Ankle Fracture

What is an ankle fracture?

When a bone breaks or cracks, the injury is called a fracture. In the ankle, three different bones can be fractured:

The tibia — This is the larger of the two bones in the lower leg. The tibia's lower end flares out, forming a hard, bony knob called the medial malleolus, which you can feel at the inside of your ankle.
The fibula — This is the thinner of the two bones of the lower leg. Its lower end forms a hard, bony knob called the lateral malleolus, which you can feel at the outside of your ankle.
The talus — This is a wedge-shaped bone that is located deep inside the ankle, braced between the heel bone and the ends of the tibia and fibula. The talus supports the lower ends of the tibia and fibula, and it forms a solid base for the normal range of ankle movements.

Although there are many ways to fracture an ankle bone, the most common injuries involve a sharp twist of the ankle, or a direct impact that fractures at least one of the bony knobs in the ankle.

Ankle fractures are common injuries among people of all ages, interests, and lifestyles. People involved in a wide range of athletic activities, including ballet dancers, snowboarders, basketball players, and skydivers, are at high risk of ankle fractures because of the physical demands placed on their ankles.

Ankle fractures also occur during slips on icy pavement, falls from a high place, or direct impacts to the ankle during a car crash or motorcycle accident. High-impact ankle injuries are especially dangerous if the bone pokes through the skin and is exposed to the air. The open wound allows bacteria to contaminate the broken bone, and greatly increases the risk of infection.

Symptoms of an ankle fracture

If you have a fractured ankle, your symptoms probably will include:

pain, swelling, tenderness, and bruising at your ankle joint
inability to move your ankle through its normal range of motion
inability to bear weight on your injured ankle (however, if you can bear weight on the ankle, don't assume there is no fracture)
in some cases, a "crack" or "snap" in the ankle at the time of injury
in open fractures, severe ankle deformity, with portions of the fractured bone visible through broken skin.

Diagnosing an ankle fracture

After reviewing your symptoms, the doctor will want to know:

how and when your injury happened
whether swelling and bruising developed immediately (often a sign of a more serious injury) or several hours later
whether you had difficulty putting weight on your ankle immediately after the injury happened.

In addition, your doctor will review your medical history, especially any previous injuries to your ankle, foot, or lower leg. If you have symptoms of an open fracture, the doctor also will want to know the approximate date of your last tetanus shot.

The doctor will examine your ankle, foot, and lower leg. During this examination, the doctor will check for swelling, deformity, abrasions, bruising, and soreness along the lower part of your tibia and fibula, especially at the medial malleolus and lateral malleolus (bony knobs). The doctor also will gently press and feel parts of your injured ankle to determine whether there are any points of extreme tenderness that can help to identify the site of a fracture. He or she also will compare range of motion of the injured ankle with the normal joint movement in your uninjured ankle. After a significant injury, your pulse, foot movements, and skin sensation will be checked to see if there are signs of artery or nerve damage.

If the results of your physical examination suggest that that you have a fractured ankle, your doctor will order x-rays to confirm the diagnosis.

Expected duration of an ankle fracture

If your fracture can be treated without surgery, you probably will wear a cast for about six to eight weeks. Once your cast is removed, you may need physical therapy before you can resume your normal activities. Total recovery time varies depending on the severity of your injury and the physical demands of your lifestyle.

If you need surgery to repair your fractured ankle, your recovery will take longer than an ankle fracture that could be treated without surgery.

Preventing an ankle fracture

An athlete who has recovered from an ankle injury may find it helpful to use high-top shoes, an ankle brace, or ankle taping to reduce the risk of further joint damage.

Treating an ankle fracture

If your ankle fracture involves only one malleolus, and the segments of broken bone lie very close together, your doctor usually can treat the injury by immobilizing your ankle and foot in a cast for six to eight weeks. After the cast is removed, your doctor may prescribe physical therapy to help restore the normal range of motion in your ankle joint.

If you have more extensive damage to your ankle, or the fragments of broken bone are separated far from one another, your doctor may recommend surgery to repair your fractured ankle with special screws or wires. Injuries resulting in broken skin require antibiotics given intravenously (into a vein) to prevent infection.

When to call a professional

Call your doctor or go to an emergency room immediately if:

you have injured your ankle and cannot walk on it
your injured ankle is very painful or tender
your injured ankle is obviously swollen, black and blue, or deformed.

Also, check with your doctor if you have less severe symptoms that do not improve within three to four days.

Prognosis

If an ankle fracture is treated promptly and properly, the prognosis is good. Overall, about 80% of all sports-related ankle fractures heal without any long-term complications. However, as with any significant injury near a joint, arthritis may develop years later.