When any of the bones in the ankle become broken in any way, this is an ankle fracture. And when this happens, the ankle becomes unstable (the worse the fracture, the more unstable). Ankle fractures can be anything from just a small break in a single bone to multiple bone breaks and even ligament damage. More severe fractures can even require a person not to put any weight on their ankle for months.
Causes of Fractures
- “Rolling“ the ankle too far (usually accidentally)
- Landing on the ankle in an unnatural way
- Twisting or over-rotating
- Injury from a vehicle accident or other incident
Anatomy of the Ankle
- Fibula (the “calf bone”)
- Tibia (the “shinbone”)
- Talus (the lower bone in the ankle joint)
Though they extend down the entire lower portion of the leg, the tibia and the fibula meet with the foot to form the ankle. These are the parts of these bones that are found in the ankle:
- Various ligaments to stabilize and support the ankle joint
- Posterior malleolus, the back of the tibia
- Medial malleolus, the tibia’s inner portion
- Lateral malleolus, the bottom of the fibula
When it comes to ankle fractures, there are two joints involved:
- The “Syndesmosis” (between the fibula and tibia)
- The ankle joint itself
If you injure your ankle, you should always have it looked at by a doctor. Why? Because it can be difficult to determine the severity of the problem by yourself, or even what the problem is. For example, breaks and sprains often feel very similar.
Symptoms of a fracture include the following:
- Sudden and intense pain
- Inability to bear weight
- Visibly deformed ankle or foot
Making a Diagnosis
In addition to a physical examination, your physician will most likely do an X-ray of your ankle, foot, or even your entire leg. This will not only help them determine what type of injury it is and its severity, but it will also allow them to see if any other bones have been harmed. Your doctor may also apply pressure and do a “stress test”, which is an additional X-ray to see if surgery is required. CAT scans and MRIs may also be done to further examine the bones and surrounding tissue.
Some types of ankle fractures may be treated without surgery, for example, the ankles with milder injuries may be stabilized in a splint or cast so that they may heal without being thrown out of position. Of course, the ankle will still need to be monitored by an expert to ensure it heals properly.
More severe and/or difficult ankle fractures may require surgery. Like non-surgical treatments, surgery in these cases is all about putting the ankle in proper alignment and stabilizing it so it can heal. Screws and plates are often inserted surgically into the ankle to do just this.
Orthopedic surgeons like Dr. Samimi are the ones who diagnose injuries and determine whether a surgical or non-surgical treatment is appropriate. Dr. Samimi is specifically trained in the evaluation and treatment of injuries to the musculoskeletal system (the joints, bones, tendons, muscles, nerves and ligaments in the body), and he thoroughly goes over the pros and cons of all treatment options with patients, especially when it comes to surgery.
On average, broken bones heal in a matter of six weeks. Depending on the amount of tendons and ligaments injured and their severity, this healing time may take longer. During this time, your doctor may do further X-rays to examine the ankle’s progress more closely. If surgery is not involved, these are usually done during the initial six weeks of healing.
With an exception for sports, the majority of patients are able to resume their regular activities within three to four months, though they often go back to driving in as little as nine to 12 weeks. Going back to sports should be deferred for several months, depending on the injury and the sport. Still modern research shows that full recovery can actually take up to two years, long after any visible signs (like limping) have gone away.
Rehabilitation and Physical Therapy
Just because the cast comes off doesn’t mean the ankle is quite ready for use. Rehabilitation is imperative for all ankle injuries in order to make sure that the ankle is strengthened and moved properly to prevent further harm. Most rehabilitation will involve prescribed home exercises, but sometimes physical therapy with a professional may be required. Getting the ankle (specifically the muscles surrounding it) back to full strength and agility may take up to several months or more.
The specific type of injury will be what determines when a patient can resume putting weight on their ankle. While most patients do have a limp for a while, some may need to use a cane or walking brace to avoid putting further pressure on the injury. In any case, your doctor will tell you when and how you can start putting weight on your ankle again and walking normally. Do not attempt to do so before they tell you it’s okay. Starting too soon can result in additional injury and may even have you starting the healing process all over again.
At the very least, an ankle injury will probably require you to wear a splint while it heals. Still there are all kinds of different support items that are common. As mentioned earlier, there are also casts to keep the ankle immobile and stabilized while it heals. For less serious injuries or ones that are further along in the recovery process, removable braces may be worn. If sports are to be resumed after the ankle heals, support items (namely braces) may be worn during the activity for at least several months.
Smokers, the elderly and people with diabetes and certain other illnesses are at greater risk of problems following initial treatment. This is mainly because it often takes longer for bones to heal in these groups of people, but it is important for everyone to be aware of potential complications.
Especially with non-surgical treatment, the fractured bones are at risk of moving out of alignment before they can heal fully. This can eventually lead to arthritis and other problems if not corrected. If this “malunion” does happen, the pending treatment will depend on the severity of the movement and the ankle’s overall stability. Still, this is precisely why it is imperative to follow your doctor’s instructions and not miss follow up appointments.
When it comes to surgery, however, risks include pain (including pain from any screws and plates that are inserted), blood clots, surrounding tissue damage (to blood vessels, nerves or tendons), and arthritis (usually later on).