Ankle Fracture (Broken Ankle)

Ankle Fracture (Broken Ankle)

 

Article by J.Miller, Z.Russell, A.Clarke

What is an Ankle Fracture?

An ankle fracture is where the 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 followed by physiotherapy to restore your range of motion, strength, proprioception, balance and function. The most common procedure is an Open Reduction with Internal Fixation (ORIF).  Essentially, your ankle surgeon with use metal pates 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 restore the normal anatomy of this important weight-bearing joint. Poor post-fracture alignment can have significant implications for the development of tibiotalar joint arthritis and reduced function.

It is important that you are compliant with your doctor’s prescribed instructions because frequently patients are placed in a removable cast boot.

Based on that, it is very important to only 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 on a frequent basis 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 medical opinion, crutches and non-weight-bearing (NWB) status is recommended.

How Long Does it Take to Heal a Fractured Ankle?

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

All fractures normally take a minimum of 6-weeks for the bone to remould and become stable. Lower limb fractures that require full weight-bearing have extra load requirements, so 12-weeks is normally 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 guideline specifically recommended by your surgeon.

  • You can normally remove your boot and begin to move your ankle up and down immediately after surgery to prevent ankle stiffness.
  • A compression stocking should be worn to control swelling along with ice and elevation above your heart. Eg 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 activites.
  • 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 of time (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 easily 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 normally 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 are unable to 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

Sprained Ankles

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

Ankle pain that results from a traumatic injury is often a sports-related injury. But you don't necessarily have to be an athlete or even a social sportsperson to twist your ankle.

Something as simple as walking on an uneven footpath can cause a rolled ankle, resulting in an ankle sprain. Ankle injuries can potentially occur at any age. Thousands of people sprain their ankle every day around the world. Just while you've been reading this article, a few hundred people have sprained their ankle. While ankle pain can result from a large number of ankle and foot injuries, the most common ankle injuries are sprains (low and high ankle), which involve ligaments and bones in the ankle. But you can also fracture a bone, tear muscles or over-stress a tendon when you sprain your ankle.

High ankle sprains are generally a more significant injury. These injuries require thorough assessment and treatment to avoid long-term ankle arthritis. If you can't perform a single-leg calf raise within a few weeks of the injury, please seek an early professional ankle assessment.

Related links:

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. These are generally less troublesome than if you experience a talar dome fracture with your actual ankle joint. Potts fracture is a significant fracture of your tibia and fibula simultaneously. All suspected fractures require medical investigation and professionally managed 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 Xray and potentially to an orthopaedic surgeon. Related links:

Ankle Tendinopathies

While muscle strains are more common in your legs, there are important muscles which 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 the progression of ankle arthritis. 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

Systemic Conditions That Can Cause Ankle PAin

Soft Tissue Inflammation

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