Ankle fracture

The ankle is arranged in such a way that it resists too much unwanted movement of the foot.  If this resistance is over come it can lead to a fracture of the ankle bones on the inside, outside, and back of the ankle (sometimes, all at the same time).  There are many different variations of the same injury and the inclusion of more tissue will mean the management of the injury is complex.

This is normally acquired through weight bearing activity (running, team sports, uneven terrain) where the ankle collapses either inwards or outwards (like a sprain).  Due to the arrangement of ligaments and the bones, and the amount of weight/force the ankle takes when running, it is really quite vulnerable to twisting injuries like these.  They are seldom severe enough to cause a fracture, but if the conditions are right, a fracture will certainly occur.

• Usually trauma related (a bad fall or tackle in football, or a car accident, for example)
• Swelling (immediate) that can vary in quantity, but is usually significant.
• Inability to weight bear or walk.
• Inability to move the foot and toes properly.

Clinical examination will focus on the immediate symptoms, such as acute pain (if you haven’t already been to hospital) swelling and bruising.  These with the questioning would be enough to suspect a fracture.

X-Ray will help to confirm the diagnosis and clarify the further course of treatment and management.

Initial restoration of normal anatomy is key.  If the relationship of the bones in the ankle joint has been severely disrupted, then surgery will usually be the only option.

If the bone on the outside of the ankle is injured in isolation, often early immobilisation and use of crutches will be sufficient to aid both pain and healing.  The more damage to the ankle is reflective of less stability and so the treatment becomes more complex and often involves surgery.  For example if there is a break to both the inside and outside bones of the ankle and the parts are too far away from each other to heal properly, surgery is the only option. This would be followed by immobilisation and crutches and an extensive rehabilitation program when out of the cast.

No matter how serious the injury is, a decent rehabilitation program is key for a healthy return to activity.  The physiotherapist will coordinate this.  Manual therapy (massage/joint mobilisation) will help calm any pain and increase strength and movement of the ankle.  Due to the amount of time spent on crutches, rehabilitation will focus on the injured leg as a whole to make sure there is no associated weakness (this can lead to pain in other joints later on down the line).

Strength work of the joints above the ankle can begin (to a limited extent) very quickly, and your physiotherapist will issue you with these.