What is an ankle fracture?
An ankle fracture is also known as a broken ankle. The term covers a fracture (break) to one or more of the multiple bones that make up the ankle joint. Fractures at the very end of the lower leg bones the tibia and fibula are classed as ankle fractures, as are fractures to the talus and calcaneus bone of the foot. Ankle fractures can occur in two different joints, the ankle joint itself and also the syndesmosis, which is the joint between the end of the Tibia and Fibula. These joints allow it a lot of movement and flexibility. The point where the lower leg connects to the foot is through the tibiotalar Joint (the joint between the tibia and the talus) this joint allows the foot to point downwards and upwards. The second joint is the subtalar Joint (the joint between the talus and calcaneus). This joint allows the ankle to bend from side to side. The two joints are protected by one strong capsule and stabilised by surrounding ligaments and muscles making it a solid and flexible joint.
Why & when does an ankle fracture happen?
Ankle fractures are a common injury and effect people of all ages. They are normally the result of high impact trauma like car or motorcycle accidents or landing awkwardly after a trip or fall where the ankle rolls and twists with weight behind it. Minor injuries like mild falls and mild knocks to the ankle can result in an ankle fracture but this typically only happens when there is an underlying bone weakening condition like osteoporosis. The ankle joint is supported by a matrix of ligaments and due to nature of the injuries most fractures also cause damage to the surrounding ligaments. Due to the risk of damage to the arterial and nervous supply to the foot ankle fractures are considered a medical emergency.
What to do if an ankle Fracture is suspected after trauma?
If you suspect someone has sustained an ankle fracture after any type of trauma then you must immediately call for medical help. As mentioned previously most people injured by high impact accidents may have sustained injuries to arteries and nerves as well as the fracture making medical attention vital. It is important to make sure the individual is safe and comfortable without having to move the individual as any walking or weight bearing will be very painful. On arrival paramedics will stabilise the ankle and foot before taking the patient to accident and emergency.
What does an ankle fracture feel like?
An ankle fracture has very similar symptoms to an ankle sprain only pain levels are much more severe. An ankle fracture from trauma causes a very intense immediate sharp pain around the fracture site this pain can radiate up into the shin, calf and knee and down into the foot. The fracture is often accompanied by swelling, bruising and visible joint deformity and is aggravated by any foot movements this makes weight bearing and walking excruciating. The intense pain after a break will last for several hours which will be aggravated or prolonged by any treatment options like manipulation or traction. Post-surgery or after treatment when the bone starts to heal there will be a dull continuous ache from the swelling and healing process that will last weeks to months. During the healing process the bone is trying to knit together and re-unite. This stage can be quite painful and it is very important to rest to ensure that the bone reconnects properly. The soft tissue and ligaments surrounding the fracture also start to form scar tissue to bind everything together allowing the structure to try and restore its original state and function.
How will an ankle fracture be diagnosed?
Patients will be taken to A&E and a full examination will be done to rule out any additional injuries or complications like nerve and arterial damage to the foot. Your doctor will order an X-ray of the ankle to confirm the diagnosis and identify the location and the extent of the fracture. Occasionally if the extent of the fracture isn’t fully visible on an X-ray then an MRI or a CT scan will be ordered as this will give a more detailed view of the fractured site. Doctors will also use an MRI scan to assess whether the pain felt after trauma is coming from injury to the muscles, ligaments or joint capsule that support the ankle and not indeed from a fracture. The occurrence of a lower leg fracture from mild trauma may prompt doctors to investigate for any underlying bone weakening conditions.
What treatment options are available for an ankle fracture?
The treatment options and healing times for lower leg fractures varies hugely depending on the position and severity of the fracture and also on the complications from any additional injuries. Most cases of stable ankle fractures do not need surgery however it is occasionally necessary to surgically stabilise multiple unstable fractures or complete breaks that could lead to ankle dislocation. Traction or manipulation may be used to correct the position of the fractured bone and a splint or a cast will be used to reinforce and stabilise the fracture and left on for 4-6 weeks until it is well healed. Patients will initially have to rest and avoid weight bearing and will be required to use crutches whilst recovering. The doctor will most likely prescribe anti-inflammatory medication and painkillers for pain relief and to reduce any swelling. An ankle fracture can take anything from 6 - 8 weeks to heal if not longer for more severe breaks. Patients will be referred to a physiotherapist who will provide exercises to strengthen ankle ligaments and muscles to aid the healing process. It is vital that during the healing process the patient still tries to move a lot to reduce the risk of a DVT. Fluctuating pain levels will be experienced throughout the healing process however most of the discomfort towards the end of the healing process comes from stiffness levels caused by long term immobility. The rehabilitation exercises as well as massage and some manipulative therapies can aid in recovering your ankle and foot flexibility.