When people twist their ankle they might sprain it. This means that the muscles and soft tissue around the ankle joint are injured. But sometimes the ankle joint is fractured (broken) as well. This is a more serious injury that may affect one or more bones in your ankle. If the ankle is fractured, the ligaments are often torn and cartilage damaged too. Usually these kinds of fractures heal without any trouble – but it takes some time.
If an ankle is fractured, the foot becomes swollen and painful, and can no longer support your weight. Bruises form, and it becomes nearly impossible to move the foot. Sometimes the bones also change position, causing them to become misaligned.
Ankle fractures usually occur during sports or exercise. For instance, your ankle might twist and break if you fall or land the wrong way after a jump. That can also easily happen when running on uneven ground or if you take a wrong step.
It takes several days or weeks for the swelling to go down completely, and it can take months for the ankle joint to fully recover from the fracture. Until then, the foot can't be moved much and can't carry much weight.
If strain is put on the foot too soon, the healing process may be disturbed, and the fracture might not heal properly. Additional treatment might then be needed. On the other hand, if a person doesn't move their foot for a long time, it could become less mobile and weaker.
Ankle fractures usually heal well. Osteoarthritis may develop as a long-term complication, though. The ankle may also remain unstable, increasing the risk of twisting it again.
Fracture of inner and outer ankle
The doctor will first ask you about what happened, and then examine your foot and ankle to see how severe your injury is. If he or she suspects that the ankle is fractured, an x-ray of the ankle is taken. Sometimes x-rays don't lead to a clear diagnosis. Then a computed tomography (CT) scan, and perhaps a magnetic resonance imaging (MRI) scan, might be done too. Ligament and cartilage injuries can usually be seen better with MRI scans.
The foot and ankle are first immobilized (prevented from moving), elevated and cooled as needed. The joint is immobilized in order to protect it and allow it to heal properly. If the bones have moved or slipped out of the joint, they can be put back into place. Bandages, splints, braces and plaster casts are generally used for around six weeks.
After a while you can gradually start putting more strain on the joint and strengthening it. The point at which people are advised to start doing gentle exercises or physiotherapy depends on things like how bad the injury is: Sometimes gentle exercises are already possible a few days after the injury or surgery, and sometimes only once the splint or plaster cast has come off. Because the foot is immobilized at first, it may be a good idea to use injections that can prevent thrombosis.
Surgery isn't always necessary for ankle fractures. Whether or not it's needed depends on many factors, including
- how severe the fracture is,
- what part of the ankle is broken,
- whether there is an open wound or break in the skin near the broken bone (an open fracture),
- whether blood vessels or nerves have been damaged, and
- whether the bone fragments have moved out of place.
Screws or plates may be used during surgery to hold bone fragments in place so they can grow together again.
After surgery, the ankle is immobilized (kept still) using a bandage, splint or plaster cast. Some bandages and splints are removable, making it possible to already start doing gentle exercises during the immobilization phase. When the fracture has healed and the bones have grown back together, the screws and plates can often be removed, depending on the situation.
When people are ill or need medical advice, they usually go to see their family doctor first. Read about how to find the right doctor, how to prepare for the appointment, and what to remember.
Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). S3-Leitlinie: Prophylaxe der venösen Thromboembolie (VTE). AWMF-Registernr.: 003-001. October 15, 2015.
Deutsche Gesellschaft für Unfallchirurgie (DGU). Überarbeitete Leitlinie S2-e: Sprunggelenkfraktur. AWMF-Registernr.: 012-003. May 12, 2015. (Leitlinien Unfallchirurgie).
Goost H, Wimmer MD, Barg A, Kabir K, Valderrabano V, Burger C. Fractures of the ankle joint: investigation and treatment options. Dtsch Arztebl Int 2014; 111(21): 377-388.
Lin CW, Donkers NA, Refshauge KM, Beckenkamp PR, Khera K, Moseley AM. Rehabilitation for ankle fractures in adults. Cochrane Database Syst Rev 2012; (11): CD005595.
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