The ankle is a complex joint that forms where three bones come together. The bones of the lower leg, the tibia and the fibula, are above the joint, and the talus is below the joint. When a doctor talks about an ankle fracture, he or she is usually talking about a broken bone of the tibia or fibula. Both the tibia and the fibula wrap around the talus to form the ankle joint. The bony prominences at the ankle are called the medial malleolus (the end of the tibia) and the lateral malleolus (the end of the fibula). The ends of these bones for a cup for the talus to sit within.
When you stress an ankle joint beyond the strength of its elements, you injure the joint.
If only the ligaments give way and tear, you have sprained the ankle.
If a bone gives way and breaks, you have an ankle fracture.
Fractures can occur with simultaneous tears of the ligaments. You can do this in several ways:
Rolling the ankle in or out
Twisting the ankle side to side
Extreme flexing or extending of the joint
Severe force applied to the joint by coming straight down on it as in jumping from a high level
Common symptoms of an ankle fracture include
- Pain to touch
- Inability to walk on the leg
- Deformity around the ankle
When a doctor evaluates your ankle, the main task is to determine if you have fractured a bone or if the joint has been damaged sufficiently to have become unstable. Joint instability often suggests multiple fractures, a fracture with a ligament injury, or sometimes ligament injury alone.
The doctor will seek a history of the injury and will ask the following. These questions are important because different mechanisms of injury are associated with different fracture patterns.
Where does it hurt now?
How long ago did your injury happen?
Does your knee, shin, or foot hurt also?
How did the injury happen?
Did your ankle turn in or out?
Did you hear a crack or a pop?
Were you able to walk immediately after the injury?
Can you walk now?
Do you have any new numbness or tingling in your leg, ankle, or foot?
Have you had previous ankle fractures, sprains, or surgeries?
The doctor will perform a physical exam, looking at or for the following:
Evidence of bruising, abrasions, or cuts
Swelling, bleeding, and tissue damage
Pain, deformities, and the grinding or movement of broken bones of the knee, shin, ankle, and foot
Pain, excess looseness of a joint, or complete tear in ligaments
Fluid in the joint and joint stability
Seeking a pulse and looking for injured arteries
Testing sensation and movement in both your ankle and foot
Ankle x-rays if a broken bone is suspected
X-rays of your knee, shin, or foot depending on where pain is
The basic treatments of ankle fractures are described below. Again, anyone with a broken ankle must discuss their individual treatment plan with their doctor, but this outlines some of the basics of ankle fracture treatment:
- Ice and Elevation
Swelling is almost universally seen following a broken ankle. An important part of treatment of an ankle fracture is to minimize swelling. Limiting swelling will help control the pain from the ankle fracture and minimize the damage to the surrounding tissues.
Most patients with an ankle fracture are seen in the doctors office or emergency room. The first step is to obtain X-rays to see what the fracture pattern is, how badly displaced the fracture is, and what the condition of the bone looks like. Depending on the appearance of the ankle fracture on X-ray, treatment decisions can be made.
Splinting an ankle fracture is commonly performed in the emergency room. A splint is often done for a few days, followed by a cast. The splint will allow more room than a cast in case there is continued swelling. If the ankle fracture is not badly displaced, the splint may be put on without moving the broken ankle. If there is displacement, a “reduction” will be performed. After being given anesthesia, the ankle fracture will be re-set to improve the alignment and displacement of the broken bones.
A cast is usually done after a few days, unless the swelling is minimal and it may be done early after the injury. A cast is made either of plaster or fiberglass. Plaster molds to the skin better, and is preferred if the cast is needed to hold the broken bone in a specific place. If the fracture is not unstable, or if some healing has taken place, a fiberglass cast may be used. The fiberglass is lighter weight and more resilient to wear.
Crutches are important, because almost all types of ankle fractures will require some level of immobilization and rest following the injury. Sometime, patients will not be able to place any weight on the ankle for several months, other times within days to weeks. Determining when you can place weight on the broken ankle depends on the type of ankle fracture; this will have to be discussed with your doctor.
Surgery is needed for many types of ankle fractures. While not always necessary, surgery for ankle fractures is not uncommon. The need for surgery depends on the appearance of the ankle joint on X-ray and the type of ankle fracture present. Achieving and maintaining alignment of the broken ankle is of utmost importance. Arthritis is common after an ankle fracture, and the best way to reduce the risk of arthritis is to obtain a normal looking ankle joint. If surgery is needed to achieve this goal, your doctor may recommend an operation.
Preventing ankle fractures can be difficult.
Many occur as “slip and fall” incidents. Being careful in your activities is the best prevention.
Proper footwear when participating in sports also may reduce your risk
- Stiffness of ankle
PHYSIOLINE’S SPECIALIZED PHYSIOTHERAPY HAS VITAL ROLE TO PLAY
At Physioline, all the members of the rehabilitation team work together so as to provide proper care and the therapy in order to:
- Relief pain
- Restoring range of motion
- Strengthening of muscles
- Prevention of complications
- Gait training
- Restoration of activities of daily living
- Visit Physioline for the Consultation and treatment