Running with plates and screws in the ankle is conditionally possible, depending on the completion of the healing process and the body’s long-term acceptance of the implants. These internal fixation devices are typically made from titanium or stainless steel. They are surgically installed during open reduction and internal fixation (ORIF) to stabilize severe ankle fractures. Their primary function is to hold fractured bones in correct anatomical alignment while natural bone healing occurs. Returning to high-impact activities like running hinges on a structured, medically-cleared return-to-sport protocol.
Medical and Physical Criteria for Clearance
Before attempting to run, the ankle must meet medical and physical benchmarks established by a surgeon and physical therapist. The foremost requirement is radiographic healing, meaning X-rays must confirm the fractured bone has fully united, demonstrating a solid bridge of new bone across the fracture site. Running before full union risks hardware failure or re-injury.
Physical recovery is equally important, focusing on overcoming deficits caused by the injury and the necessary period of immobilization. A patient must achieve near-full restoration of ankle joint range of motion (ROM) to ensure proper mechanics and gait when running. Restricted movement can force compensation, placing excessive stress on the knee, hip, or lower back.
The recovery process must include rigorous rehabilitation to rebuild muscle strength and dynamic stability in the ankle and surrounding lower leg muscles. Readiness is often measured by the ability to perform a single-leg calf raise without pain, indicating sufficient strength to absorb the impact forces of running. Balance and proprioception—the body’s awareness of joint position—must also be trained to prevent the ankle from giving way. Once these criteria are met, the surgeon will provide formal clearance, allowing for a graduated return-to-activity plan that slowly reintroduces impact.
Running While Hardware Remains In Place
Once medical clearance is granted, many people successfully return to running with the plates and screws permanently left inside their ankle. The biocompatible materials used for internal fixation, like titanium, are inert within the body and provide long-term stability without interfering with joint function. However, the presence of metal hardware can introduce potential complications during high-impact activities.
Localized tenderness or irritation of the overlying soft tissues is a common complaint, often occurring directly over the hardware where it is close to the skin. This can manifest as bursitis or tendon irritation, especially if a plate or screw head is prominent and rubs against a tendon or the inside of a shoe. Some individuals also report a heightened sensitivity to cold temperatures, attributed to the metal’s higher thermal conductivity.
A more complex issue is stress shielding, where the bone relies too heavily on the strength of the metal implant. This means the bone is not subjected to enough natural stress to encourage its own density, potentially leading to weakened bone structure underneath the plate. Running with incomplete rehabilitation can also lead to gait compensation, where the runner alters their stride to avoid pain or stiffness, which can cause secondary injuries elsewhere in the body. While modern hardware is durable, the sustained, repetitive impact of running can, in rare cases, lead to hardware loosening or material failure over time.
The Factors Influencing Hardware Removal
The decision to remove plates and screws is often elective, driven by symptoms experienced during activity, especially for runners who place high demands on the ankle. The most frequent reason for a second surgery is chronic pain or discomfort attributable to the hardware, such as rubbing against nearby tendons or causing a painful prominence under the skin. Studies show that a significant percentage of patients undergo hardware removal primarily due to subjective complaints that interfere with their quality of life or athletic performance.
For high-impact athletes, removal may eliminate the risk of late hardware failure or improve the overall comfort and flexibility of the ankle joint. Removing the implants alleviates mechanical irritation and may provide a subtle improvement in soft tissue movement. Conversely, hardware is often left in place if it is deeply positioned and not causing issues, or if the patient prefers to avoid the risks of a second operation.
Every subsequent surgery carries risks, including infection, nerve injury, and the need for another recovery period. Removing screws can leave small tunnels in the bone, which temporarily creates a localized weak spot susceptible to a new fracture through a screw hole. The decision to remove the hardware is personal, involving weighing symptoms against surgical risks and required recovery time.