What is an Ankle Fracture and what are its effects?
There are four main bones that make up the ankle joint. These are the tibia, fibula, talus, and calcaneus bones and are the main sites of broken bones or fractures when doctors are speaking about ankle fractures or a broken ankle. You can feel the edges of the tibia and fibula on your ankle. They are the bony bumps on the inner and outer sides of the ankle also known as the medial malleolus and lateral malleolus respectively.
Ankle fractures can vary in severity. A simple fracture can involve the breakage of a single bone in the ankle joint while a more complex fracture could involve multiple bones and ankle ligaments. The more severe or complex an ankle fracture is, the more likely it is to affect your ability to stand, walk, or weight bear.
Ankle fractures or a broken ankle is a condition that you should seek medical attention urgently. Unlike ankle sprains which may heal with rest, ice, elevation, and compression, ankle fractures that are untreated can lead to serious long-term health effects like ankle instability, chronic pain, or foot deformities.
What are some types of ankle fractures?
Ankle fractures are classified by which bones are broken or damaged. Additionally, if bone pierces through the skin, it is considered an open fracture. If the bones lose their position and shifted out of their natural place, it is considered a displaced fracture.
Some types of ankle fractures include:
Stress fracture: These are small fractures of the ankle bones caused from repeated overuse of the ankle joint rather than trauma. High impact activities such as marathons or other sports where the foot is repeatedly striking the ground is the most common causes of stress fractures. The fibula long bone and the heel bone (calcaneus) are the usual sites of stress fractures. However, stress fractures can occur in multiple places.
Maisonneuve fracture: this type of ankle fracture involves a ligament that holds the two long bones at the end of the lower leg together, also called the syndesmotic ligament. A sprain of the syndesmotic ligament together with a fracture of the fibula long bone is what is defined as a Maisonneuve fracture
Pott’s fracture: this type involves fractures of the two long bones of lower leg, the fibula and tibia (also called bimalleolar fractures)
Weber fracture: this is a fracture at the end of the fibula long bone (lateral malleolus fracture)
Pilon fracture: a fracture that usually occurs from a fail from height or motor vehicle accident. In a Pilon fracture, the talus bone of the foot is forcefully driven into the end tibia long bone resulting in fractures of both bones
Snowboarder’s fracture: this fracture is produced when the foot is forced down and inwards. Unsurprisingly, this type of fracture is common among snowboarders and it usually occurs as a result of a forceful landing with the foot turned in and the toes turned up. The force generated is sometimes enough to break off a part of the outer side of the talus bone of the foot.
What are some symptoms of ankle fractures?
Severe pain that stops your activity is the most common symptom of an ankle fracture. In most cases, a broken bone in the ankle will take away your ability to walk, jump, or run. The pain is a very sudden and immediate. Weight-bearing on the affected ankle will be near impossible due to severe pain and joint instability. The only exception may be if the injury is caused by stress fractures.
You will likely experience swelling of the area and your ankle will look significantly swollen within 30 minutes. There may also be bruising of the area and your foot may lose its shape (foot deformity) due to the displacement of bones. In any cases where the foot is deformed and the bones are out of place, you should seek medical attention immediately.
How are ankle fractures diagnosed?
It can be difficult to differentiate between a very severe ankle sprain and an ankle fracture. It is best to seek medical attention if you suspect you have sustained an ankle fracture.
Diagnosis of an ankle fracture is usually done with both a medical examination of the ankle and leg, and X-ray imaging. X-ray imaging will allow the doctor to see if there are breakages or displacements of the bones. Further imaging may be done through CT-scans if fractures are not obvious on XR images.
What are the causes of ankle fractures?
The causes of ankle fractures are very similar to the causes of ankle sprains. This includes a forceful twisting or rotating of the ankle joint, rolling the ankle, falling down (especially on even surfaces), and trauma or mechanical injury. Some sporting activities such as basketball or football also have a higher risks of ankle fractures occurring, but fractures can happen any time there is strong forceful pressure placed on the ankle joint.
How can ankle fractures be treated?
Treatment for ankle fractures depends on the severity of the ankle injury. If the ankle bones are moved out of position or have pierced through the skin, then surgery is usually required. Surgery will usually require the use of metal screws and plates to restore the position of the ankle bones and is also recommended if a specialist deems the ankle to be too unstable to be treated in a plaster cast.
In certain types of simple fractures, you may be treated non-surgically with a plaster cast and asked to refrain from weight-bearing on the foot for a period of time. You will be prescribed painkillers and your ankle will be stabilised in the cast for up to 6 weeks.
What are surgical treatment options for ankle fractures?
Most commonly ankle fractures are treated with a procedure called open reduction internal fixation (ORIF). This involves reducing (restoring position) of the damaged or fractured bones into proper place and then fixing the bones with metal hardware such as screws and plates.
Read our article on Ankle Fracture Surgery.
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We provide extensive information about Ankle Fracture Surgery on our procedures page.
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Important: Information is provided for guidance only. Individual circumstances may differ and the best way to approach a condition is by individual medical consultation where a specialist can tailor a treatment plan to suit your needs.
Edited by Dr Roderick Kuo
Last updated: 5/5/24