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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 19318
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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In April last year I fell and dislocated and broke my left

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In April last year I fell and dislocated and broke my left ankle in 3 places; it was fixed surgically (ORIF) and within 5 weeks the bones had joined, but recovery is proving very difficult, complicated by the effects of an old back injury almost 50 years ago and a painful right hip so I cannot stand for more than a few minutes, can walk only a short distance without pain, and cannot carry more than a kilo or two without my back going into spasm. In addition the circulation in the injured leg is still poor. I wear a compression sock except at night, but even so by evening the ankle is tight and painful and the foot is slightly swollen and red, and without the sock the leg and foot immediately become quite red. I have difficulty sleeping at night because of the pain and discomfort in the right hip. I do my exercises every morning, and take ibuprofen intermittently for the hip pain, but don't know what to do to improve the circulation in the injured leg.
Hello from JustAnswer.
It will help if you could provide some further information.
Poor circulation can be either arterial or venous (or both).
The swelling, tightness, and use of compression stockings are common for poor venous function.
Have you had any studies of the arterial supply to the leg?
If so, what was done? What was the result?
Customer: replied 3 years ago.

I have not had any studies done of the arterial supply to the leg. I was told that it would take time for the circulation to improve after such a bad break and ORIF, but almost a year seems a very long time to have to wait for improvement.

Yes, it is unusual for it to take a year for this to recover, but you are correct that your other medical problems are hampering recovery of circulation.

As noted above, the symptoms that you describe are more typical for poor venous circulation. Muscular activity of the legs are important for venous function, as it is the squeezing of the veins by the skeletal muscles that push the blood up the leg against gravity. When someone is limited in what activity can be done by the legs, such as from pre-existing back problems, it will impair venous function.

The usual recommendation is simple walking, but if that cannot be done, other exercises of the legs can also be done. Someone with a bad back may find that exercises in a pool are better tolerated, since the buoyancy in water relieves weight bearing in the back.

Regarding other interventions to improve venous circulation, the compression stockings are the usual next recommendation. It also is reasonable to elevate the feet several times per day for 15-30 minutes, ideally above the level of the heart. There also is a supplement that can help with venous function, called horse chestnut.

If there is poor arterial function, that will usually cause pain in the leg that is worse with use of the muscles of the leg. There also can be evidence of poor arterial function if there is a decrease in blood pressure in that leg or diminished pulses felt at the ankle or foot, although the swelling also may interfere with feeling pulses well. If poor arterial circulation is suspected, then there are studies that can be done to assess the arteries, usually first with ultrasound/doppler. If there is evidence of poor arterial circulation, then there are several medicines that can be used, including aspirin, cilostazol, or pentoxyfylline.

At this point, it would be reasonable to perform the additional interventions for poor venous circulation. If necessary, further evaluation towards assessment of arterial circulation can be done subsequently.

If I can provide any further information, please let me know.
Customer: replied 3 years ago.

From what you tell me, the problem is certainly venous rather than arterial. In any case I take aspirin daily as a general precaution. I will check to see if horse chestnut is available in my country (Bosnia and Herzegovina). Exercise in a pool is not an option for me, but as part of my daily exercises I "air cycle" lying on my back. I have regained pretty well full mobility of the ankle (including rotation) so the circulation, and the painful hip impeding walking, are my main problems. Do you have any suggestions for the hip, other than pain killers?

Taking the ibuprofen more consistently would be the next step for the hip. It will take 2-3 weeks of consistent use to achieve the full effect of the ibuprofen.
Customer: replied 3 years ago.

Thank you - I was not aware that I needed to take ibuprofen consistently so I will try that.

It does not always need to be, as many people do not need the full effect, but if intermittent use is not effective, consistent use is the next step.
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