The 26 Review
- What is Ankle Fracture? One or more bones of the ankle joint break. Sometimes this includes ligament rupture.
- Causes Various forms of trauma: falling, twisting, crushing, tripping, direct impact, and abnormal rotation.
- Symptoms Pain, swelling, bruising, weakness, inability to put pressure on the foot, protruding bone.
- Diagnosis Physical examination, X-ray, severe cases include CT scan or MRI.
- Treatment Surgery or casting/walking boot. Includes compression therapy, ice, rest, crutches, or knee scooter.
Let’s take a closer look…
The ankle is made up of three bones: the tibia (shin bone), which forms the inside, front, and back of the ankle, the fibula, which forms the outside of the ankle and the talus, a small bone that sits between the tibia and fibula and the heel bone. When one or more of the bones that make up the ankle joint is broken, it is identified as an “ankle fracture”. A fractured ankle can range from a small break in one bone to several full breaks in multiple bones (comminuted fracture). Both are extremely painful and can affect people of all ages. The most common type of ankle fracture is a break in the outer bone (fibula) of the lower leg. This type of break usually happens along with a break in the inner bone (tibia) of the lower leg.
A fracture can also involve just the tibia, just the fibula, or both bones. In some cases, the bone remains intact, however, the nearby ligaments (tissue that connects bone to bone) will rupture instead. A fracture in any of these bones and ligaments can be a serious injury. When dealing with an ankle fracture it is important to be seen by a Podiatrist immediately after the injury. Many people will rush to the Emergency Room and don’t know that ankle fractures can be handled the same day in our office which bypasses those enormous hospital bills and waiting times.
There are many different causes of ankle fractures, but the most common is usually a fall or misstep off a curb or staircase. Other causes include car accidents, sports injuries, tripping, and direct trauma to the ankle. Sometimes, medical conditions such as osteoporosis will predispose bones to be weaker and more likely to break. Ankle fractures can also be caused by repetitive stress on the ankle, such as from running or other high-impact activities.
In some cases, a severe ankle sprain can feel the same as an ankle fracture, and therefore, every ankle injury should be evaluated by a Podiatrist. Symptoms may vary between patients, however; the most notable symptoms of an ankle fracture will be severe and throbbing pain, severe swelling and bruising, tenderness when the area is touched, an inability to put any pressure on the foot, and any physical signs of deformity such as bone protruding towards the skin.
Diagnosing an ankle fracture will always include some imaging study, typically starting with X-rays. A CT scan is a very detailed X-ray scan that is useful for surgical planning in complex trauma while an MRI is used to evaluate the integrity of the tendons and ligaments that may have been damaged during the initial injury.
Treatment: Non-Surgical For Ankle Fracture
While surgery may be unavoidable for some ankle fractures, non-surgical treatment is sometimes the best option for others. If the fracture is deemed stable and in a good position to heel without surgery, casting and non-weight bearing with the aid of crutches or a knee roller may be a viable option. Utilizing a walking boot may be another conservative option to protect the ankle fracture while it heals. During non-surgical treatment of an ankle fracture, multiple appointments and X-rays are taken within 6 weeks to ensure the fracture has not moved while in the cast and that healing is taking place. A walking boot and eventual ankle brace/compression wrap will be used during the initial recovery time after the casting.
Treatment: Surgical For Ankle Fracture
The stability of the bone(s) of the ankle joint is the most important factor in determining appropriate treatment and whether surgery is necessary or not. If the ankle fracture is determined to be too unstable or if the bones are not in an adequate position to heal on their own by casting alone, you may need to be treated with surgery. Surgery is completed in an outpatient setting either in a hospital or ambulatory surgery center. During ankle surgery, the bone fragments are first repositioned into their normal alignment and then held together with special screws and metal plates attached to the outer surface of the bone
In some cases, a screw or rod inside the bone may be used to keep the bone fragments together while they heal. Plates and screws used for this surgery are not removed after healing unless they are causing problems to the patient, in which case, they can be removed after the fracture has healed. Patients undergoing ankle fracture surgery will likely be in a cast for roughly 6-weeks while using a knee roller or crutches. Once adequate healing is evident as seen on follow-up x-rays, the individual will transition to a walking boot for multiple weeks and subsequently into an ankle brace and sneakers.