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Healing: bruising

Bruising is due to bleeding. Blood from injured blood vessels and soft tissue spreads out under the skin and may track a long distance from the fracture site. For example it is common for people who have a break near the knee to see bruising coming out behind the ankle. The big muscles of the calf direct the blood down; it can't come directly to the surface near the knee. sprains of the ankle often result in bruising tracking down to the toes.

The amount of bruising that you see under the skin depends on many different things. Obviously the amount that you bled, but also the looseness of the tissue, the tightness of any splints, bandages or casts and how much you had the leg hang down. The amount of visible bruising is not necessarily a guide to how bad the soft tissue injury was. There is a big vein under the skin at the ankle (the saphenous vein). If you disrupt that you will have massive bruising even if the rest of the soft tissue injury was relatively minor.

Once the injury stops bleeding the blood clots and the red blood cells die; then the iron containing blood pigment, haemoglobin, escapes from the cells. This pigment is red when it contains oxygen but is a dark purple when it is depleted of oxygen. This depletion happens very quickly after the blood clots, so bruising is "black and blue". The inflammatory cells which start mopping up the dead tissue, further denature the pigment so that it can turn yellow and green. Eventually as the blood clot is reabsorbed and converted to scar tissue the pigment is also reabsorbed. However, when there has been a large amount of bruising the skin may be stained permanently. It can take up to 18 months for the colour to return to normal.

Where there has been a lot of bruising there is likely to be a lot of scar tissue and you need to take care to avoid adhesions. Stretching the joints and recovering full movement of the muscles and tendons is the best way to avoid a problem. This is of more importance than the staining.

Myles Clough MD OS

From: Maureen

Hi--when I broke my fibula--about 3 inches above the ankle, the entire lower leg and foot was black. It was the ugliest thing I've ever seen on a human! Gross! This lasted about 3 months. I had horrible soft tissue damage and even after the cast, I think the break was ok (pain-wise) and the tissue parts still hurt. Today--6 months later, there is still a clear line around the lower leg where the bruising began. The foot is somewhat discolored. Is this permanant. Could the pain I feel now--(occassionally) be from the soft tissue damage? Thanks for all you help with our bone problems!!

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 27 May 2020
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