Ankle Fracture (Broken Ankle)

Ankle Fracture (Broken Ankle)

Article by John Miller

What is an Ankle Fracture?

An ankle fracture is a break (fracture) within one or more of the three bones that constitute your ankle. These are your tibia (shin bone), fibula (outside leg bone) and your talus (a smaller bone that sits above your heel and articulates with its concave upper surface under your tibia and fibula).

How Do You Treat a Fractured Ankle?

Each ankle fracture needs specific rehabilitation based on its injury type and fracture stability.

Unstable fractures will almost always require surgical stabilisation. Post-surgery you will undertake intensive physiotherapy to restore your range of motion, strength, proprioception, balance and function. The most common procedure is an Open Reduction with Internal Fixation (ORIF).  Your ankle surgeon uses metal plates and screws to stabilise your ankle to allow the bones to heal.

Stable fractures may be treated with a protective and supportive splint and monitored for appropriate fracture healing. If they show signs of instability, then your surgeon may consider operative stabilisation.

The anatomic reduction (restoring your bone alignment as close to pre-fracture as possible) is necessary to fix this essential weight-bearing joint’s normal anatomy. Poor post-fracture alignment can have significant implications for the development of tibiotalar joint arthritis and reduced function.

You must be compliant with your doctor’s prescribed instructions because frequently, patients are in a removable cast boot.

It is crucial only to perform the exercises prescribed by your Orthopaedic Surgeon or Physiotherapist. You should also wear your walking boot/cast and only apply as much weight-bearing as advised by your physiotherapist or surgeon.

Do your exercises frequently throughout the day. Multiple sessions of short duration are generally better than longer sessions done only once or twice.

Can You Still Walk on a Fractured Ankle?

It is best to avoid walking on any fracture limb until your fracture is assessed for stability. Until you seek a medical opinion, crutches and non-weight-bearing (NWB) status are recommended.

How Long Does it Take to Heal a Fractured Ankle?

Everyone is different, but those who follow their doctor and physiotherapist instruction usually recover quicker!

All fractures typically take a minimum of 6-weeks for the bone to remould and become stable. Lower limb fractures that require full weight-bearing have additional load requirements, so 12-weeks usually is the minimum that an ankle fracture could be considered stable enough to jog, for example. But, everyone’s fracture is different, and you really MUST follow your ankle surgeon specific advice.

The following are general guidelines that are subject to surgeon modification. Everyone is different so please only follow the approach recommended explicitly by your surgeon.

  • You can typically remove your boot and begin to move your ankle up and down immediately after surgery to prevent ankle stiffness.
  • You should wear a compression stocking to control swelling along with ice and elevation above your heart. E.g. Lie down with your foot and leg elevated.
  • Physiotherapy usually starts at 2-3 weeks post-op. Your physiotherapist will then guide and progress you through your various rehabilitation phases to safely restore your joint range of motion, muscle flexibility, strength, proprioception, balance, endurance, power, day to day function (walking, stairs work etc.), and then finally, your resumption of impact and multi-directional sports or activities.
  • 4 weeks non-weight bearing in a boot, followed by 4 weeks of protected weight-bearing in a boot.
  • If syndesmotic fixation – remain NWB until hardware removal at 8-12 weeks
  • Patients with intra-operative evidence of osteoporosis or osteomalacia (esp Diabetics) will be non-weight bearing (NWB) for an extended period (generally 8-10 wks). Your surgeon will advise you.
  • At 8 weeks, transition to regular shoe wear commonly commences
  • You may begin driving at 8 weeks if surgery on the right foot, automatic transmission only for left post-op.
  • At 12 weeks, most patients may be allowed to commence gentle running / higher impact activities. Please don’t commence running until advised by your physiotherapist or surgeon!
  • Once you can efficiently perform and single leg calf rise and hop on the surgical foot (single leg hop), you can usually consider a return to light jogging or gentle sports training.
  • It is common for post-ankle fracture rehabilitation to take 6 months to a year. Everyone is different, but those who follow their doctor and physiotherapist instruction typically recover quicker!

If in doubt, please check with your surgeon or physiotherapist.

Do You Need a Cast for a Fractured Ankle?

Whether you require a cast or not will be determined by your doctor on a case by case basis.

Can a Fractured Ankle Heal on its Own?

Ankle fractures are more likely to require surgical intervention and physiotherapy than not. Fracture stability is the primary issue.  Then due to disuse and protection, every ankle becomes stiff and weak post-immobilisation or surgery.  Your doctor and physiotherapist will commonly treat these injuries, so please seek their professional opinion to help you get back on your two feet as soon as possible.

Is a Broken Ankle an Emergency?

It is best to see a doctor as soon as possible. If you can see a deformity, foot blueness, numbness, pins and needles, or you cannot walk on your ankle or move your toes, it is best to head top emergency as soon as possible for an assessment.

Common Ankle Injuries

ankle pain

Sprained Ankles

The most common ankle injury is a sprained ankle, but ankle pain can have numerous sources.

Ankle Fractures

An ankle fracture occurs when there is a break in one or more of the bones. The most common ankle fractures are avulsion fractures of your distal fibula, which can be a side effect of an ankle sprain. All suspected fractures require medical investigation and professional management by your health professional to avoid long-term foot and ankle issues. If your healthcare professional suspects an ankle fracture, you will be referred for at least an X-ray and potentially an Orthopaedic Surgeon.

Ankle Tendinopathies

While muscle strains are more common in your legs, there are essential muscles that converge into tendons that wrap around your ankle to stabilise your ankle and foot to protect them from sprains and allow you to walk and run. These muscles and their tendon vitally provide you with a normal foot arch and avoid flat feet. Your muscles or tendons can become injured or inflamed as a result of overuse or trauma. The inflammation is called tendonitis. They can also tear, completely rupture, or sublux out of place. Medically tendon injuries are known as tendinopathies, and at the ankle may include:

Ankle Arthritis

Your ankle pain and dysfunction can lead to degenerative conditions such as ankle osteoarthritis. While arthritis usually is a chronic deterioration of your ankle joint, it is crucial to slow ankle arthritis progression. Please seek the professional advice of your ankle and foot health practitioner, e.g. physiotherapist or podiatrist.

Biomechanical Conditions

Biomechanical disorders may result in foot deformation, painful weight-bearing and potentially nerve compression. In simple terms, this is where your foot and ankle do not have normal bone alignment and motion contr. Here are a few possible conditions related to poor ankle biomechanics.

Muscle Injuries

Nerve-Related Ankle Pain

Children & Youth Conditions

Systemic Conditions that may cause Ankle Pain

Soft Tissue Inflammation

Other Useful Information

Article by John Miller

Common Youth Leg Injuries

youth sports injuries

Why are Children's Injuries Different to Adults?

Adolescent injuries differ from adult injuries, mainly because the bones are still growing. The growth plates (physis) are cartilaginous (strong connective tissue) areas of the bones from which the bones elongate or enlarge. Repetitive stress or sudden large forces can cause injury to these areas.

Common Adolescent Leg Injuries

In the adolescent leg, common injuries include:

Osgood-Schlatter's Disease

Pain at the bump just below the knee cap (tibia tubercle). Overuse injuries commonly occur here. The tibia tubercle is the anchor point of your mighty quadriceps (thigh) muscles. Because of excessive participation in running and jumping sports, the tendon pulls bone off and forms a painful lump that will remain forever. This type of injury responds to reduced activity and physiotherapy.

More info: Osgood Schlatter's Disease

Sinding-Larsen-Johansson Disease

Pain at the lower pole of the knee cap (patella). Overstraining causes Sinding-Larsen-Johansson disease. Because of excessive participation in running and jumping sports, the tendon pulls bone off the knee cap. This type of injury responds to reduced activity and physiotherapy.

More info: Sinding Larsen Johansson Syndrome

Anterior Knee Pain

Anterior knee pain or patellofemoral syndrome frequently gets passed off as growing pains. Cause of this pain includes overuse, muscle imbalance, poor flexibility, poor alignment, or more commonly, a combination of these. Anterior knee pain is one of the most challenging adolescent knee injuries to sort out and treat. Accurate diagnosis and treatment with the assistance of a physiotherapist with a particular interest in this problem usually resolves the condition quickly.

More info: Patellofemoral Pain Syndrome

Knee Ligaments

The cartilage between the leg bones have a better blood supply and are more elastic in adolescents than in adults. As adolescents near the end of bone growth, their injuries become more adult-like. Hence more meniscal and ACL (anterior cruciate ligament) injuries are likely. MCL (medial collateral ligament) injuries result from a lateral blow to the knee. Pain felt on the inner side (medially) of the knee. MCL injuries respond well to protective bracing and conservative treatment.

More info: Knee Ligament Injuries

ACL (anterior cruciate ligament) injuries

This traumatic knee injury is significant. Non-contact injuries of the ACL are becoming more common than contact injuries of the ACL. Adolescent females are at high risk. Combination injuries with MCL or menisci are common. Surgical reconstruction is needed if the adolescent wishes to continue participating in "stop-and-start" sports.

More info: ACL Injury

Meniscal injuries

Your meniscus is crescent-shaped cartilage between the thigh bone (femur) and lower leg bone (tibia). Meniscal injuries usually result from twisting. Swelling, catching, and locking of the knee are common. If physiotherapy treatment does not resolve these damages within six weeks, they may require arthroscopic surgery.

More info: Meniscus Tear, Discoid Meniscus

Sever's Disease

Heel pain is commonplace in young adolescents due to the stresses of their Achilles tendon pulling upon its bony insertion point on the heel (calcaneum). It is a common overuse injury due to excessive volume of training and competition, particularly when loads are increased dramatically in a short period. Diminished flexibility and muscle-tendon strength mismatching may predispose you. Physiotherapy, reduced activity, taping and orthotics are the best ways to manage this debilitating condition for the active young athlete.

More info: Sever's Disease

Ankle Sprain

An ankle sprain is probably the most common injury seen in sports. Ankles sprains involve stretching of the ligaments and usually occur when the foot twists inward. Treatment includes active rest, ice, compression and physiotherapy rehabilitation. An ankle sprain usually improves in 2-6 weeks with the correct treatment. Your ankle physiotherapist should check even simple ankle sprains. A residually stiff ankle post-sprain can predispose you to several other lower limb issues.

More info: Sprained Ankle

Patellar Instability

Patellar (kneecap) instability can range from partial dislocation (subluxation) to dislocation with a fracture. Partial dislocation treatment is conservative. Dislocation with or without fracture is a much more severe injury and usually will require surgery.

More info: Patella Dislocation

Osteochondritis Dissecans

The separation of a piece of bone from its bed in the knee joint is Osteochondritis Dissecans (OCD). This injury is usually due to one major macro event with repetitive macro trauma that prevents complete healing. This injury is potentially severe. Treatment varies from rest to surgery. An Orthopaedic Surgeon's opinion is vital.

More info: Juvenile Osteochondritis Dissecans (JOCD)

Growth Plate Fractures

A fracture through the growth plate can be a severe injury that can stop the bone from growing correctly. These fractures should be treated by an Orthopaedic Surgeon, as some will require surgery.

Avulsion Fractures

youth pelvis hip avulsion

Image source: https://radiologyassistant.nl/pediatrics/hip/hip-pathology-in-children

An avulsion fracture occurs when a small segment of bone attached to a tendon or ligament gets pulled away from the main bone. The hip, elbow and ankle are the most common locations for lower limb avulsion fractures in the young sportsperson.

Treatment of an avulsion fracture typically includes active rest, ice and protecting the affected area. This active rest period is followed by controlled exercises that help restore range of motion, improve muscle strength and promote bone healing. Your physiotherapist should supervise your post-avulsion exercises. Most avulsion fractures heal very well.  You may need to spend a few weeks on crutches if you have an avulsion fracture around your hip. An avulsion fracture to your foot or ankle may require a cast or walking boot.

An excessive gap between the avulsed bone fragment and main bone may not rejoin naturally in rare cases. Surgery may be necessary to reunite them. In children, avulsion fractures that involve the growth plates also might require surgery. All avulsion fractures should be reviewed and managed by your trusted physiotherapist or an Orthopaedic Surgeon.

For more information regarding your youth sports injury, please consult your physiotherapist or doctor.

Common Youth Leg Injuries

Pelvis & Hip

Knee

Heel & Ankle

Common Youth & Teenager Sports Injuries

Common Youth Neck & Back Pain

Common Youth Arm Injuries

Common Treatments For Foot Pain

With accurate assessment and early treatment, most foot pain responds extremely quickly to physiotherapy allowing you to quickly resume pain-free and normal activities of daily living. Please ask your physiotherapist for their professional treatment advice.

Acute Treatment

Subacute Treatment Options

Other Treatment Options

Balance Improvement