Fractures can happen in our bones when a force causes a discontinuation of a bone. In the case of ankle fractures, it means that one or two bones of the patient’s ankle is partially or fully broken.
Fractured ankles usually happen because of two main reasons:
- ankle-twisting injuries such as in falls / tripping or
- injuries experienced during sports or play
Ankle fractures happen moreso to men under the age of 50. Over 50, it is women who gets more ankle fractures.
Also, there are different types and severity of these fractured ankles; from simple “clean” ones to complex ones which can involve two or 3 bones that make up the ankle joint.
It is very, very important to get medical attention and treatment after an ankle injury to determine if you have a fracture or not. so dont “just walk it off”. It’s always better to be safe than sorry, and earlier treatments are always better than late ones.
What is an ankle fracture?
It means at least one (1) broken bone of the ankle, and can be very mild to very severe (multiple fractures and crush etc). There’s a few types of ankle fractures:
- Lateral malleolus fracture – only the bone on the outside of the ankle, the fibula, is broken.
- Medial malleolus fracture – only the bone on the inside of the ankle, the tibia, is broken.
- Bi-malleolar fracture – “bi” here means two (2) bones are broken: the fibula and the tibia.
- Trimalleolar fracture – tri means three bones are broken, the fibula, tibia, and the posterior malleolus (located at the tibia at the back of the foot).
The severity of the fracture is classified as:
- Nondisplaced – the pieces of the fractured bone remain where they’re supposed to be
- Displaced – means that at least one of the fractured part has moved from where they’re supposed to be
- Comminuted – means that the bone has at least three (3) or more pieces splintered
- Complex Fracture – usually means that soft tissue surrounding the broken bone is severely damaged such as blood vessels, ligaments, tendons etc
- Compound Fracture – means that the sharp bony fractured fragments has/can pierce through the skin.
When an ankle fracture involves multiple broken bones and/or where the bony fragment has shifted from its original location, then the fractured ankle will be deemed as “unstable ankle fracture” which will require immediate treatment, likely surgical intervention and correction. A compound fracture also involves a higher risk of infection.
Signs and symptoms of a fractured ankle
- Immediate, severe pain when/after a twisting injury or fall
- A “pop” or “snap” felt or heard
- Bruising, discoloration and/or swelling in the ankle
- Sharp pain in the ankle area
- Inability/difficulty bearing weight on the ankle when standing, walking
- Pain that increases with or without activity and doesnt seem to improve that much with rest
- Throbbing ankle pain that is always present
- Inability to put a shoe on due to swelling and pain
- A bump or bony deformity that may be seen or felt at the ankle
If the bone is piercing the skin, immediately go to a hospital emergency room.
Physiotherapy and ankle fractures
If you see a senior physiotherapist after your ankle injury and if they suspect an ankle fracture, they will:
- Instruct you in acute injury care using the RICER formula: rest, ice, compression, elevation and rehab
- Immobilize your ankle by wrapping it with an wrap, or applying a brace (or customized ankle-foot orthosis, AFO) to limit motion and control swelling
- Immediately apply cold therapy to reduce pain and swelling.
- Instruct you to keep the involved ankle elevated to control swelling.
- Teach you how to walk without putting weight on the injured ankle, using crutches or a walker.
- Make recommendations/referrals for additional care with an orthopedic physician
If you have an ankle fracture, medical and physiotherapy treatment will depend on how many bones are broken, and if it is a simple, complex, or compound fracture. Initial treatment involves the realigning and stabilizing of the bones by your orthopedic specialist, and is performed in the hospital emergency room or, if needed, with surgery.
After a fractured ankle corrective surgery, your affected ankle will be placed in a cast or fracture boot to stabilize and rest it (and prevent reinjuries) for a couple of days.
You will likely be hospitalized for at least one night (usually 2-3 or more), and you will be visited by your orthopedic surgeon to check on your ankle healing and ensure things are going well (and make sure no post-op infections or medical issues).
Then you will be discharged and referred for post-surgery ankle physiotherapy.
In the beginning, you may consider to request for our house call/home visit physiotherapy, where we send our senior physiotherapist to you to provide ankle physiotherapy in the comfort of your home as you may be tired post-surgery.
We recommend a few sessions of home visit physiotherapy, and then “upgrade” to in-clinic physiotherapy. The reason for this is a few reasons:
- more equipment to help you heal faster
- we find that patients who come to the clinic has higher motivation (perhaps it also includes a sense of outing / normalization / socialization)
Ankle fracture physiotherapy ranges from 12 weeks (3 months) all the way to 24 weeks (6 months), depending on
- how severe the injury was
- your ankle’s healing rate
- if there was infections or issues post surgery
- how well your ankle and you respond to ankle physiotherapy
- how fit you were before the ankle injury and surgery (of course, fitter patients tend to recover faster)
You may be taught how to use crutches or walker in the short term to offload your surgery ankle; and you will also be taught how to go up and down steps / stairs / kerbs too. When an x-ray confirms that the fracture has healed, your orthopedic surgeon will remove your cast. Usually then, physiotherapy becomes more intense to bring you back to normal activities and lifestyle.
If You Do Not Require Surgery
Physiotherapist can help treat a broken ankle after it has been treated by a physician and immobilized. After the bone is stable enough for weightbearing, the goal with ankle p, we can help you gain back your ankle
- walking/gait pattern
- sport skills where applies
Same like post surgery ankles, the physio will teach you how to walk without bearing weight on the injured ankle, using crutches or a walker; going up and down stairs as well as getting in and out of cars and beds too (practical stuff – you can ask them for customizations based on your living and work setup too)
When the doctor sees that your fractured ankle is healing well and stable, they will decide on a date for the ankle cast to be removed. Then you will begin bearing weight on that leg again, and continue your physiotherapy treatment.
Physical therapy treatments may include:
- Walking Instruction – begin to put some of your weight on the injured leg, starting with no weight bear > partial weight bear and gradually progressing to full weight as your physician recommends.
- Gait Training – specific instruction and exercises to get you back to normal walking pattern. The focus will be on how your foot and ankle move, and the timing of your steps. The ground may vary from flat, unstable, hilly, treadmill etc
- Swelling management – may include gentle massage, the use of a compression wrap, cold therapy, or heat therapy, and elevating the affected ankle when at rest.
- Ankle Exercises – expect a customized ankle exercise plan to start when your cast is removed. Its main goal is to help strengthen and regain movement in the recovering ankle. It is very important to regain the ability to bend/move your ankle to get back normal standing, walking and running again
- Restoring Ankle Mobility – manual (hands-on) therapy to gently move your foot and ankle joints and surrounding tissues to reduce stiffness, and increase the ankle’s bending range of motion.
- Return to Work/Play Normal Activities – training specific to your job, leisure activity, or sport.
Return to full life, sports and work activities generally happens around 12 to 24 weeks after an ankle fracture from 1st day of medical care and physiotherapy.