Red/Purple leg and foot after TPF (anybody have this)

[68gto]

I was injurred on 3/4/06 with a Tibial Plateau crush ad fracture (lateral).  A primary concern at this point is that when I am vertical in the walker/crutches (I'm still NWB) my leg turns a VERY VERY angry red/purple from the top of the knee through the foot. The foot especially looks bad (probably cause I can see it easier).  The OS keeps telling me it will clear up and has been saying that since the beginning but it actually comes on quicker (within seconds of being vertical) now.  In a few minutes the foot is aching and throbbing and the knee is huge and nasty looking.   sitting with legs horizontal or elevated color returns.  Color also returns to some extent if I bend the knee to about 90  when sitting up.   I saw a vascular surgeon who said it was neurological.  Both dopler venous and arterial tests didn't disclose anything but they were done in the horizontal position.  Could this be an RDS/CRPS symptom?  I hope not. There's no burning or pain except the aching.  I keep thinking its a venous problem being horizontal and blood can't for some reason get back up the leg.  Has anybody experienced this.  I was immobile for 6 weeks too.   Could the hardware in my knee (7 nails and plate) cause this, the ends of a couple of nails do protrude and I wonder if they don't press on the vein/nerve on the side of the knee.  Muscles have extreme atrophy, maybe when I can weight bear things will clear up?   Looking for someone who's experienced this and can give some info.  thanks

[overmodulated]

Hang in, listen to the OS.  I had a nasty TBF and same problem as yours whenever I was vertical.  The entire leg throbbed as you described, the knee was about the size of a cantaloupe (only a little exaggeration used here), and I couldn't fit a shoe or sneaker on my foot most of the time.  Only when I layed down and elevated it did it feel and look better.  This went on for many weeks.

Until you can start working that leg (that is, doing some serious Physical Therapy with lots of movement) to get the blood flowing again, and especially until you can start bearing weight, the swelling and redness should be expected.

Hang in, keep us posted on progress.  This is one tough break, as you're well aware.

[Marion]

Hi,
During my recuperation, before I was up and about, they recommended pumping my ankles (flex/point/flex/point) to help circulation and avoid clots. Maybe you want to ask the docs about this?

I just read that your calf muscle (specifically the soleus) is sometimes considered to be an 'auxiliary heart' due to its role in pushing the venuous blood back up to the heart.

M.

[68gto]

Thanks for your replies.   I have my next checkup 5/19 where last weeks CT Scan results get looked at. And if things look good I'm hoping for some weight bearing. I've been doing the calf pumps and PT once a week which haven't helped the situation I described. Hopefully, as stated above getting the muscles working wth weight will help. PT will increase when I can actually do some real exercises. I can't imagine the situation staying this way indefinitely.

[Marion]

"doing the calf pumps and PT once a week"

but surely you're doing the calf pumps and other PT exercises a few times a day?

[marse]

Hi GTO - Don't know if this will be helpful or not but it's worth a try I think:  Can you reach your foot?  If so, gently press on the bottom of it to help push blood and fluids back up your leg.  If you can't reach it, maybe someone in your household can massage it for you.  And if neither of those options work, use the top of your "good" foot to press gently against the bottom of your "bad" foot.  After the massage - be sure to elevate it to help with drainage.  I'm 7 weeks post surgery for a Type II TPF (plate, pin & three screws).  If I am upright for long, my leg still turns red, my foot purple.  I guess it will do that until I can put weight on it.  Sometimes I put a soft pillow on the end of the bed and press my foot against it and that seems to help circulation too.  Good luck- ~ Marse

[68gto]

Marion,  that didn't come across right.  I meant I only get PT once a week because there's not a lot we can do yet. I have a few exercises but basically for the hip, other than toe touches, and foot slide for  ROM. Marse, let me know if weight bearing helps clear this up, you probably will be before me. Its just hard to imagine weight bearing will solve this problem when the good leg isnt getting a whole lot of work and stays perfectly normal.  This is really bugging me, especially after reading all that stuff on RDS/CRPS on this site and the vascular surgeon calling it a neurological problem.

[swissvicky]

Hi, I can totally identify with all this as i suffered very serious TPF 10 weeks ago whilst sledging in Switzerland. I hit a wooden post at approx 30 mph. I was in hospital there for 12 days after emergency surgery to fit plate and 7 screws and bone graft. The pain was unbearable as you all know. Having returned to the UK 8 weeks ago, I'm going to physio twice a week and it is only in the last two weeks that I have noticed any major changes in the amount of weight I can use and the ROM is almost 100%. I am still very worried though by the colour of my leg (dark purple) and the fact I cannot fully straighten my leg. I have been PWB for about three weeks which has helped my quads return to life as had totally withered away. I have been using an exercise bike from about two weeks after my operation - though only managed a full revolution last week. 
I too am unable to sleep due to the pain and have been prescribed anti-depressants which I have not yet taken. I am used to be very busy and very active and now I seem helpless and can't imagine walking properly again. I am desperate to get better so I can get to back to how life was and I am practicing on one crutch as much as I can.  My foot and my lower calf go totally ice cold at various parts of the day (including now as I'm typing!).  The answer I get to any of my questions is that things will get better with time and that I must accept the seriousness of my injury and not rush things. It is easy for the doctors to say when they are not the ones staring at the same four walls everyday. To be honest, as mush as I couldn't wait to get back home from Switzerland - the treatment by the health professional there was far superior to the treatment I have received back home in England.
I am so glad I've discovered this website as it has helped me feel better about my injury by knowing someone else knows what it is like. Most days I cannot imagine having a pain free leg ever again. 
Please don't worry if things take longer than you want to get better - I'm just accepting now. Also, I've seen how much progress my leg has made in the last two weeks and that has encouraged me to do even more home physio. Until my accident I never had any understanding of what a worthwhile job physiotherapists do.  I am eternally grateful to mine.
Good luck, Vicky

[marse]

Hi Swiss Vicky & GTO - I suppose all of our fractures are different - even though they are all TPFs.  And we are all at different stages of healing...but we do all share much this experience at near the same time.  It is interesting to me that some of what has happened and is happening to us differs.  I go to PT once every two weeks since there's not much I can do while non-weight bearing.  The exercises I do are mainly leg lifts, glute and quad sets and squeezing a ball between my knees to try to maintain some quad strength.  Then of course there are the ROM exercises, pulling on my leg with a strap while lying on my belly, heel slides, etc.  and finally general stretches to help with aches and pains caused by crutching and hiking my right hip up to keep my foot off the ground.  I was in the hospital for 2 nights, was in a leg immobilizer for a week, and had my stitches out after a week.  I cannot drive so unless I can con my husband or daughter into taking me somewhere, I am mostly housebound except for doctor's appointments...yuck.  A couple of times a week, I go stir crazy and go for a "crutch" up and down my street.  For some reason, this type of break seems to strike really active people. (I guess it's because of our activities - skiing for me)  We aren't used to being quiet for long, are we?  So of course this experience is even more difficult for us than it would be for someone who lives a less active life.  I dream of walking, so I sleep with my walker right next to the bed, so I don't accidentally "forget" if I wake during the night and get up.  Speaking of sleeping, I was having a difficult time - so I asked my OS.  He said to try Tylenol PM before trying anything stronger like Ambien so I did and it has helped me re-establish a more normal sleeping pattern.  Also, as my range of motion has increased, it has gotten easier for me to sleep in my favorite positions.  Vicky - since you are PWB - maybe you can let GTO & Me know how that is going.  Does the bottom of your foot hurt?  Just pressing on my arch really seems to hurt so I'm anticpating that when I start to put weight on my foot after being off it for 95 days, it will hurt.  Also, does your leg swell again when you start to bear weight?  I have so many questions....Anyway - GTO - I hope your are having less redness, swelling and pain with your leg now.  Vicky - I've had my bike and cycle trainer set up for weeks, but still haven't been given the go ahead to use it.  Did you find it hard at first?  I just started on anti-depressants last week.  I'm using them because I was having days when I could not stop crying.  It was weird and I didn't like feeling so low, so I asked my GP for a prescription to help me get through the next few months.  Keep the faith that all will get better for us - slowly, but steadily ~ Marse

[jsteenso]

Hang in there. Just to add a bit of levity, after 40 years of Motorcycling (road racing, sport riding, MSF safety instructing, etc.) I was taken out by a Saturn L200 in a crosswalk with the walk sign lit. This was on March 11th, 2006. I had surgery on March 17th and while in the hospital recovering was afflicted with gout (for the first time) in the leg that had been operated on. The gout hurt worse than my TPF or recovery from the resultant surgery which I somehow thought was quite funny. So there I was with tears streaming down my face from the pain while laughing at the hilarity of my predicament.
Short story long; I have the same symptoms while standing exacerbated by the gout episode so I have nothing but sympathy for you. Hope it gets better!

[68gto]

Went back today to OS for checkup and WB decision.   After 11 weeks its going to be another 4 before even partial weight.  This is crazy! I don't  see 15 weeks NWB for anybody.

[mtsarpilot]

Wow, that has to feel frustrating.  But remember, every injury and healing rate is different.  You have to trust the OS is doing the right thing for you.  Similar to what you are experiencing, I was immobilized 11 weeks for my patella fracture when everyone else was getting out of the brace in much less time.  It was very frustrating at the time.  But in the end I have come out of this far better than I could have expected.  Keep in mind that this is for your life long term.  While another 4 weeks feels like it sucks now, if it makes a difference for the rest of your life, it is worth it and the right call.  In 2 years you won't be bothered by the fact that you had to go another 4 weeks, but if the OS let you start to early and messed the healing up, you'll surely still be hating it years later. 

Hang in there.  Emotionally it is really tough to go in to the OS all hopeful that you can walk soon, and then have those hopes dashed.  Hard to take, but you gotta trust they are doing the right thing.  Revel in the progress you are making, and kick this thing in the butt in 4 more weeks.

Joel

[overmodulated]

68gto:  I had to be completely NWB for 16 weeks. 

It worked out being even longer due to a necessary second operation (12 days after the first repair), plus the extra time that it took for me to get an appointment with the OS for approval to attempt that first step (i.e. bear weight again).  When I tried applying weight to the injured leg for the first time in 20 weeks, it felt like I had no strength left, and it hurt like hell.  Despite my best efforts during PT, there is no substitute for normal daily weight-bearing activity.  Quads are always the first to go.  It felt like I had the equivalent strength of a newborn baby who had never taken a step before.   Long, tough road , but you'll come out of it ok my friend.  Make it easier by being diligent with PT. Keep us all posted.

[68gto]

68gto:  I had to be completely NWB for 16 weeks. 

It worked out being even longer due to a necessary second operation (12 days after the first repair), plus the extra time that it took for me to get an appointment with the OS for approval to attempt that first step (i.e. bear weight again).  When I tried applying weight to the injured leg for the first time in 20 weeks, it felt like I had no strength left, and it hurt like hell.  Despite my best efforts during PT, there is no substitute for normal daily weight-bearing activity.  Quads are always the first to go.  It felt like I had the equivalent strength of a newborn baby who had never taken a step before.   Long, tough road , but you'll come out of it ok my friend.  Make it easier by being diligent with PT. Keep us all posted.

Thanks for your reply.   This is too frustrating, completely unexpected to get the news of 4 more weeks when 3 weeks ago the prognosis was that it looked good from Xray and just wanted CT scan to confirm.  I forgot too,  OS cancelled ALL PT at the same time until I can weight bare.   I saw the surgery report in my records and facts don't jive with what OS is telling me either.   I get the feeling he's being WAY WAY over cautious for some reason. Maybe somebody suied him in the past.      Can anybody recommend a good OS in the DC/Northern Va. area?

[swissvicky]

Dear All,

I've just been reading all the latest entries here and I'm surprised re the NWB some people have been advised of. Briefly I am now almost  weeks post op from my high impact accident and TPF. I have been having phsyio from a few days after the operation. I have been PWB for about three weeks officially.  Last week my OS said I was heling very well and was able to fully WB whenever I was ready. My physio then had me walking without crutches for approx 5 mins in her office last Wed. It felt wonderful and very strange however, I have had really bad knee pain and stiffness ever since. I seem to have gone backwards in my recovery. I am still using my exercise bike and strecthes but the knee feels like it will never straighten as it is so tight. I thought I was on the road to recovery and now I have gone backwards. It must have been too early to even try to walk without my crutches. I have more physio tomorrow and I am dreading it.

I was asked last week about using my exercise bike. I have been doing half revolutions on my bike from about 3 weeks post op. Only for a few minutes about 3 times a day. In the past three weeks however, as my knee was bending more, I have been able to do full revolutions on the bike and I have been cycling about 5 miles three times a day. I have the resistance very low. However, like so many of you my thigh muscle had completely disappeared and was waving in the wind so my physio advised that I put my bad leg to the top on my bike and increase the tension quite high and push down with my bad leg to the botton then repeat (by using good leg to drag the pedals back to where I started).  This, along with the protein tablets I have been taking, has really increased my thigh muscle. What also helped my thight muscle return was going onto one crutch a lot of the time.

I have been totally fed up these last few days thinking that my knee will always be very stiff and painful. My physio has told me I am unlikely to straighten my leg fully as I used to be able too and there will be certain activties I can no longer do. I am also worried regarding the very top screw as it protrudes clearly from the top of shin and I dread falling in the future or grazing my leg and damaging the screw with it being just below the skin.

I haven't heard anyone mention scar adhesion. My scar is from just above my knee all the way down my shin bone so my physio told me to massage my scar gently to keep it moving so it doesn't heal directly onto the shin bone with it being so close together. I don't have to bother with this for the bone graft scar on my hip as there's more flesh there!! My leg is still a strange colour, won't straighten and is painful as hell and I'm sick of it. Like somebody mentioned before, TPF is something which will happen mainly to active people. 

Does anybody have any guidance when the general pain will ease so every time I move I'm not reminded of how seriously I have injured my leg??? At this moment in time, it seems a long way off especially with my OS constantly telling me how bad my accident was and the injury.

I hope my experience is of some help to people as reading all your messages makes me feel much better and less isolated. Thanks, Vicky

[yippy]

Swissvicky.
 I see a massage therepist regularly and she has done absolute wonders for my scar adheshion. I didn't have a scar in the front of my leg but had a large scar on the inside of my leg after an artery repair I damaged when I did my TPF.After many massages this scar feels free and not adhered to anything. I would give this a go but like all things related to these nasty breaks it takes a bit of time. ( I am nearly at 2 years and still have issues)
Good luck.
68gto hang in there I remember being where you are and all I can say is that it all gets better even though I never thought so when I first did my injury. If the vascular sugeons have checked you out I would be happy. I blocked my popliteal artery when I broke my leg and this showed up when I was horizontal.
Keep up the physio etc you will see improvement.
Marianne

[68gto]

Thought I'd post about this issue as its been 3 months.

After starting to weight bear in July the purpling gradually started to improve. It had gotten to be pretty nasty --- Now it is gone completely, although I still have a bit of rudiness in that leg but getting better all the time.  I was 15 weeks NWB so I guess it is brought on by lack of muscle contraction and once you get going again it clears up.


Also, I had developed a condition where the skin on the front of the shin to the foot would get very red and have a burning sensation.  I don't know if that was a bit of RSD or not. It would come and go. But that too has now diminished and gone away completely over time.

Hope this helps anyone else that might be experiencing it.