Conditions

Introduction to Ankle Fractures

An ankle fracture occurs when one or more of the bones in the ankle are broken. This type of injury is quite common and can happen to anyone, whether from a sports injury, a fall, or an accident. The ankle joint plays a key role in allowing us to walk, run, jump, and stand, so a fracture can seriously affect daily activities. In this guide, we will break down what an ankle fracture is, how it happens, and how to treat it for a full recovery.

General Anatomy of the Ankle

The ankle joint is where the lower leg meets the foot. It is made up of three main bones:

1. Tibia: The larger of the two bones in the lower leg, it is located on the inside of the leg.
2. Fibula: The smaller bone of the lower leg, located on the outer side of the leg.
3. Talus: The bone that sits between the tibia and fibula and connects the leg bones to the foot bones.
   

These bones are held together by strong ligaments, and muscles around the ankle allow us to move our foot up and down and side to side. The lateral malleolus (outer ankle bone) and medial malleolus (inner ankle bone) are two parts of the fibula and tibia that are commonly involved in fractures.

There are also several ligaments that help stabilize the ankle joint:

• Lateral ligaments: Located on the outside of the ankle, they prevent the ankle from rolling outward.
• Medial ligaments: Found on the inside of the ankle, they help to prevent the ankle from rolling inward.

Causes of Ankle Fractures

Ankle fractures can occur in many different ways, often as a result of sudden trauma. Some common causes include:

1. Twisting or rolling the ankle: When the foot turns too far inward or outward, it can put pressure on the bones and cause a fracture.

2. Falling: A sudden fall, especially if the foot lands awkwardly, can cause the bones in the ankle to break.
3. Sports injuries: High-impact sports like basketball, soccer, or football can lead to ankle fractures due to quick turns or jumps.
4. Car accidents: A direct blow to the ankle or a twisting injury during a car crash can lead to a fracture.
5. Osteoporosis: Older adults with weakened bones are more likely to suffer fractures from minor accidents.

Symptoms of Ankle Fractures

The symptoms of an ankle fracture can vary depending on the severity and location of the break. Common symptoms include:

• Pain: Severe pain around the ankle, especially when trying to move the foot or bear weight on the leg.
• Swelling: Swelling around the ankle joint is common and may make the ankle appear puffy or larger than usual.
• Bruising: Discoloration around the ankle as blood vessels are damaged.
• Deformity: In more severe fractures, the ankle may appear out of place or the bones may be visibly misaligned.
• Limited mobility: Difficulty or inability to walk or stand on the affected foot.

Investigations for Ankle Fractures

When you visit a doctor with an injured ankle, they will perform several tests to determine the nature and extent of the fracture. Common investigations include:

1. Physical Examination:

   • The doctor will inspect the ankle for signs of swelling, bruising, or deformity.
   • They will also check for tenderness by gently pressing on the bones and ligaments.

2. X-rays:

   • An X-ray is the most common way to diagnose an ankle fracture. It provides a clear image of the bones, helping the doctor identify where the fracture has occurred and whether the bone is displaced (out of alignment).

Initial X-ray of the ankle fracture  

3. CT Scan or MRI:

   • In more complex fractures, or if the X-ray doesn’t show all the details, a CT scanor MRI may be used to get a more detailed image of the bones and surrounding tissues. This is especially useful for assessing damage to ligaments and soft tissues.

Treatment Options for Ankle Fractures

Treatment for an ankle fracture depends on the severity and type of fracture. There are two main types: non-displaced fractures (where the bones stay in alignment) and displaced fractures (where the bones move out of place). The treatment approach will vary accordingly.

1. Non-Surgical Treatment (For Stable, Non-Displaced Fractures)

• Rest: Avoid putting weight on the injured foot. Using crutches or a walker can help you move without putting pressure on the ankle.
• Ice and Elevation: Ice helps reduce swelling, and elevating the ankle above the heart level can also reduce swelling.
• Splint or Cast: For stable fractures, a splint or cast is usually applied to immobilise the ankle and allow the bones to heal properly. You may need to wear a cast for 4 to 6 weeks.
• Pain Relief: Medication like Arcoxia or Diclofenac can help manage pain and reduce swelling.

2. Surgical Treatment (For Displaced or Complex Fractures)

• Open Reduction and Internal Fixation (ORIF): If the fracture is displaced or if there are multiple fractures, surgery may be required. During surgery, the bones are realigned, and screws, plates, or pins are used to hold the bones in place while they heal.

X-ray showing plates and screws used to stabilise the fractures.

• Post-Surgery Care: After surgery, the ankle will be immobilised with a cast or splint for several weeks. The doctor will monitor wound healing through follow-up visits. Repeat X-rays will be required to ensure good bone healing and exclude problems with implants.
• Rehabilitation: Rehab after surgery starts almost immediately. This is aimed at maintaining the strength of the lower limbs, reducing swelling around the ankle and ensuring patients are able to move around using their crutches and cast.

Rehabilitation and Recovery

Rehabilitation is a crucial component of recovery following an ankle fracture. It helps restore strength, flexibility, and balance to the ankle, reducing the risk of future injuries.

Physical Therapy:

• Range of Motion Exercises: Early physical therapy involves gentle movements to help restore the range of motion in the ankle.
• Strengthening Exercises: Once the bones have healed, exercises to strengthen the muscles around the ankle are essential for regaining full function.
• Balance and Stability Training: To reduce the risk of re-injury, balance exercises are important. This helps the ankle regain its ability to handle various movements.

Gradual Return to Activity:

• Follow Your Doctor’s Advice: It’s important to follow your doctor’s guidelines about when you can return to normal activities. You should avoid high-impact activities, like running or jumping, until the ankle is fully healed.
• Supportive Footwear: Wearing shoes that provide support can help protect the ankle from further injury.

Recovery Time

The recovery time for an ankle fracture varies based on the severity of the injury:

• Non-Surgical Treatment: If the fracture is stable and treated with a cast, recovery typically takes 6 to 8 weeks.
• Surgical Treatment: After surgery, recovery may take longer, often around 3 to 4 months, depending on the complexity of the fracture.

Prevention Tips for Ankle Fractures

Although some injuries are unavoidable, you can reduce your risk of an ankle fracture by following these tips:

• Strengthen Your Ankles: Regularly exercise to strengthen the muscles around your ankle. This will help protect the joint from injury.
• Wear Supportive Shoes: Make sure your shoes offer good support, especially if you're playing sports or walking on uneven ground.
• Be Careful in High-Risk Activities: If you participate in sports or activities that involve jumping or quick movements, take extra precautions, such as wearing ankle supports or braces.
• Watch Your Step: Be mindful of your surroundings, especially on uneven or slippery surfaces.

Conclusion

Ankle fractures are a common injury, but with the right treatment and rehabilitation, most people can make a full recovery. Whether treated with a cast or requiring surgery, the key is to follow your doctor's instructions and give your ankle enough time to heal. Physical therapy and strengthening exercises will help ensure you regain full mobility and reduce the risk of future injuries. If you have an ankle fracture, don't hesitate to seek medical care to ensure the best possible outcome!