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A fractured ankle is a break of one of the bones of the ankle. Ankle fractures are serious and should be treated quickly. Ankle fractures occur in 4.22/10,000 people (1). Broken ankles are more commonly seen in young males (ages 15-24) and women (ages 75-84) (2).
When treating ankle fractures, it’s important to consider what type of fracture the person has, as well as the person’s medical history.
In this article, we’ll discuss everything you need to know about the management of ankle fractures.
Let’s dive in…
Anatomy
The ankle joint is a hinged synovial joint. The ankle is made up of three bones: the distal tibia (shin bone), the distal fibula (the bone on the outside of your leg), and the talus (the bone connecting the tibia to the heel bone).
The “medial malleolus” is the bump on the lower inside portion of your ankle. The “lateral malleolus” is the bump on the lower outside portion of your ankle.
The lateral ankle ligaments connect the fibula to the foot. There are also ligaments present on the inside of your ankle called the “deltoid ligament” that connect the tibia to the foot. There are syndesmotic ligaments that are present between your tibia and fibula.
The anatomy of the ankle is important to understand. When ankle injuries happen, disruption of one or more bones/ligaments can occur. Treatment is chosen depending on the extent of the damage.
What Causes a Broken Ankle?
Acute ankle fractures can occur from twisting injuries, falls, motor vehicle accidents, and crush injuries. Anything that places a considerable amount of force on the ankle can cause it to fracture.
Acute ankle fractures are often seen in high-impact sports. However, they can also occur from simply putting your foot and ankle down awkwardly, causing the bones in your ankle to crack. Wearing certain shoe gear, like high heels, can also increase your likelihood of sustaining an ankle fracture.
Stress fractures of the ankle, however, can occur due to gradual repetitive stress in the ankle joint. This can happen from certain activities such as marching, jumping, hopping, or running for very long distances. If you have increased your training regimen too fast and too soon, this could increase your chances of sustaining a stress fracture of the ankle.
What Are the Symptoms of a Broken Ankle?
- Immediate severe pain in your ankle
- Swelling of the ankle
- Bruising of the ankle
- Ankle deformity from ankle dislocation
- Inability to bear weight
- Discoloration of the skin
- Tenderness to the touch of the ankle
- A “pop” or “crack” sound at the time of injury
- Numbness or tingling in the ankle/foot
- Radiating pain that starts in your ankle and spreads up to your leg and thigh
- Gradual dull, achy pain that persists with rest (in the case of a stress fracture)
If you suspect that you may have broken your ankle, sit down immediately and ice and elevate your foot. RICE therapy should be started immediately. It would be best to avoid eating or drinking anything until you get your ankle evaluated in case you need surgery.
How Do You Diagnose a Broken Ankle?
You should go to the emergency room or your foot doctor’s office to be evaluated. Your doctor will perform a history and physical exam. Your doctor will want to know your medical history.
Obtaining a thorough medical history is important because factors like diabetes and positive smoking history can impact the healing of an ankle fracture.
Your doctor will order an x-ray to evaluate your ankle. He/she will be checking to see how many bones of the ankle are broken, and if the fractures are displaced (the gap between broken fragments) or non-displaced (broken but in proper alignment). Your doctor will also be checking for ligament injury.
If there are multiple breaks in the bone, your doctor may want to order a Computed Tomography scan (CT scan). A CT scan can help provide detailed visualization of broken bones. Occasionally, this may be needed for surgical planning.
A Magnetic Resonance Imaging scan (MRI) may be ordered. This can provide further detail on the fracture as well as identify any ligament/tendon injuries that may also be present.
If your doctor suspects a stress fracture, they may order a bone scan. During a bone scan, radioactive material would be injected into your vein. This material would accumulate at the fracture site and can help identify/confirm a fracture.
How Do You Treat a Broken Ankle?
Treating ankle fractures will depend on the extent of the injury. Your doctor will be checking if the fracture is nondisplaced or displaced. Another important factor is whether the fracture is comminuted (multiple pieces).
Nonsurgical Treatment for a Broken Ankle
If the ankle fracture is nondisplaced, your doctor may suggest that you stay off of your foot in a cast or splint for 6-8 weeks minimum to allow for bone healing. This would be a good option for someone who sustains a non-displaced stress fracture of the ankle.
Your doctor will see you every 3-4 weeks after the injury to obtain new radiographs and ensure fracture healing is taking place.
Nonsurgical treatment may also be recommended if someone has extensive health problems such as a history of blood clots, or severe peripheral vascular disease. If your doctor believes that you are too high risk to undergo surgery, he/she may recommend nonsurgical treatment.
Surgical Treatment for a Broken Ankle
If you sustain a displaced lateral or medial malleolar ankle fracture, your doctor will recommend surgery. If the fracture gap is greater than 2mm or there is shifting of the fracture fragments, your doctor will recommend repairing the broken ankle to ensure the best outcomes.
The most common type of ankle fractures are unimalleolar fractures of the lateral malleolus of the fibula. Occasionally, bimalleolar and trimalleolar ankle fractures can occur. Bi means “two”, and Tri means “three”.
A bimalleolar ankle fracture occurs when there is damage to the medial malleolus of the tibia and the lateral malleolus of the fibula.
A trimalleolar ankle fracture occurs when there is damage to the medial malleolus of the tibia, the lateral malleolus of the fibula, and a fracture of the posterior (back) of the tibia.
The more breaks you have in the ankle, the more unstable the ankle becomes.
Ankle dislocations are often seen with bimalleolar and trimalleolar ankle fractures.
If your ankle is dislocated, your doctor will reduce your ankle dislocation under sedation while in the Emergency room. This will help realign the fracture fragments and can help prevent vascular injury.
Occasionally, there may be a syndesmosis injury with associated high fibular fracture (Maisonneuve fracture). Syndesmotic injuries should be repaired surgically.
Closed ankle fractures are usually repaired using plates/screws/pins. Open ankle fractures, however, need to be stabilized using an external fixator. An external fixator uses rods that attach to the bone and stabilize the fracture using a device outside of the body.
If you have an open ankle fracture, you will need to be hospitalized and receive IV antibiotics. Your vascular status will need to be assessed to ensure blood vessels were not lacerated during the injury. If they were, they will need to be repaired if at all possible. Your doctor will perform an incision and drainage to clean the fracture site and stabilize the fracture fragments using an external fixator.
Surgery for ankle fractures can be performed by your Podiatrist or Orthopedic Surgeon. Ankle fractures need to be repaired in the operating room under general anesthesia. Surgery can last anywhere from 1-3 hours or more.
After surgery, your doctor will apply a cast or splint on your leg. You will need to remain non-weight bearing in a cast or splint for a minimum of 6-8 weeks. Your doctor will get radiographs every 3-4 weeks to assess fracture healing.
Do You Have to Wear a Cast for a Fractured Ankle?
Casts are beneficial in protecting your ankle during the healing process and should be worn the first few weeks after ankle fracture repair. Casts can also help keep your ankle in proper alignment during the healing process, and also help reduce swelling in the limb.
Can You Shower With a Cast On?
You won’t be able to get your foot wet in the shower for several weeks while your foot is in a cast or splint. You can keep your cast covered while in the shower by using a cast bag. You can find this on Amazon. After a few weeks, your doctor may let you transition into a below-knee boot. The boot can be removed to shower.
Do You Need Crutches With a Walking Boot?
If your doctor wants you to stay off of your foot after an ankle fracture, you will need crutches to help you stay off of your foot. However, if you have balance issues or weigh over 300lbs, you should use a knee scooter instead to help you stay off of your foot. If you are allowed to bear weight on your foot, you do not need crutches while using a walking boot.
Should You Sleep With a Walking Boot?
It’s best to sleep with a walking boot when you are healing from an ankle fracture. This is because the boot will protect your ankle when you are unknowingly moving around at night. You can loosen the bootstraps slightly to help you sleep. Keep your leg elevated on pillows while wearing the boot to help reduce swelling.
How Long Will a Broken Ankle Take To Recover?
Ankle fractures can take 6-8 weeks to heal. After your ankle fracture heals, you will need physical therapy for at least a month to regain strength and improve balance. Thus, it will take 3 months minimum for you to recover from a broken ankle. Some fractures may take longer than others to heal, especially if they are largely comminuted/displaced. Certain factors like smoking can also slow down recovery.
Can You Walk on a Broken Ankle After 4 Weeks?
If you have a non-displaced ankle fracture that doesn’t require surgery, like in the case of a hairline stress fracture, your doctor may allow you to walk on the broken ankle in a cast boot as long as you can tolerate it. Your doctor will be closely monitoring your fracture with x-rays every 3-4 weeks to make sure the fracture is healing.
What Are the Long-Term Effects of a Broken Ankle?
High-impact ankle fractures that extend into the joint can cause long-term complications such as arthritis, stiffness, and even nerve pain. You may notice occasional pain or discomfort while performing your activities. Pain may be worse the longer you are on your feet.
What Happens if a Broken Ankle Is Untreated?
If you have a broken ankle that is left untreated, you may develop permanent deformity and damage to the ankle. If you walk on a displaced ankle fracture, the fracture can worsen. You may develop delayed healing of the fracture site or non-union. A non-union is a fracture that doesn’t heal. Non-unions can be painful.
How Long Does the Pain Last With a Broken Ankle?
Pain from an ankle fracture can be present until the fractured bones are healed. This can take 6-8 weeks minimum. However, pain may be present for months due to arthritis and nerve injury that can occur at the time of injury. Your doctor will help you manage your pain with pain medications and physical therapy.
Conclusion
In conclusion, ankle fractures are serious injuries that should be addressed immediately. Waiting to treat an ankle fracture can result in increased pain and deformity. If you suspect that you have an ankle fracture, you should go to the Emergency room or visit a foot and ankle surgeon near you.
Have you broken your ankle before? How long did it take to heal? I would love to hear your thoughts! Leave a comment below!
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References
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- Court-Brown CM, McBirnie J, Wilson G. Adult ankle fractures–an increasing problem? Acta Orthop Scand. 1998 Feb;69(1):43-7.https://pubmed.ncbi.nlm.nih.gov/9524517/
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- Egol, K. A., Tejwani, N. C., Walsh, M. G., Capla, E. L., & Koval, K. J. (2006). Predictors of short-term functional outcome following ankle fracture surgery. JBJS, 88(5), 974-979.https://journals.lww.com/jbjsjournal/Abstract/2006/05000/Predictors_of_Short_Term_Functional_Outcome.7.aspx
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