Ankle fracture

An ankle fracture is a break in one or more of the bones that form the ankle joint: the lower ends of the tibia (shinbone) and fibula (the thinner outer leg bone), and sometimes the talus, the bone that sits between them. Breaks range from a small crack in one bone to several breaks that leave the joint unstable.

• Immediate, often severe pain after a twist, fall, or impact
• Swelling and bruising around the ankle
• Tenderness when the bones are pressed
• Difficulty or inability to put weight on the foot
• An ankle that looks deformed or out of place
• In some injuries, numbness, tingling, or coolness in the foot

Ankle fractures usually result from:

• Rolling or twisting the ankle — sometimes the same motion that causes a sprain
• Falls, including missing a step or a curb, or falling from a height
• High-energy injuries, such as car crashes

Smoking, diabetes, and older age can slow healing and make complications more likely.

A clinician examines the ankle, foot, and leg, and checks blood flow and feeling in the foot. X-rays show where the bone is broken and whether the pieces have shifted; X-rays of the foot or lower leg may be added to look for other injuries. Sometimes X-rays are taken while standing, or with gentle stress on the ankle, to see whether the joint is stable. A CT scan can show breaks that extend into the joint and help plan surgery, and an MRI is occasionally used to check the ligaments.

Ankle fractures are often described by which bony knob of the ankle (malleolus) is broken — the outer, inner, or back — and how many are involved, such as bimalleolar (two) or trimalleolar (three). Injury to the ligaments that hold the tibia and fibula together (the syndesmosis) is also important to identify.

Treatment depends on whether the ankle joint is stable and whether the bones are in good position.

Non-surgical treatment is used for stable fractures in which the bones have not shifted. The ankle is protected in a short leg cast, splint, or walking boot, sometimes with limits on how much weight you can put on it, and follow-up X-rays check that the bones stay in place while they heal.

Surgery is usually recommended when the bone pieces are out of place, when the joint is unstable, or when more than one part of the ankle is broken. The surgeon realigns the bones and holds them with plates, screws, or rods; an injury to the syndesmosis may be stabilized with screws or a suture-button device. Some hardware stays in permanently, and some may be removed later.

An open fracture, in which the bone breaks through the skin, needs emergency treatment because of the risk of infection.

Broken ankle bones generally take at least six weeks to heal, and the ligaments and tendons can take longer. During this time you may need crutches or a knee scooter, and following your weight-bearing instructions closely is important. Follow-up visits with X-rays track healing.

Once healing is under way, physical therapy helps restore motion, strength, and balance. Stiffness and swelling can last for months. Returning to sports or physically demanding work depends on regaining full strength and motion, and complete recovery can take a year or more. A fracture that involves the joint surface can lead to arthritis later.

• Wear supportive, well-fitting shoes, and avoid high heels on uneven surfaces
• Reduce fall risks at home with good lighting, handrails, and clear walkways
• Keep the muscles around the ankle strong and work on balance
• Complete rehabilitation after any ankle sprain