Coping with ankle injury

Dear Doc: I had a bad auto accident last year – a compound fracture of my left ankle. It was sticking out of my skin. I consider myself a tough guy, but this would make anybody pale.

I had a good surgeon who put in plates and screws, and I went through rehab, just as he told me to do. I did everything to a T, that’s the kind of guy I am.

But now I’m still in pain. Lots of pain. Pain that wakes me up at night. Pain when I sit at my desk, watching TV at home, in the car. I know the cartilage has been damaged, but why do I still hurt? P.S.: I was wearing my seat belt. – David

Dear David: First, I’m glad you were wearing your seat belt. As bad as it was, it probably would have been worse if you hadn’t buckled up.

I can’t believe some people still don’t wear seat belts. I had a guy in the other day who said he doesn’t wear them when he’s close to home because he’s only in the car for a short time. I wanted to say, “Dude, my only crash ever took place about two miles from my house.”

That was when a young woman texting in her car didn’t see me stopped at a stop light. When she plowed into me at 40 mph, my car crinkled and her car crinkled, but because we were both in our belts, we just walked away. Totaled cars, not totaled people.

Now on to your problem: A compound fracture is so much more serious because the bone that went through your skin might just lead to a bone infection. That’s bad news. It also means more complications, longer recovery, more rehab.

Where to start? Physical therapy is the mainstay. They’ll tell you how much to do and how much not to do. This is critical. Too much can put stress on the joint; too little and it won’t heal.

The next step is custom-fitted compression stockings. The over-the-counter kind of TEDs (for thromboembolic deterrent) are fine, but because they’re not custom-fitted, they have drawbacks. Custom stockings are expensive (often costing $100), but they are dandy and can really help with daytime pain.

Now, on to treating the pain with pharmaceuticals. Advil (ibuprofen) is good, but you need to take it every eight hours to get the full anti-inflammatory effect. That’s why I like generic Aleve, two tablets twice a day – that’s 440 milligrams twice daily. Do this for four weeks to get the full effect.

Note that we’re not using it as a painkiller, but as an inflammation killer. It can do wonders, and it’s not addictive or habit-forming.

What about acupuncture? It works for many, especially to get you over the pain hump so you can use your ankle more. I’d try six sessions before deciding whether it’s worthwhile for you.

Same for massage therapy and same for chiropractic, which also can work for anyone with chronic pain. By six visits you should know if either of these will work for you.

And finally, we land on drugs such as hydrocodone and Oxycodone. They do work, especially when you’re home at night trying to get a good night’s sleep. I prescribe them often for just that.

I used to use more of these, but I’ve cut back, just like most other doctors, because of the danger of abuse and the risk of misuse. Used properly and judiciously, these drugs can help you get the rest you need. Stay well.

Dr. Zorba Paster is a family physician, professor at University of Wisconsin School of Medicine and Public Health, and host of the public radio program “Zorba Paster on Your Health,” which airs at noon Wednesdays on 91.1 FM, and noon Sundays on 91.9 FM. His column will appear twice a month in The Spokesman-Review. He can be reached at askzorba@doctorzorba.com.