us have to go through this. But, it will get better…
I am bimalleolar fracture post op two weeks. I am so relieved to have come across your post Jackie. I have been reading on bimalleolar post op recovery and have yet to find anyone who has mentioned a recovery where they have been able to continue squatting, calve raises, running, jumping etc. Thank you for sharing! This brought joy to my heart!
I am a very active 28 year old petite female. Prior to the injury I religiously participated in weight training daily, marathon running, hiking, softball, and kickball. I received this injury the morning of 11/5/17 sliding to home base in a coed kickball tournament. The catcher and pitcher both trampled on top of my right leg causing the fracture.
After the surgery I was immediately put in a splint and told that I was to be Non weight bearing until my post op follow up two weeks after. The only thing that is concerning me at this point is if my incisions have healed properly. Ocassionally, I would feel as if my incisions were leaking and running down my ankle. Also, after being discharged from the hospital a couple days later I caught a fever and flu/cold that lasted a week and a some change. Is this normal? Any signs or symptoms I should be aware of that may suggest my incisions may be infected even though I cannot visually see my incisions? Maybe I will just have to wait it out and see at my next appointment. The anxiety!
Bimalleolar (Trimalleolar) Fractures
I sustained my Trimalleolar compound fracture and dislocation on 4th Dec 2016 , went into trauma and had my right ankle set into an external frame. I was bed ridden in hospital for 9 days for the swelling to go down enough for the surgeons to fix the plate and 8 screws to the break on the Fibula and a long screw through the Tib/Fib to inhibit movement , a couple of days after I was released with a back slab cast and crutches ,NWB for 8 weeks it wasn’t my idea of fun that’s for sure. In my case the swelling was so bad I stayed in a back slab cast and skipped going into a fibreglass cast and went into the CAM boot which I hated , I had my last surgery about 6 weeks ago , recovered for a couple of days and sought out a quality Physio Therapist whom I am very happy with , this to me is one of the most important facets of recovery , finding someone you are comfortable with because they will push you to near on breaking point for your own good. I have seen some good progress since starting Physio and have recently started to walk with out crutches for short distances in a good quality shoe. One of the hardest things I have found is putting the faith in your body ,and telling your foot its ok to touch the ground because it feels foreign and uncomfortable because the tissue on the underside of my foot went all soft and squishy haha and it was like you are just walking on bone due to disuse . 5 months in it is still swollen and hurts now more than ever , but on the upside I can walk which I did not see happening as quickly (if 5 mths is quick) . I’m fully aware I am along way from recovered but there is a very dim light at the end of the tunnel , so for those who have sustained this injury recently please prepare yourself and your family for the long journey ahead.
I am 75 years old and on April 12 suffered a Trimalleolar fracture in dislocation of my left ankle. I too developed numbness and burning in my foot, but before the surgery I felt very little pain. Putting all those screws probably causes a good deal of the pain. However, a peroneal nerve stretch injury is fairly common with this injury causing numbness and pain. Fortunately, this injury will usually clear spontaneously. My orthopedist thinks I can start weight bearing at 5-6 weeks.( I already do some minimal wb for balance with no pain ). I am a practicing neurologist and want to get back to work. I have too much arthritis in my back, knees, hands to use crutches because that is 10 times as painful as the ankle. My knee rover gets me everywhere and is fun. I must say that the recovery timeline given at the top of this article is way to pessimistic and extreme. Cut those times in half to be more realistic. I’d shoot myself if I thought I would be disabled that long.After all, how many more years do I/we have? Good luck to you all, and DO NOT get discouraged. Think of this as an extended vacation. Open your iPad and chill.
I agree with the time that they posted that it just makes me cry my eyes out. I had my fracture on the 15th of april and was sent home after surgery on the 20th. I had my meeting last week two weeks post surgery and he said it was healing perfectly and that once i am full weight bearing he gives me two weeks to be back to normal. Although this time is killing me I dont want to set myself back at all. but i am hoping for a quick recovery as my wedding is the beginning of seotember, and I am not limping nor wearing a boot down that aisle
Wanted to see how you are doing on weight bearing without boot for your wedding? I had my fracture on April 13th and can walk without crutches and boot. My resident told me to start weight bearimg on June 6th (7.5 weeks post op) and when I went back to ortho for my next check up at 10.5 weeks the consultant told me to start to weight bear. Did the resident make a mistake? I’m so worried my bones may have shifted if the resident had me start too soon. Very worried!!!
Hi all, I am 51 and I experieced a trimalleolar fracture Feb 4, had an ORIF on Feb. 6. I was in a plaster cast for 2 weeks and have been in an air cast ever since. I started doing range of motion exercises 4 times per day as soon as the Dr. gave me the go-ahead. I managed to work through the non-weight bearing period with the help of a knee scooter. At 10 weeks, I was given the go-ahead to start progressing in weight bearing. It has been going very well. I am not needing a cane or anything. A little achy and swollen at the end of the day, but managing with a little ibuprofen. Just a head up with the air cast, try get shoes with some height for you good foot. My hips and back were being put out due to the height of the air cast. This was causing me to limp more as well. My progression has been better than I thought. For those struggling, I hope your healing goes well.
I also have trimalleolar fracture & dislocation as a result of a body surfing accident whilst on holiday in Puerto Vallarta Mexico 27/3/17. I was rushed to hospital & had ankle relocated and surgery in theatre next day. I have a cast and use crutches. I have pain every day and I stave off painkillers as long as I can until I can’t stand it. I tire of staying home with ankle elevated. I do go to gym 3 days a week okayed per Doc but only sitting down weight training. I get reevaluated 9 May. I am 54 yrs old. I work in a factory standing all day with heavy lifting. Obviously I’m off work. I have no idea if I will ever be able to go back. Attitude and perseverance are important but I get angry, impatient, and cry sometimes. Hoping for the best of recovery.
Thank you for a very informative site. I fell down some stairs on Feb 21,2017 and had trimolleor fracture surgery the next day. I have had severe pain including really aweful burning (nerve damage) to my right foot and ankle every day since. I have been in physical therapy since week 5. I am very discouraged that the pain is just as bad now as it was 2 months ago. Have tried to go without the Percocet as I do not want to get dependent on it but barely hanging on by a thread.
I slipped on the ice on January 10th and suffered a trimalleolar fracture and dislocation. On January 16th I had surgery and 12 screws and a plate. I used a knee scooter, it makes getting around so much easier, and even fun! I started physical therapy at 7 weeks, one time each week. At 9 weeks my doctor released me to full weight-bearing but the physical therapist suggested that I make a gradual transition. At 12 weeks I am able to walk in cross trainers, full-weight bearing, around the house. I sometimes wear my stirrup splint if my ankle feels painful or unstable. When I go to work (I am a teacher) I walk in my CAM boot and plan to continue this until about 16 weeks. Since I have started walking I have much more pain and swelling. I very occasionally take ibuprofen for the pain, I usually just elevate and ice it in the evenings.
When I began researching a timeline for this injury I found a great 30 something blog. I used her timeline as a guide for myself, (even though I’m 52) I think that it really helped me to have realistic goals.
I think this article does a great job in helping us realize what a slow process it is to recover from an injury like this. I have never appreciated my hubby so much in our 27 years! Cheers to all of the caretakers!
Great article. This Tri. Fracture is testing my patience greatly. Reading this, while informative, didn’t help. Snowmobile accident on February 20, surgery on March 2 2017. I have a plate and 12 screws. I have a feeling I’m not quite half way to weight bearing walking by the way some of the comments I’m reading here. I’m trying to not take pain medication because there really isn’t “pain”, just discomfort. I don’t know how this works but I hope I am alerted to everyone’s updates via email.
I slipped and fell March 1 and suffered a trimalleolar fracture on my right. Surgery was done March 2. I have a plate with 6 screws on the outer part of the ankle and 2 screws on the inner ankle. I have been non weight bearing since then. I am scheduled to go to the doc on April 10 and doc is hoping that there will be sufficient healing so I can be partial weight bearing with me being full weight bearing at 12 weeks post surgery. After reading the comments I am concerned that he may want me to be partial weight bearing too soon. My boss wants me to return to work in the soonest time but I’m concerned as my job involves constant movement.
I’m really glad I found this site as it gives me some insight into my mobility and flexibility while recovering. I started doing ROM approximately 1 week post surgery. I currently do those and muscle retention exercises: leg raises
Hi guys! Trimalleolar fracture with a dislocation here! I’m in week 9, I can walk with crutches or a cane depending on the time of day. It is a long process and I am ready to move on!
Thanks for sharing, it feels great knowing I’m not alone, cheers!
Suffered a trimalleolar on feb 17 , going to see Md tomorrow for X-rays and see about upgrading weightbearing . I’m still in a lot of pain and I will be at 5 and 1/2 weeks . I’m wondering g about why some have non weight bearing for 12 weeks. Nervous I have damage in my foot as the top of foot is still very painful. My job is physical therapy in a nursing home …. how will I be able to help my patients ! It requires lifting , and I’m in pain myself !
I got knocked over and rolled my ankle ending up with a trimalleolar fracture on Feb 11th. I’m glad I found this site as it gives me an idea of the tough uphill battle ahead of me to get back to some semblance of normalcy.
It’s a little disheartening reading some of the other posts and I agree it has been tough having to rely on others for the basics: showering, meals, laundry, grocery shopping… but I’ve had a awesome support system of family, my dog, friends, boss, etc.
However, I’m a fighter. This may only be the beginning of my uphill trek, but at least I now have a realistic perspective from which to start. I’ll take it a day at a time, little steps, and each forward progress is a goal attained even if it’s slow…
Gosh, I sound like the Tortoise in “The Tortoise and the Hare”… LOL.. Guess you can just call me Snappy! Hey, at least I’ll be, H E Double Hockey Sticks, on wheels with my knee scooter and it’s bell! Watch out!
I’m going to keep a positive mental attitude in place, look for the good not the bad, and be willing to laugh at myself because it appears that I will look like a clumsy dork for quite some time!
I have a bimalleolar fracture from a freak accident. I’m 62 yrs old. This is wonderful informative site, which I have found most helpful. It’s four weeks since fixation surgery. One plate, thirteen screws, two which bind my syndesmotic joint between tibia and fibula are to be removed 12 weeks post surgery. I have been instructed to only apply “touch weight” until 6 weeks after surgery. The ankle swells when my leg is vertical and it gets quite painful, but the swelling goes away after elevating my leg. I’m hoping the swelling will go away altogether. The ankle joint is still tender and painful under certain movements. I am inspired by all the posts I have read here and I will battle on to make my recovery. It seems everyone’s experience Whilst similar is also unique.
I had the Tri fracture with a dislocation. I’m 2 years in August post op and still have pain in both my ankle and foot. I limp in the morning due to stiffness. I can’t stand and walk for too long without once again having pain. It’s a serious injury and no one can possibly understand the recovery period as it is challenging and hard. I was not walking without any aid until post op 5 months ! People think you should be up and running after six weeks. They haven’t a clue. I had physio for over a year and I’m still doing exercises. I personally don’t think it will get right. It was far too damaged. I feel for others going through this.
I fell and dislocated my leg and had a trimalleolar fracture on December 17. I have two plates and thirteen screws—very painful. I am glad I found this information as my doctor did not prepare me for what to expect. God bless.
I had a trimalleolar fracture the day after Thanksgiving, in my own home. Freak accident. Slip and fall on tile floors. Surgery 2 weeks after and it’s now been 3 weeks post surgery. This has the been the longest 5 weeks of my life. On top of this, I have a one year old nursing baby. I’m in my mid-late 30’s. It’s been miserable. I’m almost 100% dependent on my hubby who takes care of me, our baby, himself, his job, and our home 🙁 I feel like such a burden. I want to stress as little as possible to heal as quickly as possible. My doctor wrote a note for me not to work for another 3 weeks but I’m conflicted because there’s a lot going on. I thought I would be back to my very active self once I could be weight bearing but based after reading this article, it helped me on what to expect realistically. I think i feel more depressed now though knowing it might be even longer before things return to normalcy.
A year and a half ago I had surgery for a trimalleolar fracture. To be honest you shoud never stop your physical therapy, always find time to do it at home for the next few years if not for the rest of your life. Stretching and working the mussels is something that Im still doing daily. I broke down and joined a gym at 41 years old knowing that I would never be the same if I didnt. Im still about 10lbs off on my repaired left leg, my right is still stronger. I still have pain, but I deal with it and I also walk all day but I can now run at top speed. You will get better but you have to put a lot of work in it to be close to 100% wich you will never be 100% but close is pretty darn good. My gait was off so my body and to adjust to a new walk, the way my feet hit the ground when I walked. Because of this I developed plantar fasciitis. Be sure to ask your doctor about inserts for your shoes. You will trust your ankle again for the most part to do its job and hold you up while holding 100lbs and Ive done it and it held me. Good luck to all of you on your recovery. My the force be with you!!
June 6th got into a fight ended up 2 on 1 got tackled broke 3 bones one in 6 pieces did phisical therepy off work 5 months now back for 3 weeks and it’s killing me got ankle braces tommy copper compression and have a compression sock coming in the mail tomm yes it’s a very serious break and swells up bad being on concrete all night at my job affected my living walk in pain with a bad limp and hope to god it gets better then this Dec 12th is my next xray hope I get goof news
My journey to recovery of trimalluear ankle fracture post op slip n fall has been very difficult and slow recovery process. 74 days bed confined and non weight barring was exhausting to bounce back from that and pain level was tremendous and agonizing for 2.5 months. Find a comfortable shoe for pt was a tad bit of process left foot man’s 10.5 and right foot regular size female 8. Finally To get the strength to do pt after being so confined. And then have courage to start putting weight on now healed bones ..walker for 80 days. Then weaned to crutches 2 weeks. Then 1 crutch slowly barring more and more weight on affected ankle ..then to wean off the boot into shoe(swelling and more swelling) doing pt 2 plus hours every other day is geueling… Finally little over 3 months into this .. I am getting some range of motion back into foot. Flexion is taking a lot longer to rebound.. Gave up the cane and have quit a noticeable waddle to my fair but things are finally moving forward and progress is being made. It is nothing you can rush and it will come with time lots of time to he and there will be a lot of bad days eventually good ones will come and you have push thru the pain to gain back mobility . in just a few more weeks I will hit my 4 month mark of being off of work . I am able to walk few hundred feet and almost 6 minutes intervals ..swelling is down looks good … Pain level down to consistent 3 like dull tooth ache.. I can only wear a shoe for about 4 to t hours and it has to come off…. Heat to get moving on am with ankle pump excerises get range of motion and end the day packing it with ice several times before bed while elevating it . 3 weeks to get walk further and shoe on longer so I can return to work. Good luck if you are facing this injury .no easy or fast cure unfortunately painfully slow and very difficult and long recovery
I had such a silly fall resulting in a trimalleolar fracture of my left ankle. Surgery 06.10.2016. After reading up on the condition I am happy to report that I appear to be recovering well. Followed Dr.s instructions and kept my leg elevated (very frustrating having to ask for help with everything) did all my toe wiggling, buttock clenching and leg raises . things appear to be going well as the pain has subsided dramatically and am lucky enough to have the space to put a bed downstairs. Without the aides to living life over the past few weeks would have been difficult. Now have a full cast on for the next 4 weeks (shocking pink) before next appointment when I may be able to commence weight baring . I have to say have been pleasantly surprised by my recovery so far and hope it continues despite my foot looking a bit like a dogs dinner. I have to praise our emergency services and say God bless the NHS.
I’m so glad I found this article. I am a year and a half post tri fracure and I still swell and hurt so much. I get sharp stabbing pains. The Dr’s have done 3 procedures but they don’t help for long. They have done so many tests and can’t tell me why it hurts so much still. Does anyone else have this?
Hi Chris.
Yes, I’m 2 years in August post op and still have pain in both my ankle and foot. Very stiff every morning and it takes me a while to get going. I have different pains and they move about, but mainly the pain is around the inner ankle bone. I feel for you and it has been a very difficult road for me too. Susan
I slipped on day 2 of my holiday. It’s been 14 days I have a trimalleolar fracture. Put in temporary supporting cast had numerous Xrays my consultant said if after three weeks the bones have not moved they will put my foot in a cast and I will not require surgery? I have been in and out of hospital with pain and large blood blister on ankle where cast been rubbing. I am lying everyday to get the swelling down I am optimistic but worried about long term complications / problems.
I fell and had a trimalleor fx and to go with it a butterfly fibia fracture with a chip broken under it. I developed the blisters after the surgery and caused pain under the cast. They removed it 8 days postop and put me in a boot with no,wt bearing for at least 12 weeks. I am now at 11 weeks and it has been miserable. Not being able to do for my self is horrible. Next week we are removing 2 of the screws and hopfully I will start therapy in 2 weeks after that. I will still have 2 pieces of hardware and 12 screws in my leg. I have a great looking scar because my surgeon is a sports specialist, he didn’t make big stitches or staples. I have a very smooth scar that will face over time who I is good cause it is about 10 inches long on the outside of leg. Hoping to walk by Christmas and hoping the nerve pain will go away soon.
I have a trimalleolar fracture and am 12 weeks non-weight bearing. Currently, I am week 6 and will go in for x-rays next week. My Doctor told me to do 2 sets of 15 minutes ROM exercises, which I have done every day since week 3 and my ROM is quite good. The problem is I have intense burning at the Medial Malleolar site (the bone on the inside of my foot) along with the bank across my ankle, which is exacerbated when I do my ROM exercises and burns and stings almost contantly. My PA suggested I stop my ROM exercises for 3 or 4 days to see if it alleviates the pain, but I’m nervous I will lose my range of motion that I’ve worked so hard to have. Anyone else experience this intense burning pain? I’m hoping it’s normal pain…..
On August 6 I broke both ankles…trimalleolar fracture in my left…a broken right ankle and a fractured foot. I had surgery on 8/19 and had a plate n several screws put in. I am about 6 weeks post surgery and still no weight bearing. After my post op appt I was put in a CAM boot. My right ankle was already in one, no surgery needed. I have seen so many different posts with different recovery times n NWB times….my dr says 6-8 weeks but some ppl were walking in a boot 2-3 weeks after surgery! This has been a rough, rough situation and am just ready to get back to some normalcy. Today I have a healed right ankle/foot and am a little more mobile with crutches. I am just tired of sitting day in and day out. I would not wish this on my worst enemy. You definitely have to stay positive.
Cont’d. Therapy: I has a physical therapist come to me in the hospital to give me my exercises to do on my own and teach me how to use the walker on one foot. The boot is was heavy so it was helpful to know how to place my left leg on the ground while holding up the affected right leg. When I went home, I was ordered home therapy. Physical therapy and Occupational therapy. I asked for nursing which typically is not ordered because my dressing was something that I or my husband could do but I had never had a break like this before and wanted skilled eyes on my wound/dressing to ensure there was no infection and the healing was taking place as planned. So my doc ordered nursing. Physical therapy taught me how to get around on all my devices and increased the type of exercises I did. occupational therapy helped me adjust to my new condition and helped me make adjustments to my daily routine so I could depend less on others. I am a pretty active person but coming home and dealing with all the throbbing and leg elevation, I found myself wanting only to sleep and watch Netflix. Occupational therapy designed a daily Out Of Bed routine to get me up and rolling. A lifesaver really. When I am able to beat some weight, I will be ordered outpatient physical therapy to ease the joints ligaments tendons and muscles back in business. I hope this has been helpful. Therapy is an integral part if this process .
I fell on May 18, 2016 and it resulted in a trimaeleolar fracture. The surgery was done on May 23. The surgeon put in one plate and 8 screws. My Doctor told me to start putting weight on it gradually on my last visit. He said he expects me to walk in with a cane at my next visit…I was in a wheel chair at the time. Is he crazy? It is almost a month since that visit and I am using a walker and am nowhere near putting my full weight on that leg. The pain is pretty bad when I try although I have slowly been able to put more and more weight on it. Is this pain normal?
I just experienced a trimal about two weeks ago.. Fracture blisters lready present and all…i have fallen a half dozen times in he spint already. I do stairs in my cruches. Loaded some tires today in a friends trunk.. Do dishes..laundry..go shopping.vacuum..get my own food n ice.. Shower even. Its mind over matter pain wise and matter over mind responsibility wise… Ive been resched for operation another 7 days from injury on account of swelling and blisters. At 22 years old on the street is no way to be with this injury. But i know ill be fine because i wont allow a lazy attempt at recovery.. Prayers for makng it past surgery…heart to make it thru recovery
My break was a trimalleolar. I’m 3 months post surgery and I think I’m doing pretty well with walking, but my entire foot is numb. It was not numb at the time of the break, not after the reduction, and it was not numb pre-surgery. It was numb immediately following surgery and I’m freaking out about it. The doc says he doesn’t know why it’s numb, shouldn’t be . . .????
In any case, the ankle is good, not as much flexibility as I’d like, but I’m walking. If the numbness would just go away, then I’d be a happy camper. Anyone else have numbness?
Thank you for your comment as it pertains to my concern. I am early on as my accident was March 8, 2017. Surgery was performed within 24 hours of accident. The coloeing in my toes is good as long as elevated; however, all my toes and the ball of my foot are numb. Dr. doesn’t seem to be concerned, but I am.
I have a trimalleolar fracture from a freak fall accident that resulted in several (at least 6) screws and a couple (2 maybe 3) plates. Thank you for the heads up about physical therapy and how long it will take to restore some semblance of normalcy. It’s been about one month since the surgery and I’ve not worked since – this is driving me batty – sitting at home day after day. Like the previous poster said – it’s good to know what I’m up against.
I am 8 months on after a bi-malleolar fracture.Its a very long process.I was part weight bearing 6 weeks after surgery.I taught this isn’t too bad.Was walking with limp after 12 weeks,and then i hit a wall.Progress has been extreamly slow.Im still walking with a limp in the morning until it warms up.Still have really bad ROM and pain when doing physio.Every day seems like starting all over again regarding the stiffness.I think people need to be realistic about the time needed to recover from these bad injuries.My friend is 3 years on from the same fracture and at 90% ROM.I hope i get to 90% as i am at 50-60% at the moment.It will get better but it takes a lot longer than a year.I was told 6 months by my doc and physio,which was very misleading.
I had a Trimalleolar Fracture which was closed by surgery 5.3.16. After x-rays on 6.13.16 my podiatric surgeon released me to full weight bearing. I know that flies in the face of the 3-4 months mentioned in the article, but so far their have been limited pain in the ankle and usually only after full range of motion and strength physical therapy. I go back 7.7.16 for another check up and x-rays and will see if there is any problem.
I had my second open reduction internal fixation surgery in my right ankle last april 15 because my first surgery failed and yesterday my doctor removed the cast, 7 weeks after the surgery and advised me to start in just toe – touch.i followed what he said but i feel that my tibia bone seem to be different than yesterday .i dont know if it moved a little bit or i am just overthinking because it is a little bit big in appearance today than yesterday.is it really ok to remove the cast for 7 weeks after surgery for a bi malleolar fracture?
Why did your surgery fail?
This is right on the timing for weight bearing. I am doing physical therapy and I have been off work 2 months – they want me to work – I can’t even walk.
This article is very thorough. I have tried other sites but not as informed as this site. Thank you for your full detailed synopsis of these type of fractures
. I can now say i know what i am up against.
I slipped and had the tri break in my left foot while on holiday. It wasn’t painful at first quite numb. But when they put it back in place then I felt the pain. Did this 23 October 2015 it’s February 5th and I can walk a little before really bad pain but at the top of My plate. I can’t put up with this so want it removed see surgeon 29th February but I’ve not been told or given physio ?? Am 54 and had enough of the pain anyone else like me
I have recently ended up with a trimalleolar fracture that I received from a nasty accident. Never did I think that this injury would have such a devastating impact on my life. I am so dependant on others and equipment, which causes huge frustrations and can be quite upsetting. Not only is my physical health turned upside down, but so is my mental health. A person that experiences this injury must be supported with as much help and support as possible.
I had my procedure done in May2014 it is now August 2015 and my foot still kills me is still vascular problems with swelling and the screws and plates still hurt me and I have to lay down and elevate it which doesn’t really help much even pain medication doesn’t help the back of my leg has been slice 2 with muscle involvement and then they also remove they said a butterfly chip. I did have physical therapy but do you have any answers why I would be over a year and a half and I’m still having as much pain
This article does a great job explaining the general recovery from bi- and trimalleolar fractures. This is a long process and physical therapists play a big role in the recovery process. Due to the extended period of NWB status, patients typical lose a lot strength and experience decreased ROM. It is important that physical therapists understand the surgery each patient went through, in order to help them through the recovery period and help them feel comfortable easing back into weight bearing on the involved extremity.