Does a broken ankle bruise. Broken Ankle: Symptoms, Causes, and Treatment Options

27.07.202317.07.2023 by alexxlab

What are the common symptoms of a broken ankle. How can you differentiate between a sprain and a fracture. What are the main causes of ankle fractures. What treatment options are available for a broken ankle. How long does it take for a broken ankle to heal. What complications can arise from an ankle fracture. How can you prevent ankle injuries.

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Understanding Broken Ankles: An Overview

A broken ankle, also known as an ankle fracture, is a serious injury that occurs when one or more of the bones in the ankle joint break. This joint consists of three main bones: the tibia (shinbone), fibula (smaller bone of the lower leg), and talus (a small bone that sits between the heel bone and the tibia and fibula). Ankle fractures can range from small cracks in the bone to severe breaks that pierce through the skin.

The severity of a broken ankle can vary significantly, impacting both treatment approaches and recovery time. While some minor fractures may heal with conservative treatments, more severe cases often require surgical intervention to ensure proper alignment and healing of the bones.

Types of Ankle Fractures

Lateral malleolus fracture: Involves the lower end of the fibula
Medial malleolus fracture: Affects the inner portion of the tibia
Bimalleolar fracture: Includes breaks in both the lateral and medial malleoli
Trimalleolar fracture: Involves breaks in the lateral and medial malleoli, as well as the posterior malleolus (back of the tibia)
Pilon fracture: A severe break that affects the weight-bearing surface of the tibia

Recognizing the Symptoms of a Broken Ankle

Identifying the symptoms of a broken ankle is crucial for seeking timely medical attention. While the severity of symptoms may vary depending on the extent of the fracture, there are several common signs to watch for:

Immediate, throbbing pain at the site of injury
Significant swelling around the ankle
Bruising or discoloration
Tenderness when touched
Visible deformity or misalignment of the ankle
Difficulty or inability to bear weight on the affected foot
Limited range of motion in the ankle

How can you differentiate between a sprained ankle and a broken ankle? While both injuries can cause pain and swelling, a broken ankle is often characterized by more intense pain, particularly when attempting to bear weight. Additionally, a visible deformity or the sound of a “crack” at the time of injury may indicate a fracture rather than a sprain. However, it’s important to note that only a medical professional can definitively diagnose a broken ankle through physical examination and imaging studies.

Common Causes and Risk Factors for Ankle Fractures

Ankle fractures can occur due to various circumstances, often involving sudden force or twisting motions applied to the ankle joint. Understanding the common causes can help in prevention and risk assessment:

Primary Causes of Broken Ankles

Twisting or rotating the ankle beyond its normal range of motion
Falls, especially from a height or during sports activities
Direct impact or trauma to the ankle, such as in car accidents
Missteps on uneven surfaces or during everyday activities
High-impact sports injuries

What factors increase the risk of sustaining an ankle fracture? Several conditions and lifestyle choices can make individuals more susceptible to this type of injury:

Participation in high-impact sports (e.g., basketball, football, soccer)
Poor physical conditioning or sudden increases in activity level
Improper footwear or sports equipment
Osteoporosis or other conditions affecting bone density
Age-related decline in balance and coordination
Smoking, which can impair bone healing and increase fracture risk
Environmental factors, such as cluttered living spaces or poor lighting

Diagnosis and Imaging Techniques for Ankle Fractures

Accurate diagnosis of a broken ankle is essential for determining the appropriate treatment plan. Healthcare providers utilize a combination of physical examination and imaging studies to assess the extent and location of the fracture.

Diagnostic Process

Physical examination: The doctor will inspect the ankle for swelling, bruising, and deformity, and assess pain levels and range of motion.
X-rays: Standard X-rays are the primary imaging tool for diagnosing ankle fractures, providing clear images of bone alignment and fracture patterns.
CT (Computed Tomography) scan: For more complex fractures, a CT scan may be ordered to provide detailed 3D images of the bone and surrounding structures.
MRI (Magnetic Resonance Imaging): In some cases, an MRI may be used to evaluate soft tissue damage associated with the fracture.

How do healthcare providers determine the severity of an ankle fracture? Doctors consider several factors, including the number of bones affected, the location and pattern of the fracture, whether the fracture is open or closed, and the degree of displacement between bone fragments. This comprehensive evaluation guides treatment decisions and helps predict recovery outcomes.

Treatment Options for Broken Ankles

The treatment of a broken ankle depends on the severity and location of the fracture. The primary goal is to promote proper bone healing and restore ankle function. Treatment options range from conservative approaches to surgical interventions:

Non-Surgical Treatments

RICE protocol (Rest, Ice, Compression, Elevation)
Immobilization with a cast or walking boot
Pain management with over-the-counter or prescription medications
Use of crutches or a wheelchair to avoid weight-bearing

Surgical Interventions

Open reduction and internal fixation (ORIF) with plates, screws, or rods
External fixation for severe or open fractures
Arthroscopic procedures for certain fracture types

What factors determine whether surgery is necessary for a broken ankle? The decision to pursue surgical treatment typically depends on the fracture’s stability, alignment, and the patient’s overall health and activity level. Displaced fractures, open fractures, or those involving the joint surface often require surgical intervention to ensure proper healing and reduce the risk of complications.

Recovery and Rehabilitation Process

Recovering from a broken ankle is a gradual process that requires patience and dedication. The healing timeline can vary significantly depending on the severity of the fracture and the chosen treatment method.

Typical Recovery Milestones

Initial healing phase (6-8 weeks): Bone fragments begin to knit together
Progressive weight-bearing (8-12 weeks): Gradual return to normal activities
Strengthening and flexibility exercises (3-6 months): Restoring ankle function
Full recovery and return to sports (6-12 months): Depending on individual factors

How can patients optimize their recovery from a broken ankle? Following the healthcare provider’s instructions closely is crucial. This may include:

Adhering to weight-bearing restrictions
Participating in physical therapy sessions
Performing prescribed home exercises
Maintaining a healthy diet to support bone healing
Avoiding smoking and limiting alcohol consumption
Attending follow-up appointments for progress monitoring

Potential Complications and Long-Term Effects

While most broken ankles heal successfully with proper treatment, complications can occur. Being aware of potential issues allows for early intervention and improved outcomes.

Common Complications

Posttraumatic arthritis: Damage to the joint surface can lead to arthritis over time
Chronic pain or stiffness: Some patients may experience ongoing discomfort or reduced mobility
Malunion: Improper alignment of the bones during healing
Nonunion: Failure of the bone to heal completely
Infection: Particularly a risk with open fractures or surgical interventions
Deep vein thrombosis (DVT): Blood clots can form due to immobilization

What steps can be taken to minimize the risk of complications after an ankle fracture? Adhering to the treatment plan, maintaining good overall health, and participating in rehabilitative exercises are crucial. Regular follow-up with healthcare providers allows for early detection and management of any emerging issues.

Prevention Strategies for Ankle Injuries

While not all ankle fractures can be prevented, several strategies can reduce the risk of injury:

Wear appropriate footwear for different activities and terrains
Maintain good physical conditioning, including balance and strength exercises
Warm up properly before engaging in sports or physical activities
Use caution when walking on slippery or uneven surfaces
Ensure adequate lighting and remove tripping hazards in living spaces
Consider using ankle supports or braces during high-risk activities
Address underlying health conditions that may increase fracture risk

How effective are ankle strengthening exercises in preventing fractures? While no exercise can completely eliminate the risk of injury, strengthening the muscles supporting the ankle can improve stability and reduce the likelihood of sprains and some types of fractures. Consult with a physical therapist or healthcare provider for a personalized exercise program tailored to your needs and activity level.

Understanding the nature of broken ankles, recognizing symptoms, and knowing the available treatment options are crucial for anyone who may be at risk of this injury. By following prevention strategies and seeking prompt medical attention when needed, individuals can minimize the impact of ankle fractures on their daily lives and long-term health. Remember, proper care and rehabilitation are key to achieving optimal recovery and returning to normal activities after a broken ankle.

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.

Broken Ankle or a Sprain: How do you Know?

February 8, 2018

You fall and injure your ankle. Next you gauge your pain and ask: “Is it a broken ankle or a sprain?” This scenario accounts for one of the most common complaints; yet a simple twist and fall could become a complex injury involving bone, cartilage, ligaments and tendons. In this blog I will discuss ankle fractures and what the next steps are on the road to recovery.

Ankle Anatomy

Three bones make up the ankle: the tibia, the fibula, and the talus. The tibia and fibula are commonly involved in a broken ankle (ankle fracture). These articulate in multiple directions to account for the ankle’s complex range of motion. Motion between bones occurs against smooth surfaces covered with cartilage. Cartilage allows for fluid motion at a joint due to its low level of friction. For those familiar with carpentry, you can think of these bones as a mortise and tenon joint where the talus bone acts as the tenon (tongue) attached to the foot and the tibia and fibular act as the mortise making up the lower leg.

These bones are secured by ligaments (deltoid, syndesmosis, lateral ligament complex) that maintain this relationship. The deltoid ligament originates from the medial malleolus (medial tibia) and inserts on the talus, calcaneus and navicular bones of the foot distally. While commonly injured, surgical repair of this ligament is often unnecessary. The lateral ligament complex includes the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL), and the posterior talofibular ligament (PTFL). The most common type of ankle sprain involves the ATFL. The third major ligament complex is called the syndesmosis. This connects between the fibula and tibia throughout the lower leg. Injuries to this ligament are often referred to as a “high ankle sprain” and develop with rotation.

Pain free motion of the ankle relies heavily on this complex congruent relationship between the talus and the tibia and fibula. If the ankle joint is even displaced 1mm, a 42% increase in pressure to ankle may occur¹. A change in the bony anatomy of the ankle involved with an ankle fracture may introduce enough change in alignment that the ankle is now at risk for future arthritis.

Is the Ankle Sprained or Broken?

A thorough evaluation by an Orthopedic Specialist in Foot and Ankle such as Dr. Miller will identify the nature of the injury. Immediately following the injury, it is reasonable to assess the ankle with weight bearing. If there is no pain with walking, an ankle fracture is highly unlikely. Soreness with walking but the ability to walk normally suggests a contusion or sprain of the ankle. However, if you cannot stand on the ankle, an evaluation is warranted to rule out a broken ankle or ankle fracture.

Swelling is another sign of injury. If the swelling comes on gradually and is mild, the injury is likely a sprain or less severe. More immediate and significant swelling indicates a bony injury and possible fracture. When severe fractures occur, blistering of the skin is not uncommon. The blisters emanate from excessive swelling in the soft tissues following a severe fracture. Sometimes the ankle is dislocated with this amount of swelling. Immediate medical attention is required in these circumstances to reduce the ankle. Once severe swelling or blistering sets in, this can take weeks until the initial swelling resolves. In many cases these changes can delay surgery on the ankle.

As time passes ecchymosis (bruising) may occur. This can be extensive; however, this does not necessarily mean the ankle is broken. More severe ankle sprains present with significant ecchymosis over the region of injury. Besides not being able to put pressure down on the ankle or a deformity in the ankle after injury, a good reason to be evaluated for a broken ankle/ankle fracture is continued symptoms that worsen or stay the same. Some ankle fractures are stable enough that you may still be able to walk. Some people have a high pain tolerance that allows them to cope with the injury. These scenarios are best evaluated by an orthopedic surgeon when not improving.

Orthopedic Evaluation

Once you have made the decision to be evaluated for ankle pain, Dr. Miller will assess you and your injury as a whole. This includes a detailed history and physical examination with special focus on the ankle. Your age, mobility level and medical history are important, particularly as it relates to the ability heal an injury or recover from a potential surgery. Preexisting medical conditions such as diabetes, vascular problems, and inflammatory disease (e.g. rheumatoid) must be accounted for during the planning of treatment. Any remote history related to the ankle or previous injury should be known.

Physical examination will be performed during your visit. It is important to assess the ankle based on its appearance including deformity, any open wounds around the ankle, the amount of swelling present, and any preexisting rashes or skin issues. Vascular exam is used to determine the appropriate blood flow to the lower extremity, and this is performed by checking the dorsalis pedis and posterior tibialis pulses surrounding the foot and ankle. A neurological exam of the lower extremity will be used to assess any nerve injuries and the ability to move the foot. The extremity will then be evaluated for areas of tenderness and pain. This will help to locate the injury in a broken ankle more specifically and rule out other concurrent pathology.

Findings from the physical exam will then be used to evaluate radiographs of the affected ankle and surrounding areas. X-rays consist of three views of the ankle and any other areas of concern. While minimizing radiation is a good general rule, lower extremity x-rays use very low levels of radiation and in comparison account for a small fraction of the radiation you naturally receive yearly by living on Earth². Based on these images, Dr. Miller can evaluate for the presence of a fracture and the severity of the fracture.

Treatment

Once you have been identified to have a broken ankle/ankle fracture, how will the ankle be treated? Assuming you have an ankle fracture, the most important decision is whether the fracture can be treated non-surgically or the broken ankle requires surgical intervention. This decision would be made by Dr. Miller taking into account all variables described above.

In many cases the decision to perform surgery depends on the stability of the ankle. If 2 or more different fractures are identified in the ankle, surgery is commonly warranted due to the concern for instability and movement of the pieces. If the pieces heal non-anatomically, the ankle may be predisposed to accelerated wear and arthritis. If only one fracture is identified, the decision to perform surgery relies on the location and character of the fracture. Further radiographs that stress the ankle may be warranted to make this determination.

If the broken ankle has been considered stable enough to not require surgery, early weight bearing in a protective boot may be an option. This type of protection can be required for 6 weeks. You would wear the boot during all weight bearing activities. Usually at 6 weeks there is adequate healing to start weaning out of the boot.

If the broken ankle/ankle fracture is severe or unstable, surgical intervention utilizing metal implants is likely required. The day of surgery a patient typically will receive a nerve block prior to surgery that helps with anesthesia and pain control after the procedure. This process anesthetizes the leg to achieve temporary numbness. Once this is complete the actual surgery usually lasts between 1 and 2 hours. The surgery consists of reducing the broken pieces of the ankle to where they were prior to the injury and maintaining that reduction with metal hardware. Generally one or two incisions are used. A soft cast or splint would be applied for temporary protection until you return the office. After surgery it is imperative to elevate your leg to your heart level consistently until seen in the office. This improves pain relief and wound healing.

When you return to the office, the ankle is usually ready to be placed in a boot for protection. For the next 5-6 weeks no weight is to be put on the leg in most cases. One can start showering 2 weeks after the surgery on average. Around 6 weeks after the surgery, you can progressively apply weight to the leg while in the boot until you are completely weight bearing in the boot without an assist device. Range of motion and therapy begins 4-6 weeks after surgery. You can drive 9 weeks after surgery if your right leg was injured. Eleven to 12 weeks after surgery the boot is replaced with a shoe and possibly an ankle brace. Return to full impact and running would be achieved in the following months.

Appointments can be made with Dr. Adam G. Miller by calling (513)-354-3700 or booking online here.

¹ Ramsey PL, Hamilton W. Changes in tibiotalar area of contact caused by lateral talar shift. J Bone Joint Surg Am. 1976 Apr;58(3):356-7. Epub 1976/04/01.
² Coughlin MJ, Saltzman CL, Mann RA. Mann’s Surgery of the Foot and Ankle: Expert Consult-Online and Print: Elsevier Health Sciences; 2014.

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.