An ankle fracture or broken ankle is most commonly caused by the ankle twisting or rolling when a person trips or falls, or if there’s impact from an accident. Two joints are involved in ankle fractures: the ankle joint where the tibia, fibula and talus meet, and the syndesmosis joint, which is the joint between the tibia and fibula.
A fracture can range from a simple break in one bone to multiple fractures. Some fractures may involve injuries to ankle ligaments that keep the ankle bones and joint in its normal position.
Ankle fractures in children are more likely to involve the tibia and fibula, which often involves the growth plates. Growth plate fractures in the ankle require immediate attention. The long term consequences of an improperly treated fracture include legs that grow crooked or of unequal length. A child who breaks an ankle should be checked regularly as long as two years to make sure that growth proceeds properly.
One or all of these symptoms may indicate a fracture or break:
- Immediate and severe pain at the site of the fracture, which can extend from the foot to the knee.
- Swelling, which may occur along the length of the leg or be more localized at the ankle.
- Bruising and tenderness to the touch.
- Decreased ability to walk. It is possible to walk or bear weight upon the ankle with less severe fractures. Never rely on walking as a test of whether the ankle is fractured.
- Deformity or bones protruding through the skin, a condition known as an open ankle fracture. These types of ankle fractures require immediate treatment to avoid problems like infection.
Most patients with ankle injuries are treated in an emergency room or a doctor’s office. An X-ray of the damaged ankle may be taken to determine what the fracture looks like, which bones are broken, the extent of bone separation or displacement, and the overall condition of the bone. The X-ray will help determine the proper course of treatment. In some cases, special x-rays called stress x-rays are needed.
You may not require surgery if your ankle and the broken bone are not out of place or just barely out of place. The type of treatment may also be based on where the bone is broken. Your doctor may recommend any or all of the following:
- Elevation and ice to reduce painful swelling and decrease the risk of damage to the surrounding tissue.
- A splint, worn for several days, may be placed to support the broken ankle and allow room for swelling. If the damaged ankle is not displaced, the splint may be applied immediately without moving the broken ankle.
- If the bones are displaced and/or the ankle joint is dislocated, a closed reduction is performed while the splint is placed. This treatment involves setting the tibia and/or fibula bones and ankle joint to improve the position and pain at the ankle. This treatment may require some type of anesthesia.
- Rest and avoiding weight bearing upon the ankle is essential to healing correctly. Crutches, walkers and wheelchairs are usually recommended, depending on the severity and type of ankle fracture. In many cases, a patient will not be able to place any weight on the ankle for several days, weeks or even months. Your physician will make this determination.
- A cast or fracture boot can be applied to a fractured ankle once the initial swelling goes down.
NOTE: A cast or boot is most commonly used to treat fractures where one bone is minimally displaced and not requiring surgery. They can provide adequate immobilization and protection to the ankle. A cast cannot get wet or be removed without special tools. A boot can be removed for bathing and sleeping. The cast or boot is worn until the fracture is fully healed, which usually takes two to three months.
The need for surgery will largely depend on the appearance of the ankle joint on the X-ray and the specific type of fracture. Badly displaced fractures and fractures of both the tibia and fibula commonly need surgery. During this type of procedure, the bone fragments are first re-positioned to their normal alignment. They are held together with special screws and metal plates attached to the outer surface of the bone. In some cases, a screw or rod inside the bone may be used to keep the bone fragments together during the healing process. It is essential to restore the alignment of the broken bone for full recovery. Ankle arthritis can occur if a fracture heals improperly.
There are usually few complications from a broken ankle, although there is a higher risk among diabetic patients and those who smoke. Your orthopedic surgeon may prescribe a program of rehabilitation and strengthening.