Dr. Timothy K. Durnin - 9/6/2007

Question
Long story short. fell in mid June walked on it until mid July before an MRI showed "bone bruise" or stress fracture to cuboid. was placed in a hard cast 3 weeks into 5 week adventure cast loosened up and ankle joint really sore. went back cut off cast given cam that went up to my knee still no walking on it for 5 weeks. 1 week later pure agony cam was pressing on injury spot and twisting ankle. saw second Dr. in same office was advised that talus was bruised as well placed in another hard cast for 4 weeks. was told 1 week out from visit try to walk on it gradually. I still have pain in the ankle joint if my leg twists in the cast at all but walking 50% is somewhat tolerable but swelling after it was pretty intense. The pain when twisting has me alarmed this cast has loosened up as well. second Dr. assured me no soft tissue damage just a bone injury. Am I looking at passably another cast for a few weeks here? I don't want the cam it was pure hell. What is a normal amount of time for a double injury? I know PT is in my future. Thank you so much for reading!

Answer
Hi Todd,

PT is not necessarily in the future, periostitis (bone bruise) is a slow healing and painful exercise in patience.

This condition often takes months, not weeks, to become tolerable. Expect reminders a year later that it still needs time. I recommend the cast be changed every couple weeks if you are remotely active, making sure metal hinges are clear of tender areas.
Since you re-inflamed the other area, add a few weeks to recovery time, These specific injuries are unpleasant for both patient and doctor because the ridiculous amount of time it takes to recover. Many times it is better to fracture the bone instead of bruising it. Once the periosteum is breached, as in most fractures, fluid from inflammation is allowed to drain. In a "closed" injury such as this, the swelling has nowhere to go, so pressures get high and push on sensitive nerve supply causing a viscous cycle of pain. Give this double the amount of time you or your doctor thinks it will take, then a better and more realistic expectation won't disappoint you down the road. The sooner you can get ice on it the better. There is no need for PT, no soft tissue injury so there is nothing to rehab. This is purely a time game until it decides to heal, which is a loooong time!

Good Luck!

Dr. Timothy Durnin
drs.chiroweb.com