Chronic ankle pain, four years after surgery: Reflex Sympathetic Dystrophy ?

Patient

Q: Since I had surgery on my ankle four years ago (bone fragment chipped off) I have always had pain, every day. There are times that I can barely bare weight on it. Right now is one of those times, I'm taking Ibprophen and have a brace on. My job requires constant standing or walking so, I'm suffering with this problem and I don't know what to do about it. Any thoughts or suggestions would be greatly appreciated.

Doctor

A:   Unfortunately, one can’t predict the exact outcome in terms of pain after an ankle surgery, the surgeon takes care of the fracture, but in a percentage of patients there is persistent pain by unknown reasons, to this also contributes if the patient is an overweight individual, which suppose an extra stress on the joint. For these kind of patients is very important the rehabilitation program post operative. Your case may be managed as chronic ankle pain .You might benefit of Physical Therapy and anti-inflammatory medication. Some antidepressants are useful as part of the management of chronic pain. In addition, these medications may improve the patient's ability to cope, and they may reduce depression, anxiety, or fatigue associated with chronic pain. Local anesthetics, corticosteroids, or other substances may be directly injected into painful soft tissues and  joints. Would be also important to rule out according with the timing of the events and your description of the symptoms, a complication of the  fracture called Reflex Sympathetic Dystrophy (RSD), it can be considered an excessive sympathetic reaction (the sympathetic is part of the “automatic” nervous system) of joints and  soft tissues around to any injury, traumatic or unknown. RSD is characterized by pain, regional edema, joint stiffness, muscular atrophy, vasomotor disturbances like temperature and color changes), skin changes, and regional bone demineralization seen on X-rays. These changes are worsen by activity and extend over a larger area than the primary injury or surgery, including the area distal to this focus.

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