Pain broken ankle. Broken Ankle: Symptoms, Diagnosis, and Treatment Options for a Painful Injury

03.08.202311.06.2023 by alexxlab

What are the symptoms of a broken ankle. How is an ankle fracture diagnosed. What treatment options are available for a broken ankle. Can a broken ankle heal without surgery. When is surgery necessary for an ankle fracture. How long does it take to recover from a broken ankle.

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Understanding Ankle Fractures: Causes and Types

A broken ankle, also known as an ankle fracture, is a common and painful injury that can occur due to various reasons. Whether it’s caused by a simple misstep or a more severe trauma like a car accident, ankle fractures can range from minor cracks to complex breaks involving multiple bones.

The ankle joint consists of three main bones:

Tibia (shin bone)
Fibula (outer ankle bone)
Talus (a bone in the foot between the leg and heel bones)

An ankle fracture can involve one or more of these bones, and the surrounding ligaments are often damaged as well. The severity of the fracture depends on the location and number of breaks, as well as whether the ankle joint remains stable or becomes misaligned.

Types of Ankle Fractures

Ankle fractures can be categorized based on the bones involved and the stability of the joint:

Stable fractures: These involve a single bone and do not affect the alignment of the ankle joint.
Unstable fractures: These involve multiple bones or cause misalignment of the joint.
Fibula fractures: Often treated with conservative methods like a walking boot or cast.
Tibia fractures: Usually require surgical intervention.
Bi-malleolar or tri-malleolar fractures: Involve both the tibia and fibula, often necessitating surgery.

Recognizing the Symptoms of a Broken Ankle

Identifying the symptoms of a broken ankle is crucial for seeking prompt medical attention. The most common signs include:

Immediate, sharp pain following the injury
Swelling around the ankle area
Pain that radiates from the foot up the leg towards the knee
Increased pain when attempting to bear weight on the affected foot
Bruising or discoloration of the skin
Visible deformity or dislocation of the ankle joint

Is it possible to walk with a broken ankle? While some individuals may be able to walk with certain types of ankle fractures, it’s generally not recommended. Attempting to bear weight on a broken ankle can worsen the injury and lead to complications.

Diagnosing an Ankle Fracture: Medical Evaluation and Imaging

Proper diagnosis of an ankle fracture is essential for determining the appropriate treatment plan. The diagnostic process typically involves several steps:

Medical History and Physical Examination

Your doctor will first ask about the circumstances of your injury and perform a thorough physical examination. This examination includes:

Checking for damage to blood vessels near the ankle
Assessing nerve function and sensation
Gently manipulating the ankle to evaluate pain and range of motion
Examining the joints above and below the injured area

Imaging Studies

To confirm the diagnosis and determine the extent of the fracture, your doctor may order one or more of the following imaging tests:

X-rays: The primary diagnostic tool for identifying fractures and their locations
CT (Computed Tomography) scan: Provides detailed 3D images of the bones and surrounding tissues
MRI (Magnetic Resonance Imaging): Useful for assessing ligament damage and soft tissue injuries

How can doctors differentiate between a sprain and a fracture? While both injuries can cause similar symptoms, X-rays are often necessary to definitively distinguish between a severe sprain and a fracture.

Treatment Options for Ankle Fractures: Conservative vs. Surgical Approaches

The treatment of an ankle fracture depends on various factors, including the severity of the break, the stability of the joint, and the patient’s overall health. Treatment options can be broadly categorized into two main approaches:

Conservative (Non-Surgical) Treatment

For stable fractures involving a single bone, non-surgical treatment may be sufficient. This typically involves:

Immobilization with a walking boot or cast for approximately six weeks
Use of crutches or other mobility aids to avoid putting weight on the affected ankle
Regular follow-up appointments with X-rays to monitor healing progress
Pain management with over-the-counter medications like acetaminophen or ibuprofen

Surgical Treatment

More severe fractures, particularly those involving joint misalignment or multiple bones, often require surgical intervention. Surgical procedures may include:

Open reduction and internal fixation (ORIF): Repositioning bone fragments and securing them with screws and metal plates
Bone grafting: Transplanting bone tissue to promote healing in complex fractures
External fixation: Using external devices to hold bones in place during the healing process

When is surgery necessary for an ankle fracture? Surgery is typically recommended for unstable fractures, those involving multiple bones, or cases where the joint is significantly misaligned. The goal of surgery is to restore proper ankle alignment and function.

Recovery and Rehabilitation: The Path to Healing After an Ankle Fracture

Recovering from an ankle fracture is a gradual process that requires patience and dedication. The timeline for recovery can vary depending on the severity of the injury and the chosen treatment method.

Initial Recovery Phase

During the first few days following the injury or surgery, the focus is on managing pain and swelling. This typically involves:

Resting the ankle and keeping it elevated above heart level
Applying ice to the affected area for 15-20 minutes every 1-2 hours
Taking prescribed pain medications as directed
Avoiding weight-bearing activities on the injured ankle

Rehabilitation and Physical Therapy

As the fracture begins to heal, rehabilitation becomes crucial for restoring strength, flexibility, and function to the ankle. A typical rehabilitation program may include:

Range of motion exercises to prevent stiffness
Strengthening exercises for the ankle and surrounding muscles
Balance and proprioception training to improve stability
Gradual weight-bearing activities as approved by your doctor
Gait training to ensure proper walking mechanics

How long does it take to fully recover from a broken ankle? The recovery timeline can vary significantly depending on the severity of the fracture and individual factors. Generally, it can take anywhere from 6 to 12 weeks for the bone to heal, with full rehabilitation often extending several months beyond that.

Potential Complications and Long-Term Outlook for Ankle Fractures

While most ankle fractures heal successfully with proper treatment, there are potential complications that patients should be aware of:

Arthritis: Even minor misalignments during healing can lead to osteoarthritis in the future
Chronic pain or stiffness in the ankle joint
Limited range of motion
Nerve or blood vessel damage
Infection (particularly in cases requiring surgery)
Malunion or nonunion of the fracture

Can an ankle fracture lead to long-term mobility issues? With proper treatment and rehabilitation, most patients regain full function of their ankle. However, some may experience persistent stiffness or weakness, particularly in cases of severe fractures or complications during healing.

Preventing Ankle Fractures: Tips for Maintaining Healthy Ankles

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

Wear appropriate footwear for your activities
Maintain good balance and strength through regular exercise
Be cautious when walking on uneven or slippery surfaces
Warm up properly before engaging in sports or physical activities
Use protective equipment when participating in high-risk sports
Maintain a healthy diet rich in calcium and vitamin D for strong bones

Are certain individuals more prone to ankle fractures? While anyone can experience an ankle fracture, factors such as osteoporosis, participation in high-impact sports, and certain medical conditions can increase the risk.

Expert Care for Ankle Fractures: The Importance of Specialized Treatment

At Yale Medicine’s Foot & Ankle Surgery Program, patients have access to a team of highly trained orthopedic specialists experienced in treating all types of ankle fractures. Dr. Sean Peden, a Yale Medicine foot and ankle orthopedic surgeon, emphasizes the importance of specialized care:

“At Yale Medicine, we have a team of highly trained orthopaedic foot and ankle specialists and orthopaedic trauma specialists. Fractures that are complex and rare are routine because of the volume and variety of injuries we see on a daily basis. Our operating room team of surgeons, nurses, and other support staff are committed to providing the best care utilizing cutting edge technology and research.”

Why is specialized care important for ankle fractures? Complex ankle fractures often require intricate surgical techniques and comprehensive rehabilitation plans. Specialists in foot and ankle surgery have the expertise to address these challenges and optimize outcomes for patients.

In conclusion, understanding the nature of ankle fractures, recognizing their symptoms, and seeking prompt, specialized care are crucial steps in ensuring proper healing and minimizing long-term complications. Whether treated conservatively or surgically, a broken ankle requires patience, dedication to rehabilitation, and expert medical guidance to achieve the best possible outcome.

Broken Ankle (Ankle Fracture) > Fact Sheets > Yale Medicine

Overview

Whether caused by a simple misstep or a trauma such as a car crash, a fractured (broken) ankle is a painful and common injury.

Broken ankles can vary significantly in severity from a tiny crack in the bone to a large crack to multiple cracks. But even minor ones can immobilize you and require proper treatment to fully heal. This is important because a tiny misalignment now can lead to osteoarthritis down the road, making your joints stiff and limiting your range of motion.

The ankle joint is made up of three bones: the shin bone (tibia), outer ankle bone (fibula), and a bone in the foot between the leg and heel bones (talus). The ankle can fracture in more than one place, and the surrounding ligaments (which connect the bones to stabilize the joints) are also often damaged.

The appropriate treatment depends on the location or locations of your fracture. What is also critical, is whether the fracture is stable, meaning the ankle joint remains in appropriate alignment when forces are applied to it (such as when walking).

Many fibula fractures may require wearing a walking boot or cast for a period of time, whereas most tibia fractures need surgery. When both the tibia and fibula are fractured, or the joint is shifted or dislocated, surgery is usually the best option. At Yale Medicine, orthopedic surgeons from our Foot & Ankle Surgery Program are experienced in treating all types of ankle fractures.

“At Yale Medicine, we have a team of highly trained orthopaedic foot and ankle specialists and orthopaedic trauma specialists. Fractures that are complex and rare are routine because of the volume and variety of injuries we see on a daily basis,” says Sean Peden, MD, a Yale Medicine foot and ankle orthopaedic surgeon. Our operating room team of surgeons, nurses, and other support staff are committed to providing the best care utilizing cutting edge technology and research.”

What are the symptoms of a broken ankle?

If you fractured your ankle, you will likely experience immediate, sharp pain and possible swelling.

Additional symptoms include:

Pain that spreads throughout the foot and up your leg, toward your knee
Intensifying pain if you try to bear weight on your foot
Bruising or discoloration
Dislocation (the ankle appears bent, distorted, rotated, or out of place)

How is an ankle fracture diagnosed?

If you suspect you have fractured your ankle, your doctor will first ask you to describe what happened. Next, your doctor will perform a physical examination.

During the exam, your doctor will:

Check for damage to blood vessels near the ankle (by taking your pulse at the top of the foot and examining skin temperature and color)
Check for nerve damage (by assessing sensation) near the ankle
Gently move the ankle to see where the pain is and check range of motion
Examine the joints above and below the injured area

Often, a severe sprain and a fracture cannot be seen without an X-ray. An X-ray can show the precise fracture location and provide information that allows your doctor to identify the best treatment. For large fractures or ones that involve ligaments, your doctor may order more detailed image studies, including a CT (computed tomography) scan or MRI (magnetic resonance imaging).

How is an ankle fracture treated?

Depending on the severity of your ankle fracture, your treatment may be nonsurgical or surgical.

Nonsurgical

For a simple break in one bone that is stable, your doctor may recommend using a walking boot or cast for about six weeks to protect the fracture as it heals. Depending on which bone is broken—and where the break is on the bone—you may be able to put some weight on the affected leg right away or you may need to use crutches for a few weeks.

Additional recommendations for mild fractures, especially in the first few days following injury, include:

Resting the ankle
Elevating the ankle (above the heart)
Icing the area every one to two hours for 15 minutes at a time

Your doctor will have you come in regularly to have X-rays to check that the fracture fragments haven’t misaligned as they heal. Additionally, medications such as acetaminophen (Tylenol) and ibuprofen (Motrin) may help with pain and inflammation.

Surgical

For more serious fractures, including cases where the bones, and in particular the joints, are misaligned from the break, surgery may be necessary.

In many cases, your surgeon will reposition any bone fragments into their normal alignment and hold them together with special screws and metal plates to keep the fragments together while you heal. Sometimes, bone grafting (transplanting bone tissue) may be done so that new bone has a place to grow.

After surgery, your ankle should be as strong as it was before the fracture. But if the bone fragments do not remain in place, you may fracture your ankle again or arthritis could develop.

What stands out about Yale Medicine’s approach to treating broken ankles?

The Yale Medicine Foot & Ankle Surgery Program offers a wide range of treatments for fractured ankles, from expert diagnosis to the most advanced surgical care. We work closely with specialists from radiology, anesthesiology, pediatrics, internal medicine, and vascular surgery.

Experts at Yale Medicine have particular interest in the care of pediatric, diabetic, and high-energy fractures of the ankle. These types of fractures are more complex and require particular experience. Yale Medicine has ongoing clinical research studies regarding the best treatment for sports-related ankle fractures and diabetic ankle fractures.

Ankle Fractures (Broken Ankle) – OrthoInfo

A broken ankle is also known as an ankle fracture. This means that one or more of the bones that make up the ankle joint are broken.

A fractured ankle can range from:

A simple break in one bone, which may not stop you from walking, to
Several fractures, which may require surgery. These types of fractures can be very disabling. In some cases, you may not be able to put weight on your ankle for a few months, affecting your ability to walk, drive, play sports, and work.

Although ankle fractures can occur in people of all ages, they typically happen more often in adults; in fact, they are the fourth most common type of fracture in adults.

Three bones make up the ankle joint:

Tibia — the shinbone
Fibula — the smaller bone of the lower leg
Talus — the small bone that sits between the heel bone (calcaneus) and the tibia and fibula

Illustration showing the three bones that make up the ankle joint: the tibia, fibula, and talus.

The tibia and fibula have specific parts that make up the ankle:

Medial malleolus — the small prominent bone on the inner side of the ankle at the end of the tibia
Posterior malleolus — the back part of the tibia
Lateral malleolus — the prominent bone on the outer side of the ankle at the end of the fibula

The ankle joint allows you to bend your foot up and down and to move it from side to side. The syndesmosis joint provides stability.

Doctors classify ankle fractures according to the area of the bone that is broken. For example, a fracture at the end of the fibula is called a lateral malleolus fracture, or if both the tibia and fibular are broken, it is called a bimalleolar fracture.

Two joints are involved in ankle fractures:

Ankle joint — where the tibia, fibula, and talus meet
Syndesmosis joint — the joint between the tibia and fibula, which is held together by ligaments

Ankle fractures can be classified by how much the pieces of bone have moved out of their normal position.

Nondisplaced fracture. A nondisplaced ankle fracture is where the bones are not out of place. These fractures do not require surgery.

Displaced fracture. A displaced ankle fracture is where the broken bone fragments are separated. There may be breaks in one, two, or three areas, and the ankle joint may also be dislocated. Most ankle fractures with dislocations require surgical treatment.

Open fracture. When the broken bones break through the skin, the injury is called an open or compound fracture. An open fracture is an emergency and should be treated surgically as soon as possible. This is because an open wound allows outside material, dirt, and debris to contaminate the fracture, increasing the risk of infection.

Many types of injuries can cause an ankle fracture. They include:

Twisting, rotating, or rolling your ankle while walking or running
Tripping or falling from a height, such as a fall from a ladder
Impact during a car accident

Common symptoms of a broken ankle include:

Immediate and severe pain
Swelling
Bruising
Tenderness to touch
Inability to put any weight on the injured foot
Deformity, especially if the ankle joint is also dislocated
Numbness and coolness in the foot (in some cases)

Physical Examination

After discussing your medical history and how the injury occurred, your doctor will do a careful examination of your ankle, lower leg, and foot.

Imaging Tests

If your doctor suspects an ankle fracture, they will order one or more of the following imaging tests to diagnose and evaluate the fracture

X-rays. Most ankle fractures can be diagnosed with X-rays. X-rays provide images of dense structures such as bone. They can show where the bones are broken and if any of the bones are out of place (displaced). They can also show how many pieces of broken bone there are. Your doctor may also take X-rays of the leg and foot to make sure there are no other injuries.

Depending on the type of ankle fracture, your doctor may put pressure on the ankle and take a special X-ray called a stress X-ray. This X-ray is done to determine if the syndesmosis (area between the lower tibia and fibula) is injured.

Computed tomography (CT) scan. A CT scan provides detailed cross-sectional X-ray images of the ankle and is sometimes done to further evaluate the ankle injury. It is helpful in evaluating the extent of the injury to the ankle joint.

Magnetic resonance imaging (MRI) scan. MRI scans provide high-resolution images of both bones and soft tissue structures, like ligaments. Because MRI scans are more sensitive than other imaging tests, they may be used to detect ligaments injuries.

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Treatment of ankle fractures depends on the type and severity of the injury.

Medial Malleolus Fracture

A medial malleolus fracture is a fracture of the lowest part of the tibia. Fractures of the medial malleolus may be isolated, but they are more commonly associated with fractures in other parts of the ankle.

Nonsurgical Treatment

A medial malleolus fracture that is not out of place (nondisplaced) can be treated with a short leg cast or walking boot. Your doctor may recommend that you avoid putting weight on your ankle for several weeks. During this time, the doctor will take X-rays to make sure that the fracture is healing properly.

Surgical Treatment

A medial malleolus fracture that is out of place (displaced) can be surgically repaired with one or two screws. If the fracture is large and extends into the ankle joint, a plate and screws may be required.

A displaced medial malleolus fracture. Note the separated bone fragments.

Surgical repair of displaced medial malleolus fracture with screws.

Lateral Malleolus Fracture

A lateral malleolus fracture is a fracture of the lower end of the fibula.

Nonsurgical Treatment

Similar to a nondisplaced medial malleolus fracture, a nondisplaced lateral malleolus fracture can often be treated with a short leg cast or walking boot. Most isolated lateral malleolus fractures are stable enough to allow you to put weight on the ankle.

A lateral malleolus fracture is classified as nondisplaced when the bone fragments are not out of place.

Surgical Treatment

Surgical repair is necessary when a lateral malleolus fracture is displaced. The repair is typically done with a plate and screws. Usually, you will need to stay off the ankle for several weeks after surgery.

A displaced lateral malleolus fracture.

Surgical repair of displaced lateral malleolus fracture with plate and screws.

Posterior Malleolus Fracture

A posterior malleolus fracture is a fracture of the back of the tibia. Most posterior malleolus fractures are associated with another injury, usually a fracture of the lateral malleolus. This is due to attachments of ligaments between the two bones.

Nonsurgical Treatment

Many posterior malleolus fractures are small and do not require surgery. Treatment may involve wearing a short leg cast or a removable brace.

Surgical Treatment

Surgical fixation is required if the fracture is large and out of place. Typically, the surgical repair is done by placing screws in the lower tibia from front to back.

Bimalleolar Fracture and Bimalleolar Equivalent Fracture

A bimalleolar fracture occurs when both the medial malleolus and lateral malleolus are broken. Since there are injuries to both sides of the ankle, bimalleolar fractures are frequently unstable, and the ankle is often dislocated.

Nonsurgical Treatment

A stable bimalleolar fracture may be treated with cast immobilization for several weeks. During this time, you cannot put weight on your ankle. While you are in the cast, your doctor will take X-rays to make sure that the bones do not slip out of place.

Surgical Treatment

Because there are injuries to both sides of the ankle, most bimalleolar fractures need surgical repair. This is usually done with a plate and screws.

A bimalleolar fracture occurs when both the medial malleolus (left) and lateral malleolus (right) are broken.

Surgical repair of bimalleolar fracture with screws (medial malleolus) and plate and screws (lateral malleolus).

A bimalleolar equivalent fracture means that the ligaments on the inside (medial) part of the ankle are injured, and that only one bone has broken. The torn ligaments can cause the lower bone (talus) to shift and the ankle joint to go partially out of place or dislocate. Treatment involves putting the joint back in place and repairing the broken bone.

A bimalleolar equivalent fracture with torn ligaments on the medial side and a broken lateral malleolus.

Trimalleolar Fracture

A trimalleolar fracture is similar to a bimalleolar injury except the posterior malleolus is also broken. Like bimalleolar fractures, these injuries are often unstable, and a dislocation can occur.

Most of the time, if the medial malleolus and lateral malleolus fractures are repaired, the posterior fragment will go back into place on its own. If the posterior fragment is out of place, surgical repair is required.

A trimalleolar fracture occurs when the medial malleolus (left), lateral malleolus (right), and posterior malleolus (middle) are broken.

Fracture of the posterior malleolus in a trimalleolar fracture.

Syndesmosis Injury

The syndesmosis is a group of ligaments that stabilizes the small joint between the lower end of the fibula and the lower end of the tibia.

A syndesmosis injury that involves only the ligaments is often called a high ankle sprain. It can be usually treated without surgery but may take longer than a normal ankle sprain to heal.

A syndesmosis injury can also involve both a ligament sprain and one or more fractures. In these cases, surgery is required. In addition to repairing the fracture(s), the syndesmosis is repaired with one or more screws that can later be removed.

Surgical repair of a syndesmosis injury and lateral malleolus fracture.

The healing time for ankle fractures can vary depending on the extent of the injury. While most ankle fractures take at least 6 weeks to heal, it may take longer for any involved ligaments and tendons to heal.

Regardless of the type of treatment you receive, your doctor will most likely monitor the bone healing with repeated X-rays. This is typically done in the first 6 weeks.

Pain Management

After surgery, you will likely feel pain because this is a natural part of the healing process. Your doctor and nurses will work to reduce your pain. Typically, you will be given pain medicine intravenously (through an IV) in the first few hours after surgery. You will then be switched to oral pain medication. If you have not had surgery, you will be taking oral medication from the start.

Many types of oral medicines are available to help manage pain, including opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and over-the-counter pain medication such as acetaminophen. Your doctor may use a combination of these medications to manage your pain, as well as minimize the need for opioids.

Be aware that although opioids help relieve pain after surgery or an injury, they are a narcotic and can be addictive. It is important to use opioids only as directed by your doctor and to stop taking them as your pain begins to improve.

Rehabilitation

Rehabilitation is the key to your recovery, no matter which type of treatment you received.

Rehabilitation usually begins after your fractures have started to heal and your cast or walking boot has been removed. Your doctor will let you know when you can start putting weight on your ankle. They may also refer you to a physical therapist to start an exercise program.

It is very important to follow your doctor’s instructions about weightbearing. If you put weight on the injured ankle too early, the fracture fragments may move out of place, and the fracture may not heal.

Your doctor may also recommend that you wear an ankle brace for sports for several months after your fracture has healed.

Many patients will experience stiffness and swelling in the injured ankle for many months, even after the fracture has healed.

Rehabilitation will help improve the motion in your ankle and prevent stiffness. The swelling can be relieved by elevating your leg.

Other general complications include malunion, where the bones do not heal properly, or nonunion, where the bones do not heal at all.

Some complications are specific to surgery. These include:

Infection
Bleeding
Damage to blood vessels, tendons, and nerves
Problems with the plates or screws used to repair your ankle
Arthritis

People who smoke, have diabetes, or are elderly are at a higher risk for complications after surgery.

Most people return to normal activities within 3 to 4 months after the injury occurs.

If your right ankle is affected, you can probably resume driving at 9 to 12 weeks. You may still be limping after several months, and it may take longer to return to sports.

Complete recovery from some ankle fractures may take up to 2 years.

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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

Ankle fracture – how it happens, classification, treatment methods

The information provided on this 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.