A broken ankle is also known as an ankle “fracture.” This means that one or more of the bones that make up the ankle joint are broken.
A fractured ankle can range from a simple break in one bone, which may not stop you from walking, to several fractures, which forces your ankle out of place and may require that you not put weight on it for a few months.
Simply put, the more bones that are broken, the more unstable the ankle becomes. There may be ligaments damaged as well. The ligaments of the ankle hold the ankle bones and joint in position.
There are three bones make up the ankle joint:
- Tibia – shinbone
- Fibula – smaller bone of the lower leg
- Talus – a small bone that sits between the heel bone (calcaneus) and the tibia and fibula
A fracture is a partial or complete break in a bone. In the ankle, fractures can range from the less-serious avulsion injuries (small pieces of bone that have been pulled off) to severe, shattering-type breaks of the tibia, fibula, or both.
Ankle fractures are common injuries that are most often caused by the ankle rolling inward or outward. Many people mistake an ankle fracture for an ankle sprain, but they are quite different and require an accurate and early diagnosis. Both can occur simultaneously.
Cause & Symptoms
- Twisting or rotating your ankle
- Rolling your ankle
- Tripping or falling
- Impact during a car accident
Your doctor will base a diagnosis using your medical history, symptoms, a physical examination, and additional tests.
Medical History and Examination
A medical history is important to understand more about the problem. Your doctor will want to know when the pain started and when it occurs. Is it worse at night? Does it get worse when walking or running? Is it continuous, or does it come and go?
He or she will want to know if there was a past injury to the foot or ankle. If so, your doctor will discuss your injury, when it occurred, and how it was treated.
Your doctor will want to know if the pain is in both feet or only in one foot, and where it is located exactly. Footwear will be examined, and any medications will be noted.
One of the tests performed during the physical examination is the gait analysis. This shows how the bones in the leg and foot line up with walking, measures stride, and tests the strength of the ankles and feet.
X-rays can show changes in the spacing between bones or in the shape of the bones themselves. Weight-bearing X-rays are the most valuable additional test in diagnosing the severity of arthritis.
A bone scan, computed tomographic (CT) scan, or magnetic resonance image (MRI) may also be used in the evaluation.
An ankle fracture is accompanied by one or all of these signs and symptoms:
- Pain at the site of the fracture, which in some cases can extend from the foot to the knee.
- Significant swelling, which may occur along the length of the leg or may be more localized.
- Blisters may occur over the fractured area. These should be promptly treated by a surgeon.
- Decreased ability to walk—it is possible to walk with less severe breaks, so never rely on walking as a test of whether a bone has been fractured.
- Change in the appearance of the ankle so that it differs from the other ankle.
- Bone protruding through the skin—a sign that immediate care is needed! Fractures that pierce the skin require urgent attention because they can lead to severe infection and prolonged recovery.
A lateral malleolus fracture is a fracture of the fibula.
There are different levels at which that the fibula can be fractured. The level of the fracture may direct the treatment.
You may not require surgery if your ankle is stable, meaning the broken bone is not out of place or just barely out of place. A stress x-ray may be done to see if the ankle is stable. The type of treatment required may also be based on where the bone is broken.
Several different methods are used for protecting the fracture while it heals. ranging from a high-top tennis shoe to a short leg cast. Some physicians let patients put weight on their leg right away, while others have them wait for 6 weeks.
You will see your physician regularly to repeat your ankle x-rays to make sure the fragments of your fracture have not moved out of place during the healing process.
If the fracture is out of place or your ankle is unstable, your fracture may be treated with surgery.
During this type of procedure, the bone fragments are first repositioned (reduced) into their normal alignment. They are 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.
Arthroscopic surgery may be helpful in the early stages of arthritis.
A flexible, fiberoptic pencil-sized instrument (arthroscope) is inserted into the joint through a series of small incisions through the skin.
The arthroscope is fitted with a small camera and lighting system, as well as various instruments. The camera projects images of the joint on a television monitor. This enables the surgeon to look directly inside the joint and identify the problem areas.
Small instruments at the end of the arthroscope, such as probes, forceps, knives, and shavers, are used to clean the joint area of foreign tissue, inflamed tissue that lines the joint, and bony outgrowths (spurs).
Arthrodesis or Fusion
Arthrodesis fuses the bones of the joint completely, making one continuous bone.
The surgeon uses pins, plates and screws, or rods to hold the bones in the proper position while the joint(s) fuse. If the joints do not fuse (nonunion), this hardware may break.
A bone graft is sometimes needed if there is bone loss. The surgeon may use a graft (a piece of bone, taken from one of the lower leg bones or the wing of the pelvis) to replace the missing bone.
This surgery is typically quite successful. A very small percentage of patients have problems with wound healing. These problems can be addressed by bracing or additional surgery.
The biggest long-term problem with fusion is the development of arthritis at the joints adjacent to those fused. This occurs from increased stresses applied to the adjacent joints.
Arthroplasty or Joint Replacement
In arthroplasty, the damaged ankle joint is replaced with an artificial implant (prosthesis).
Although not as common as as total hip or knee joint replacement, advances in implant design have made ankle replacement a feasible option for many people.
In addition to providing pain relief from arthritis, ankle replacements offer patients better mobility and movement compared to fusion. By allowing motion at the formerly arthritic joint, less stress is transferred to the adjacent joints. Less stress results in reduced occurance of adjacent joint arthritis.
Ankle replacement is most often recommended for patients with:
- Advanced arthritis of the ankle
- Destroyed ankle joint surfaces
- An ankle condition that interferes with daily activities
As in any joint replacement surgery, the ankle implant may loosen over the years or fail. If the implant failure is severe, revision surgery may be necessary.