Does a broken ankle always bruise. How can you tell if your ankle is broken or sprained. What are the most common causes of ankle fractures. What treatment options are available for a broken ankle.

Understanding Broken Ankles: Anatomy and Types of Fractures

A broken ankle, also known as an ankle fracture, occurs when one or more bones in the ankle joint break. The ankle joint consists of three main bones: the tibia (shinbone), fibula (calf bone), and talus (small bone between the heel and lower leg bones). Understanding the anatomy of the ankle is crucial for recognizing and treating fractures effectively.

There are several types of ankle fractures, each with varying degrees of severity:

• Lateral malleolus fracture: This is the most common type, occurring at the bottom of the fibula.
• Medial malleolus fracture: Involves the inner portion of the tibia.
• Posterior malleolus fracture: Affects the back of the tibia.
• Bimalleolar fracture: Involves breaks in both the lateral and medial malleoli.
• Trimalleolar fracture: Includes breaks in all three malleoli (lateral, medial, and posterior).

Fractures can be further classified as displaced (bone fragments have moved out of alignment) or nondisplaced (bone fragments remain in proper alignment). The type and severity of the fracture will determine the appropriate treatment approach.

Recognizing the Symptoms of a Broken Ankle

Identifying the symptoms of a broken ankle is crucial for seeking timely medical attention. While symptoms may vary depending on the severity of the fracture, some common signs include:

• Severe pain, especially when trying to bear weight
• Swelling and tenderness around the ankle
• Bruising or discoloration
• Difficulty walking or moving the foot
• Visible deformity or misalignment of the ankle
• A grinding or snapping sound at the time of injury
• Numbness or tingling in the foot

Is bruising always present in a broken ankle? While bruising is a common symptom, it may not always be immediately visible. Some fractures may not show significant bruising, especially in the early stages. Therefore, the absence of bruising does not rule out a fracture.

Differentiating Between a Broken Ankle and a Sprained Ankle

Distinguishing between a broken ankle and a sprained ankle can be challenging, as both injuries share similar symptoms. A sprained ankle occurs when the ligaments that connect bones are stretched or torn, while a fracture involves a break in one or more bones.

How can you tell if your ankle is broken or sprained? Here are some key differences:

• Pain intensity: While both injuries can be painful, a broken ankle often causes more severe pain.
• Ability to bear weight: With a sprain, you may be able to put some weight on the affected foot, whereas a fracture typically makes it impossible or extremely painful to do so.
• Visible deformity: A broken ankle may appear visibly misaligned or deformed, which is less common in sprains.
• Sound at the time of injury: A fracture may produce a distinct snapping or grinding sound, while a sprain is often accompanied by a popping sound.

Despite these differences, a definitive diagnosis can only be made by a medical professional using imaging tests such as X-rays, CT scans, or MRI scans.

Common Causes and Risk Factors for Ankle Fractures

Understanding the common causes of ankle fractures can help in prevention and risk assessment. Some of the most frequent causes include:

1. Trips and falls: Losing balance on uneven surfaces or wearing ill-fitting shoes can lead to falls that place excessive force on the ankle.
2. Sports injuries: High-impact sports like soccer, basketball, and football can put significant stress on the ankle joint.
3. Car accidents: The sudden, forceful impact of a vehicle collision can result in severe ankle fractures.
4. Missteps: Awkwardly placing your foot or twisting your ankle while walking can cause a fracture.
5. Heavy impact: Jumping from a height or falling objects landing on the foot can break ankle bones.
6. Overuse: Repetitive stress on the ankle, common in runners and athletes, can lead to stress fractures.

What factors increase the risk of ankle fractures? Several factors can make individuals more susceptible to ankle fractures:

• Age: Older adults are at higher risk due to decreased bone density and balance issues.
• Osteoporosis: This condition weakens bones, making them more prone to fractures.
• Participation in high-risk activities: Engaging in sports or activities with a high risk of falls or collisions increases the likelihood of ankle fractures.
• Previous ankle injuries: A history of sprains or fractures can weaken the ankle and make it more susceptible to future injuries.
• Poor footwear: Wearing shoes that don’t provide adequate support or fit properly can increase the risk of ankle injuries.

Diagnostic Procedures for Ankle Fractures

Accurate diagnosis of an ankle fracture is essential for determining the appropriate treatment plan. Healthcare providers typically use a combination of physical examination and imaging studies to assess the injury.

Physical Examination

During the physical exam, the doctor will:

• Inspect the ankle for swelling, bruising, and deformity
• Palpate the area to check for tenderness and assess which structures may be involved
• Evaluate the range of motion and stability of the joint
• Check for neurovascular complications by assessing circulation and nerve function in the foot

Imaging Studies

Various imaging techniques may be employed to confirm the diagnosis and determine the extent of the injury:

• X-rays: These are typically the first-line imaging test, providing clear views of bone structures and helping to identify fracture locations and patterns.
• CT (Computed Tomography) scans: When more detailed imaging is needed, CT scans can provide cross-sectional views of the ankle, helping to visualize complex fractures.
• MRI (Magnetic Resonance Imaging): This technique is particularly useful for assessing soft tissue damage and detecting stress fractures that may not be visible on X-rays.
• Stress tests: In some cases, the doctor may perform a stress test under X-ray guidance to evaluate the stability of the ankle joint and determine if surgery is necessary.

How long does it take to diagnose a broken ankle? While initial assessment can be done quickly, obtaining and interpreting imaging results may take a few hours. In some cases, additional tests or specialist consultations may be required, extending the diagnostic process.

Treatment Options for Broken Ankles

The treatment approach for a broken ankle depends on the type and severity of the fracture. Treatment options range from conservative management to surgical intervention.

Non-Surgical Treatment

For stable, nondisplaced fractures, non-surgical treatment may be sufficient. This typically involves:

• Immobilization: Using a cast, splint, or boot to keep the ankle stable and allow proper healing
• RICE protocol: Rest, Ice, Compression, and Elevation to manage pain and swelling
• Pain management: Over-the-counter or prescription medications to alleviate discomfort
• Gradual weight-bearing: Progressively increasing weight on the affected ankle as directed by the healthcare provider

Surgical Treatment

Surgery may be necessary for more severe or unstable fractures. Surgical options include:

• Open reduction and internal fixation (ORIF): Realigning the broken bones and securing them with plates, screws, or rods
• External fixation: Using an external frame to hold the bones in place, typically for complex or open fractures
• Arthroscopy: Minimally invasive surgery to repair damage within the joint

What factors determine whether surgery is necessary for a broken ankle? The decision to operate depends on several factors, including:

• The stability of the fracture
• The degree of displacement
• The number of bones involved
• The presence of soft tissue damage
• The patient’s overall health and activity level

Rehabilitation and Recovery After an Ankle Fracture

Rehabilitation plays a crucial role in restoring function and strength after an ankle fracture. The recovery process typically involves several stages:

1. Initial immobilization: Keeping the ankle stable to allow proper bone healing
2. Early mobilization: Gentle exercises to maintain flexibility and prevent stiffness
3. Progressive weight-bearing: Gradually increasing the amount of weight placed on the affected ankle
4. Strengthening exercises: Building muscle strength and stability around the ankle joint
5. Balance and proprioception training: Improving coordination and reducing the risk of future injuries
6. Functional exercises: Activities that mimic daily tasks or sports-specific movements

How long does it take to recover from a broken ankle? Recovery time varies depending on the severity of the fracture and the treatment approach. Generally, it takes about 6-8 weeks for the bones to heal, but full rehabilitation may take several months. Some key milestones in the recovery process include:

• 2-6 weeks: Transition from immobilization to protected weight-bearing
• 6-12 weeks: Progression to full weight-bearing and more intensive rehabilitation
• 3-6 months: Return to most normal activities and sports
• 6-12 months: Continued improvement in strength and function

It’s important to follow the rehabilitation plan prescribed by your healthcare provider and physical therapist to ensure optimal recovery and minimize the risk of complications.

Preventing Ankle Fractures and Long-Term Considerations

While not all ankle fractures can be prevented, there are steps you can take to reduce your risk:

• Wear appropriate footwear with good support and traction
• Maintain a healthy weight to reduce stress on your ankles
• Strengthen your ankle muscles through regular exercise
• Improve your balance and coordination with specific exercises
• Be cautious when walking on uneven or slippery surfaces
• Warm up properly before engaging in sports or physical activities
• Use protective gear when participating in high-risk sports

What are the potential long-term effects of an ankle fracture? While many people recover fully from ankle fractures, some may experience long-term consequences:

• Chronic pain or stiffness in the ankle joint
• Increased risk of developing osteoarthritis in the affected joint
• Reduced range of motion or flexibility
• Weakness in the ankle and surrounding muscles
• Increased susceptibility to future ankle injuries

Regular follow-up with your healthcare provider and ongoing maintenance exercises can help minimize these long-term effects and maintain optimal ankle function.

Understanding the complexities of ankle fractures, from their causes and symptoms to treatment options and rehabilitation, is crucial for anyone who has experienced or is at risk of this injury. By recognizing the signs of a broken ankle, seeking prompt medical attention, and following a comprehensive recovery plan, individuals can optimize their healing process and return to their normal activities with confidence.

Broken Ankle Symptoms, Causes, Pictures, Treatments, and Rehab

A broken ankle is also called a fractured ankle. It happens when one or more bones in the ankle joint break. If you’ve been injured, have pain, and can’t walk or move your foot, you may have broken your ankle.

The ankle joint is made up of the following bones:

• The tibia is the larger bone in your lower leg. It’s also called the shinbone.
• The fibula, also called the calf bone, is the smaller bone in your lower leg.
• The talus is the small bone between the heel bone, or calcaneus, and the tibia and fibula.

A broken ankle is very painful.

Broken ankle X-ray photos

X-rays can show the location, type, and severity of your ankle break.

This will help your doctor determine the appropriate way to treat your injury.

You might hear the bone break at the time of injury. It may sound like a snapping or grinding noise. According to the American Academy of Orthopaedic Surgeons (AAOS), other symptoms include:

• severe pain
• swelling
• tenderness
• bruising
• difficultly walking or moving foot
• difficulty bearing weight
• foot that appears to be crooked or dislocated
• dizziness, from pain
• bone sticking out of the skin
• bleeding, if the bone pierces the skin

A broken ankle isn’t the same as a sprained ankle. A sprained ankle happens when ligaments tear or stretch. Ligaments are tough tissue that connects one bone to another.

If your ankle is sprained, you’ll have pain and swelling. The type of sprain will determine the degree of pain and swelling: a grade 1 sprain will have a little swelling, but a grade 3 sprain may have significant swelling. You may or may not be able to put weight on your ankle just after the injury.

A broken ankle can be just as painful as, if not more painful than, a sprain. Right after breaking an ankle, you may or may not be able to walk or place weight on the ankle. It depends on the type and cause of the fracture (a motor vehicle accident versus a fall, for example). You may or may not have severe bruising and swelling.

The only way to determine if there is a fracture or sprain is to visit a doctor.

To diagnose your injury, your doctor will do different tests. They might include:

• Physical exam. The doctor will examine your ankle for swelling and tenderness. If there is tenderness over a ligament, the injury is most likely a sprain. If tenderness is over the bone, it’s most likely a fracture. They might also move your foot around to determine your range of motion.
• X-ray. An X-ray lets a doctor see the location, type, and severity of the break.
• Stress test. A stress test determines if a sprained ankle needs surgery. A doctor will place pressure on the ankle and take an X-ray. If the joint opens up, this indicates a grade 3 tear that may need to be repaired.
• CT scan. A CT scan provides more detailed images by taking multiple cross-sectional pictures of the ankle.
• MRI scan. An MRI scan uses a magnetic field and radio waves to show the bones and surrounding tissue. It can help the doctor find fractures that don’t show up on X-rays. It can also see tears in the ligaments.

A broken ankle occurs when too much force is placed on the ankle. The most common causes include:

• Trips and falls. Losing your balance may lead to trips and falls, which can place excessive weight on your ankle. This might happen if you walk on an uneven surface, wear ill-fitting shoes, or walk around without proper lighting.
• Heavy impact. The force of a jump or fall can result in a broken ankle. It can happen even if you jump from a low height.
• Missteps. You can break your ankle if you put your foot down awkwardly. Your ankle might twist or roll to the side as you put weight on it.
• Sports. High impact sports involve intense movements that place stress on the joints, including the ankle. Examples of high impact sports include soccer, football, and basketball.
• Car collisions. The sudden, heavy impact of a car accident can cause broken ankles. Often, these injuries need surgical repair.
• Overuse. Repetitive force or trauma to the ankle can cause a stress fracture, which is a small crack in the bone. This type of injury is often seen in runners and other athletes.
• Trauma. Intense force to the ankle can cause crush injury and fracture. This could be caused by a heavy object falling on the foot or heavy machinery running over the ankle.

The type and severity of an ankle break depends on the amount of force that caused it. According to the Hospital for Special Surgery, types of ankle break injuries include:

Lateral malleolus fracture

This break occurs at the bottom of the fibula. It involves the bony “knob” outside of your ankle called the lateral malleolus, according to a 2019 study.

Lateral malleolus fractures are the most common type of ankle break.

Nondisplaced vs. displaced ankle fractures

Penn Medicine says that ankle fractures are often categorized as either displaced or nondisplaced.

With a displaced fracture, fragments of the bones that are broken may be separated or misaligned.

On the other hand, with a nondisplaced fracture, the broken bones remain in the correct position and retain their usual structure.

Medial malleolus fracture

A medial malleolus fracture happens at the end of the tibia. A 2019 review indicates that it specifically affects the medial malleolus, which is the knob on the inside of your ankle.

Bimalleolar ankle fracture

A bimalleolar ankle fracture involves both knobs in the ankle, which include the fibula (lateral malleolus) and tibia (medial malleolus). Based on a 2022 review, these almost always require surgery to repair.

It’s the second most common type of ankle break.

Bimalleolar equivalent fracture

A bimalleolar equivalent fracture means that in addition to one of the malleoli being fractured, the ligaments on the inside of the ankle are injured.

Posterior malleolus fracture

According to a 2016 review, a posterior malleolus fracture occurs on the back of the tibia.

Usually, this break happens with lateral malleolus fractures. That’s because the posterior malleolus and lateral malleolus share ligament attachments.

Trimalleolar fracture

A trimalleolar fracture involves all three parts of the ankle, which include the medial (inside), lateral (outside), and posterior (back) malleoli. A 2021 review suggests that, like a bimalleolar fracture, this usually requires surgery.

Pilon fracture

The AAOS says that a pilon fracture occurs in the “roof” of the ankle, which is at the end of the tibia. It’s also called a plafond fracture.

Pilon fractures are usually caused by high impact injuries like falls or car accidents.

Maisonneuve fracture

A Maisonneuve fracture, according to a 2020 study, includes two injuries: an ankle sprain and a break in the upper part of the fibula. The break is located near the knee.

This injury happens when you fall while rotating, causing the foot to awkwardly hit the ground. It’s most common in gymnasts, dancers, and skiers.

Syndesmotic injury

This injury affects the syndesmosis joint, which is located between the fibula and tibia. It’s held in place by ligaments.

If only the ligament is injured, it’s also called a high ankle sprain.

However, a 2016 review suggests that most syndesmotic injuries include a ligament sprain and at least one fracture.

Bosworth fracture

A Bosworth fracture is a type of fracture dislocation in which part of the fibula lodges behind the tibia.

According to a 2018 study, it occurs when the foot is rotated externally while supinated, meaning that weight is placed on the outer edges of the feet.

This type of fracture is very rare and usually requires surgical intervention.

Open ankle fracture

Open ankle fractures occur when there is a wound or break in the skin near the ankle. Typically, this occurs when a fragment of bone breaks through the skin during injury.

This type of fracture is treated differently than closed ankle fractures and often requires antibiotics to lower the risk of infection.

If you think you have a broken ankle, visit a doctor as soon as possible.

Meanwhile, the National Health Service (NHS) says that you can do several other things to take care of yourself, including:

• Keep weight off your foot. Elevate your ankle and prop it up on cushions.
• Apply ice. This will minimize pain and swelling.
• Apply pressure. If you’re bleeding, wrap the wound with a clean dressing.

If an auto collision or injury caused your broken ankle, or if the bone is sticking out of the skin, get medical help immediately.

Every injury is different. According to the NHS, the best treatment depends on the type and seriousness of your ankle break.

Ice

You can apply ice to reduce pain and swelling right after the injury. Wrap it in a towel before placing it on the skin.

Walking boot, cast, or splint

A small 2017 study suggests that mild ankle breaks can be treated with a walking boot, cast, or splint. These treatments keep the bone in place as it heals.

For more serious injuries, you’ll need to get surgery before using a boot, cast, or splint.

Crutches

Crutches help you walk around without bearing weight on the injured ankle. You can use them while wearing a boot, cast, or splint.

Reduction

If your broken bone has moved out of place, your doctor might need to physically move it back into position. This nonsurgical treatment is called closed reduction.

Before the procedure, you might receive a muscle relaxant, sedative, or general anesthesia to control the pain.

Surgery

Experts recommend surgery for severe ankle breaks that can’t heal with a boot, cast, or splint.

A surgeon may use metal rods, screws, or plates to realign the bone. This will keep the bone in place as it heals. The procedure is called open reduction internal fixation (ORIF).

After this procedure, the surgeon may order imaging tests like X-rays or CT scans to make sure they’ve repaired the fracture properly, according to a small 2020 study.

The AAOS says that broken ankles generally heal within 6 to 12 weeks. Injuries that don’t need surgery may heal in 6 weeks. During this time, your doctor may take regular X-rays to check on the bone.

Injuries that need surgery can take 12 weeks or longer to heal. Your total recovery time depends on your injury, age, and overall health.

During recovery, it’s important to follow your doctor’s recommendations. This will help your broken ankle heal properly. Here’s what you can do to ensure a smooth recovery:

• Avoid pressure. Try not to use your injured foot. When you walk or move, don’t apply weight on your ankle until your doctor allows you to do so.
• Rest. Don’t carry heavy items or play sports. If you need to go somewhere, ask family or friends. Your doctor will tell you when it’s safe to use your ankle.
• Physical therapy. When your bones start to heal, your doctor might have you do physical therapy. A physical therapist can show you how to exercise your ankle. These moves will strengthen the ankle bones.
• Eat healthy. Like all injuries, a broken ankle needs enough nutrients to heal. Eating a balanced diet will support recovery.
• If you smoke, consider quitting. Smoking slows down bone healing. Cigarette smoke has ingredients that disrupt your body’s ability to make new bone tissue. Quitting smoking can be difficult, but a doctor can help you create a smoking cessation plan right for you.
• Attend follow-up appointments. During recovery, visit the doctor regularly. They’ll need to check that your bone is healing correctly.

Broken ankle — can you still walk?

Typically, a minor ankle fracture won’t prevent you from walking. You might even be able to walk right after the injury.

If you have a serious break, you’ll need to avoid walking for a few months. As your ankle gets better, you can slowly return to your usual activities.

A broken or fractured ankle occurs when one or more bones in your ankle break. These bones include the tibia, fibula, and talus.

Usually, ankle breaks are caused by falls, high impact sports, car accidents, or injuries that place excessive force on the ankle.

Treatment depends on the severity of the break. If you have a minor ankle break, you might get a walking boot, cast, or splint. If it’s serious, you might need surgery to realign the bone.

Recovery can take 6 to 12 weeks. Severe ankle breaks that need surgery may take longer.

Broken ankle – Symptoms & causes

Overview

A broken or fractured ankle is an injury to the bone. You may experience a broken ankle from a twisting injury from a simple misstep or fall, or from direct trauma during a car crash, for example.

Foot and ankle bones

A fall or blow to your ankle can break one or more of the three bones in your ankle joint the fibula, the tibia and the talus. Rolling your ankle can cause a break in the knobby bumps at the end of the tibia and fibula.

The seriousness of a broken ankle varies. Fractures can range from tiny cracks in your bones to breaks that pierce your skin.

Treatment for a broken ankle depends on the exact site and severity of the bone fracture. A severely broken ankle may require surgery to implant plates, rods or screws into the broken bone to maintain proper position during healing.

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Symptoms

If you have a broken ankle, you may experience some of the following signs and symptoms:

• Immediate, throbbing pain
• Swelling
• Bruising
• Tenderness
• Deformity
• Difficulty or pain with walking or bearing weight

When to see a doctor

See a doctor if there is obvious deformity, if the pain and swelling don’t get better with self-care, or if the pain and swelling get worse over time. Also, see a doctor if the injury interferes with walking.

Causes

A broken ankle is usually a result of a twisting injury, but can also be caused by a direct blow to the ankle.

The most common causes of a broken ankle include:

• Car accidents. The crushing injuries common in car accidents may cause breaks that require surgical repair.
• Falls. Tripping and falling can break bones in your ankles, as can landing on your feet after jumping down from just a slight height.
• Missteps. Sometimes just putting your foot down wrong can result in a twisting injury that can cause a broken bone.

Risk factors

You may be at higher risk of a broken ankle if you:

• Participate in high-impact sports. The stresses, direct blows and twisting injuries that occur in sports such as basketball, football, gymnastics, tennis and soccer can cause ankle fractures.
• Use improper technique or sports equipment. Faulty equipment, such as shoes that are too worn or not properly fitted, can contribute to stress fractures and falls. Improper training techniques, such as not warming up and stretching, also can cause ankle injuries.
• Suddenly increase your activity level. Whether you’re a trained athlete or someone who’s just started exercising, suddenly boosting the frequency or duration of your exercise sessions can increase your risk of a stress fracture.
• Keep your home cluttered or poorly lit. Walking around in a house with too much clutter or too little light may lead to falls and ankle injuries.
• Have certain conditions. Having decreased bone density (osteoporosis) can put you at risk of injuries to your ankle bones.
• Smoking. Cigarette smoking can increase your risk of developing osteoporosis. Studies also show that healing after a fracture may take longer in people who smoke.

Complications

Complications of a broken ankle are uncommon but may include:

• Arthritis. Fractures that extend into the joint can cause arthritis years later. If your ankle starts to hurt long after a break, see your doctor for an evaluation.
• Bone infection (osteomyelitis). If you have an open fracture, meaning one end of the bone protrudes through the skin, your bone may be exposed to bacteria that cause infection.
• Compartment syndrome. This condition can rarely occur with ankle fractures. It causes pain, swelling and sometimes disability in affected muscles of the legs.
• Nerve or blood vessel damage. Trauma to the ankle can injure nerves and blood vessels, sometimes actually tearing them. Seek immediate attention if you notice any numbness or circulation problems. Lack of blood flow can cause a bone to die and collapse.

Prevention

These basic sports and safety tips may help prevent a broken ankle:

• Wear proper shoes. Use hiking shoes on rough terrain. Choose appropriate athletic shoes for your sport.
• Replace athletic shoes regularly. Discard sneakers as soon as the tread or heel wears out or if the shoes are wearing unevenly. If you’re a runner, replace your sneakers every 300 to 400 miles.
• Start slowly. That applies to a new fitness program and each individual workout.
• Cross-train. Alternating activities can prevent stress fractures. Rotate running with swimming or biking.
• Build bone strength. Get enough calcium and vitamin D. Calcium-rich foods include milk, yogurt and cheese. Ask your doctor if you need to take vitamin D supplements.
• Declutter your house. Keeping clutter off the floor can help you to avoid trips and falls.
• Strengthen your ankle muscles. If you are prone to twisting your ankle, ask your doctor for exercises to help strengthen the supporting muscles of your ankle.

Ankle fracture – how it happens, classification, treatment methods

The information provided on the page should not be used for self-treatment or self-diagnosis. If you suspect a disease, you should seek help from a qualified specialist. Only your doctor can diagnose and prescribe treatment.

Contents of the article:

• How fracture occurs
• Ankle fracture classification
• Symptoms
• Diagnostics
• First aid
• Treatment and clinical guidelines
• Surgical treatment
• Possible complications

What is an ankle fracture?

An ankle fracture is a partial or complete fracture of the leg bones. Ankle fractures can range in severity from less severe injuries involving small pieces of bone near the joint to severe fractures of the tibia and fibula, or both. Ankle fractures are common injuries, most often caused by the ankle twisting inward or outward. Many people mistake an ankle fracture for an ankle sprain, but the consequences are completely different and therefore require accurate and early diagnosis. Treatment and rehabilitation at home depends on this. Fortunately, both surgical and non-surgical treatments are being used today. All ankle fracture injuries should be evaluated by a physician to determine severity.

How a fracture occurs

Ankle fractures, more commonly known as ankle fractures, occur when one or more of the bones that make up the ankle joint is broken. Although an ankle fracture is an injury seen at almost any age, it is more common among older people and athletes who are physically active.

When the bones are damaged, the ankle becomes unstable. With the addition of ligament injuries, the injury can become a very serious problem, complications after an ankle fracture are possible.

An ankle fracture can be caused by sudden, inadvertent movement, such as twisting the ankle during sports or activity. Car accidents can also cause ankle fractures, especially after heavy impacts.

Also, a person can trip, fall, twist the ankle – this can cause an ankle fracture. Depending on age and previous health conditions, this problem can develop into much more serious damage if left untreated. Source:
Ankle injury analysis. Tailashev M.M., Salatin P.P., Sobolev V.V., Pozikov V.V., Kolesnikov A.S. Acta Biomedica Scientifica, 2008. p. 144-145.

Classification of ankle fractures

The ankle joint itself is formed by three bones – this is the largest tibia, then the fibula (shin bone) and the talus. It is located in the area between the calcaneus, as well as the greater and fibular bones. Ankle fractures are classified according to the area of ​​the broken bone:

• fracture in the area of ​​the medial malleolus is the inner surface of the tibia;
• posterior malleolus injury is the dorsum of the tibia;
• lateral malleolus fracture is an injury to the edge of the fibula.

The stability of the ankle joint is determined by the strength of the ligaments and bones. In case of fractures in the area of ​​the ankle joint, two joints are affected:

• ankle joint – formed by the lower leg, talus, fibula;
• joint syndesmosis is the area between the tibia and fibula held together by ligaments Source:
  Ankle joint fractures and treatments. Cherednik A.A., More Gautam Saherbao, Al-Fakih Abdulaziz. Bulletin of Medical Internet Conferences, 2014. p.432.

Symptoms

Since a sprain can sometimes feel like a broken ankle, it is always important to consult a doctor. Assessing the symptoms of an ankle fracture and post-injury pain helps in determining how serious the injury is.

An ankle fracture is accompanied by one or all of the following symptoms:

• pain at the fracture site, which in some cases may radiate from the foot to the knee;
• Significant swelling that may occur along the length of the leg or be more localized. How long the swelling lasts will depend on the severity of the injury and the amount of damaged tissue;
• a bruise that appears shortly after the injury;
• inability to walk, stepping on the whole leg. Therefore, the doctor will tell you how to walk correctly after an injury. However, a person can walk with less severe fractures, so never rely on walking as a test to see if a bone has been broken;
• changed the appearance of the ankle – it will be different from the other ankle;
• bone protrudes from under the skin in an open fracture. Fractures penetrating the skin require immediate intervention as they can lead to severe infection and prolonged recovery.

Diagnosis

The doctor will discuss with the patient the medical history (how long it hurts, before the injury) and symptoms. He will also ask how the injury happened and examine the affected area. If the traumatologist believes that you may have broken your ankle, they will order a series of examinations to more fully study the injury.

X-ray : X-rays can show if the ankle bone has been broken and how many fragments of the broken bone are there. They can also determine if there is a dislocation (tear between broken bones). The doctor may also take x-rays of other parts of the leg or foot to make sure nothing was damaged as a result of the injury.

Stress Test : A stress test is performed to determine if surgical procedures are needed to heal an injury. The doctor will put some pressure on the ankle and take a special x-ray to determine the severity of the lesion.

CT Scan (Computed Tomography): If the fracture extends beyond the ankle joint, a CT scan may be required to further investigate the injury. CT scanning allows you to get an image of a series of images in different planes, by which the doctor can determine the severity of the injury. Source:
Comprehensive diagnosis of ankle injuries. Kim L.I., Dyachkova G.V. Genius of Orthopedics, 2013. pp. 20-24.

MRI scan (Magnetic Resonance Imaging): If the doctor suspects a ligament injury has occurred, they may order an MRI scan to better view the affected area. MRI can look deeper into bones and soft tissues, such as ligaments, to create higher resolution images than most other tests.

Ankle fracture first aid

Ankle fracture treatment depends on the type and severity of the injury. First aid is needed to prevent further damage from a broken ankle and shorten the time for bone healing.

• Rest : relieve the injured ankle. Walking can lead to further injury, and only a doctor can determine when to step on your foot.
• Ice : apply an ice pack to the injured area by placing a thin towel between the ice and the skin. You need to use ice for 20 minutes and then wait at least 40 minutes before doing a cold compress again.
• Compression : An elastic bandage should be used to control swelling.
• Height : Ankle should be slightly elevated above heart level to reduce swelling.

Ankle fracture: treatment, clinical guidelines

If the traumatologist determines that the patient has a broken ankle, it is necessary to determine what type of fracture it is and how to treat it. Ankle fractures can be treated with non-surgical methods, as long as the injury is not too severe or unstable.

• Lateral fibula fracture . If the ankle is stable, non-surgical healing methods are available. These can range from wearing tall tennis shoes to short casts. The doctor may recommend rest and crutches to keep the foot light and to make sure that the fragments do not move during healing.
• Fracture of the tibia on the inside of the lower leg . If the fracture is all in place or if it is very minor, it can be cured if the ankle is not stressed for 6 weeks. A short leg bandage or a removable bandage, as well as a doctor’s recommendation when it is possible to walk, usually speeds up the healing process.
• Fracture of the back of the leg at the level of the ankle joint . In most cases, the fibula also breaks due to the fact that it shares ligaments with the posterior malleolus. If the ankle remains stable, it can be treated without surgery. Treatment may include a short leg bandage or a removable brace. It is important to determine the severity so that arthritis does not develop. As you heal, you will need to gradually develop an ankle fracture.
• Bimalleolar equivalent fracture (two of the three parts of the ankle broken) indicates that the ligaments on the inside of the ankle are also damaged. Because these injuries are usually unstable, surgery is usually recommended. In case of health problems that may interfere with the operation, a splint and a short bandage on the leg may be applied. You will need to see your doctor regularly to make sure your ankle remains stable.
• Trimalleolar fracture (all three parts of the ankle are broken). Since this is a very difficult situation, surgery is almost always recommended. Rare non-surgical treatment options include a short leg bandage, a splint, and regular doctor visits.

If the joint located between the tibia and fibula is damaged, and the ligaments are also affected, the damage can heal like an ankle sprain. The injury can be treated by removing weight from it without surgery.

However, in most cases sprains and one or more fractures occur. Recovery after an ankle fracture is rarely without surgical treatment. Source:
Treatment tactics for intra-articular fractures of the ankle joint (literature review). Zedgenidze I.V., Tishkov N.V. Acta Biomedica Scientifica, 2013. pp. 178-182.

Surgery

In the event that non-surgical treatments do not work or the ankle is too unstable, your doctor may recommend surgery for a broken ankle, followed by rehabilitation. After the operation, it is important to walk the leg, perform all the prescribed procedures in order to shorten the rehabilitation period.

Features of the operation: if the fragments are not in place, the bone fragments must be moved surgically. The fragments had to be returned to their normal position and fastened with special screws and metal plates attached to the outer surface of the bone. The surgery may involve bone grafting so that the new bone can actively heal. It is fixed with screws and a metal plate. This may reduce the risk of arthritis and speed up the return of movement.

Possible complications

After treatment, it is important to follow the surgeon’s instructions. Failure to follow this rule can lead to infection, deformity, arthritis, and chronic pain. Source:
Errors and complications in the treatment of complex ankle fractures. Salikhov R.Z., Pankov I.O., Plakseichuk Yu.A., Solovyov V.V. Practical medicine, 2014. p. 128-131.

• Mistakes and complications in the treatment of complex fractures of the ankle joint. Salikhov R.Z., Pankov I.O., Plakseichuk Yu.A., Solovyov V.V. Practical medicine, 2014. p. 128-131
• Ankle injury analysis. Tailashev M.M., Salatin P.P., Sobolev V.V., Pozikov V.V., Kolesnikov A.S. Acta Biomedica Scientifica, 2008. p. 144-145
• Comprehensive diagnosis of ankle joint injuries. Kim L.I., Dyachkova G.V. Genius of Orthopedics, 2013. p.20-24
• Fractures of the ankle joint and methods of treatment. Cherednik A.A., More Gautam Saherbao, Al-Fakih Abdulaziz. Bulletin of Medical Internet Conferences, 2014. p.432
• Therapeutic tactics for intra-articular fractures of the ankle joint (literature review). Zedgenidze I.V., Tishkov N.V. Acta Biomedica Scientifica, 2013. p.178-182

symptoms, treatment, prevention at home

Each ankle consists of an outer – lateral, and an inner – medial malleolus, these are different parts of the fibula and tibia. From the outside, we see them as two tubercles on the inside and outside of the ankle joint.

Both ankles form a “fork” of the ankle joint, through which the person’s weight is transferred to the foot. A fracture is a violation of the integrity of the bone, it can affect different anatomical structures. It is possible to fracture only the inner, only the outer ankle, or both.

If the bones are displaced or shattered, this fracture is considered complicated. Additionally, the subluxation of the joint aggravates the situation. Sometimes fragments break through the skin and tissues – then the fracture becomes open.

Symptoms of an ankle fracture

An ankle fracture can be suspected after the very fact of the injury: they fell awkwardly, twisted their leg, jumped from a height. At the time of the fracture, a crackling sound can sometimes be heard. The limb is deformed, arched at an unusual angle.

This is followed by pain, usually in the ankle area, but not always. The joint is limited in mobility, it is impossible to step on the foot. Gradually, the joint swells, a bruise grows and redness appears.

Ankle fracture treatment

If the bones are not displaced and there are no other complications, bone fragments, ligament rupture, it is usually sufficient to apply a cast for 4 to 8 weeks. With such an uncomplicated fracture, it is possible to immobilize the leg with the help of modern orthoses and bandages. They are made of durable plastic or metal covered with fabric and secured with Velcro. The bandage can be adjusted to the size of the leg, if necessary, remove and wipe the skin, but this cannot be done without the permission of the doctor.

If the fracture is closed, but there is a displacement, before applying a bandage, a reposition is performed – reduction of the joint. This is done in a hospital under local anesthesia. After that, plaster is also applied.

Surgery is necessary if bone displacement cannot be corrected without surgery, or if there is subluxation or other complications. Surgery is considered very effective, after which the ankles heal faster and complications are rare. The operation is usually performed a few days after the injury.

Regardless of the way in which the bones are placed in the correct position, rest must be observed. You can’t step on your foot, you have to walk with the help of crutches.

Diagnostics

Ankle fractures must be distinguished from ligament injuries. For an accurate diagnosis, an x-ray of the ankle joint is performed. In the picture, the traumatologist sees exactly how the fragments have shifted, what is the severity of the injury.

X-ray shows mostly hard tissues, it is difficult to assess the condition of soft tissues. In doubtful cases, computed tomography and MRI are additionally prescribed.

Modern methods of treatment

After fixing the ankle joint in the correct position, it takes a long time for all damaged tissues to recover. Physiotherapy can speed up the healing process. It improves blood circulation, facilitates the outflow of lymph and relieves swelling.

The doctor prescribes the type of therapy depending on the severity of the injury. This can be warming up with the help of paraffin applications, infrared laser therapy. Often prescribed electrophoresis with calcium to accelerate the healing of bones, magnetotherapy, acupuncture.

Ankle fracture prevention at home

Active young people and athletes, as well as the elderly, are most susceptible to this injury. The love of stilettos also increases the risk of ankle fracture, in such shoes the foot is unstable and often tucked.

Lack of exercise increases the likelihood of injury. At the same time, the muscles weaken, all the pressure falls on the bone tissue, which may not withstand the load. In older patients, the risk of injury also increases. This is due to the frequent development of osteoporosis, in which the bones become thinner and brittle.

To reduce the risk of an ankle fracture, you need to give yourself feasible physical activity, avoid uncomfortable shoes, monitor calcium levels and bone density.

Popular Questions and Answers

This injury is one of the most common. An ankle fracture accounts for up to 20% of all skeletal injuries. Traumatologist-orthopedist Sergey Prokofiev answered popular questions from patients.

How to provide first aid for a fracture?

The main thing is not to try to stand on the injured leg. You need to sit down and use gentle pressure to feel the lower leg to determine exactly where it hurts. Next, you need to fix the ankle joint with anything, at least two boards on both sides, and wrap it with a bandage or cloth on top. If this is not done, the bone fragments may be displaced.

You need to call an ambulance or take the victim to the emergency room. While waiting for transport, apply cold to the site of pain from two opposite sides. Suitable, for example, bottles of cold water or frozen foods.

If high-top shoes are worn, no attempt should be made to remove them. Just loosen the laces or unzip. Only if the shoes squeeze the ankle joint, you can try to pull it off a little, but it’s better not to. The limb should be elevated to reduce swelling. You can take any painkillers.

What are the possible complications of a fracture?

Unfortunately, it is not always possible to completely restore a joint. Complications develop in 10% of patients. This usually occurs with a complicated fracture of the ankle with displacement or subluxation.

In case of incorrect reduction, damage to blood vessels and nerves during trauma, pain or loss of sensation in the ankle joint is possible even after healing. And if the bones did not grow together correctly and no operation was performed, a shortening of one of the bones, lameness, may develop.