Ankle Fracture

A broken ankle, or ankle fracture, is a fracture or multiple fractures of one or more of three bones in the ankle joint:

• Tibia (shinbone)
• Fibula (outer ankle bone)
• Talus (which is the bone that connects your leg to your foot)

Sometimes it can be hard to distinguish if the ankle is broken or sprained, as symptoms can be similar. With an ankle sprain, the ligaments that connect bone to bone to provide stability of the ankle joints have been injured. Sprains can be in connection with ankle fractures.

 

Symptoms of an Ankle Fracture 

The most common symptoms of an ankle fracture are pain and swelling, which may be present only in the ankle region itself or spread to parts of the foot or up toward the knee. When trying to bear weight, the pain will typically be more intense. Again, ankle sprains and breaks often have similar symptoms. So, if pain persists, it’s a good idea to see a doctor who specializes in foot and ankle injuries. 

Diagnosing an Ankle Fracture X-rays are the first step to determine whether there is a broken bone as opposed to a soft-tissue injury like a sprain. Other diagnostic tests may include a CT scan or MRI to understand the full scope of the injury. 

 

Causes of Ankle Fracture 

Rotational injuries – twisting, turning or rolling while walking or running – are the most common cause of a broken or fractured ankle. Breaks can also be caused by high-force impact. This type of break due to a specific injury is called a traumatic ankle fracture. A break that occurs due to repetitive stress or impact over time is called a stress fracture. 

 

More About Stress Fractures 

Stress fractures can occur in any of the three ankle bones, especially the tibia or fibula. They are also common in the navicular bone. This bone is separate from the ankle, but lies directly beneath the talus. A stress fracture typically occurs after a person has begun a new activity that involves significant impact of the foot, such as hiking, running or field sports. They can also occur in an active person who quickly increases their activity, for example when someone who is accustomed to jogging a few miles a week and then starts training for a marathon. 

 

The Most Common Types of Ankle Fractures 

• Lateral malleolus fracture: A break of the lateral malleolus, the knobby bump on the outside of the ankle (in the lower portion of the fibula); this is the most common ankle fracture. 
• Bimalleolar ankle fracture: The second-most common type of fracture where there is a break in both the lateral malleolus and of the medial malleolus, the knobby bump on the inside of the ankle (in the lower portion of the tibia). 
• Trimalleolar ankle fracture: Here there is a break in three sides of the ankle: the medial malleolus of the tibia, as well as the lateral malleolus and posterior malleolus (in the lower portion of the fibula). 
• Pilon fracture (also called a plafond fracture): This is a fracture through the weight-bearing “roof” of the ankle (the central portion of the lower tibia). This fracture is usually due to trauma such as a fall. 

Within each of the above types of fractures, they will be either nondisplaced or displaced ankle fractures: 

• Nondisplaced Ankle Fracture – Bones are broken but still in correct position and alignment. 
• Displaced Ankle Fracture – Fractured portions of bone are separated or misaligned. 

 

Fractures and Ankle Arthritis 

The reason fractures can be linked to future ankle arthritis is that as the number of fracture lines increase, so does the risk of long- term joint damage. Additionally, trimalleolar ankle fractures and pilon fractures have the most cartilage injury. Therefore, these fractures have a higher risk of arthritis in the future. The quicker the fracture is treated effectively by a trained foot and ankle specialist, the better chance you will have of avoiding ankle arthritis in the future. 

 

Treatment for Ankle Fracture 

Certain mild ankle breaks (stable and with no displacement) can be treated non-surgically with a splint, short leg cast, or other protective device such as a walking boot. Some patients may be able to walk immediately while wearing a support while others may have to use crutches to limit weight-bearing. 

For more serious fractures in which bones or bone fragments are misaligned, surgical intervention is necessary to prevent improper healing (malunion) that would impede proper movement in the ankle and possibly lead to other complications. 

Treatment is based on the alignment of the bones and the stability of the ankle joint. The goal is to have the bones heal as close to perfect as possible, preventing any residual instability or malalignment of the bone. 

It’s important to note why alignment and proper treatment of an ankle fracture/break is so important: 

• A malalignment of as little as two millimeters in the ankle joint can lead to arthritis. 

 

Recovery from Ankle Fracture Surgery 

It takes about six weeks for bones to heal. It could be longer for ligaments or other soft tissues to heal, if also damaged. 

After surgery, patients are typically not weight-bearing for 4 to 6 weeks until the bone heals. Patients are placed on a pain management protocol. For the first couple of weeks, patients are in a splint and are elevating the limb 90% of the day. After 10 to 14 days, the sutures are removed and patients are typically placed into a removable boot. From here, patients can start moving the ankle. At the six-week visit, X-rays are typically obtained. Assuming the bone is healed, patients are then allowed to start weight- bearing and to begin physical therapy. Patients can expect six weeks of therapy or more, if required. 

If you suspect an ankle fracture or bread, you should see a doctor who specializes in foot and ankle conditions. Early intervention is essential to preserving the health of the ankle joint over the long term.