Screws and plates are often used in surgery to fix fractures or fuse joints in the ankle. In most instances, these screws and plates do not create symptoms and remain in the foot. In some patients, hardware can become prominent or irritate a tendon or other soft tissue. Initially, this may be treated with padding over the area. However, if this is not satisfactory, patients may benefit from hardware removal once the fracture or fusion has fully healed.
Patients that have previously had surgery to fix a fracture of the foot and ankle or to fuse a bone may have retained hardware that can become prominent and/or creates discomfort. While most retained hardware is asymptomatic some patients will develop symptoms. The symptoms can be due to a screw or plate that rubs against a boot, or pain may be produced when the tendon or soft tissue structure rubs against the prominent screw or plate. When patients are recovering from the original injury or surgery, the symptoms and swelling are such that the hardware is usually not a significant issue. However, over time when the swelling settles, hardware can become prominent and in some instances, may need to be removed.
On exam, the hardware can usually be palpated under the skin. There may be a bursa (fluid filled sac of tissue) or an area of inflammation associated with the area.
X-rays will reveal the hardware if it is metal (most screws are stainless steel). X-rays may also identify the area of the hardware which is likely to be causing the symptoms. Occasionally prominent, non-absorbent sutures or other forms of retained surgical material may create symptoms but not show up on x-rays. These objects are not seen on x-ray (radiolucent).
Most hardware that is placed to fix a fracture or fuse a joint does not need to be removed and in fact, will not cause any symptoms. In most instances, it is either retained within the bone or is not particularly prominent with adequate covering of soft tissues. However, with some individuals and with some types of surgeries symptoms may arise. In this instance, symptoms can be treated with local padding such as wearing a thick sock or using a local gel pad. If this is not acceptable for symptom relief then consideration should be given to removing the hardware after the fracture or fusion has fully healed.
Certain foot and ankle operations have a higher rate of needing hardware removal than others. These include:
1) previous ankle fracture fixation of the distal fibula
2) calcaneous osteotomy with a prominent screw in the heel area.
3) A calcaneal fracture with hardware on the outside aspect of the heel bone.
4) A lateral column lengthening procedure as part of a flat foot reconstruction with hardware on the outside and front part of the heel bone (calcaneous).
5) Hardware placed in the midfoot and forefoot may be prominent and may need to be replaced.