Pain after 6 weeks of an ankle repair surgery

Patient

Q: I recently had surgery to repair a torn and rupture tendons in my left ankle and they also removed a piece of broken bone in my ankle that had been broken off. They did the large incision on the side and the two small ones for the bone. The questions I have are as follows: I've recently moved from a cast and cruches (6 weeks) in those and then to a boot. The problem I'm having is pain in the bottom of my foot on the outside of the bone on the same side as the surgery site also when i step on a cold tile floor that foot feels dramaticly colder than the good foot. It's also red (foot) but just unsure why I notice the cold floor so much more on the surgery foot than my normal foot.

Doctor

A:   Unfortunately the healing time is different for each patient in particular, and depends on the severity of the initial injury, treatment modality and other factors, also the changes in temperature and color that you experience in your foot may be due to 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 worsening by activity and extend over a larger area than the primary injury or surgery, including the area distal to this focus. On the other hand you may need additional physical therapy and rehabilitation time to deal with this possible RSD and strengthening the surrounding muscles and this will help the healing process. I strongly recommend that you get an evaluation by a physiatrist and work together on a good rehabilitation program for your ankle.

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