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Ankle Fractures: Symptoms, Causes, and Treatment

Reviewed by
Dr. Steven Miller

An ankle fracture occurs when there is either a partial or complete fracture in one of the ankle bones. This is a very common injury, and according to the American Academy of Orthopaedic Surgeons, ankle fractures occur in 184 per 100,000 persons per year.

Ankle fractures can happen to anyone of any age, but typically happen more to adults than children. A child’s bones are more flexible, which may be why children incur more ankle sprains and strains than fractures or breaks.

As we age, our bones become more susceptible to breaks due to a natural loss of calcium. In older people, problems with balance and coordination can contribute to falls, making fractures more likely.

Our ankles are very complex structures. The ankle bone (talus) and the ends of the two lower leg bones (tibia and fibula) make up the ankle joint. Ligaments connect the bones to one another stabilizing and supporting the ankle, while the muscles and tendons allow movement within it.

There is a lot happening in a small area.

What Are the Types of Ankle Fractures?

There are several types of ankle fracture. They can be categorized as stress, simple, avulsion, and comminuted. A stress fracture is when there’s a crack in the outer shell of the bone. A simple fractures is a little more serious; this is when the bone completely breaks into two pieces. An avulsion fracture is when a small piece of bone is pulled off. Comminuted fractures are the most severe—the bone is shattered into several fragments.

Ankle fractures can be classified in a number of ways:

  • Open: a portion of the bone is protruding from the skin
  • Closed: bone doesn’t break the skin surface
  • Displaced: broken bones are moved from their normal position
  • Nondisplaced: bones are slightly misaligned

How Can I Tell I Have an Ankle Fracture?

There are several symptoms to watch for if you think you may have  suffered an ankle fracture, including:

  • Intense pain at the location of the break or fracture
  • Significant swelling that isn’t always localized to the site of the fracture
  • Blisters on your feet, especially over the fracture site
  • Inability to walk
  • Bruising that develops almost immediately after injury
  • Change in the appearance of the ankle

Still, it’s important to keep in mind that an ankle fracture does not necessarily immobilize a person. In fact, many people mistake an ankle fracture for a sprain or strain because if they are still able to walk or if symptoms are minimal.

If you are experiencing any of these other symptoms but are able to walk, you should still seek medical attention immediately to prevent further complications.

How Did I Fracture My Ankle?

There are several ways an ankle fracture can occur. This injury can sometimes occur if you twist or roll the ankle somehow. Other times a medical condition can lead to weak bones. Common ankle fracture causes include:

  • Stepping wrong on uneven ground
  • Having your foot stepped on while in motion
  • Jumping in an unbalanced position
  • Landing incorrectly after jumping
  • Rapidly gaining weight in a short time
  • Powerful force such as a car collision
  • Aging
  • Bone diseases

If you suffer from a bone disease such as osteoporosis or bone cancer, your bones are more vulnerable to fractures, especially the ones located in your feet, ankles, hands and wrists.

Bone is living tissue that consists of several types of cells within the framework of collagen (a protein that provides structure and strength to our bones). Bones typically develop from continuously growing pieces of cartilage that harden over time.

Marrow takes up space inside most bones, which contains the cells that form all types of blood cells in the body. When a disease takes over a bone, it weakens it and causes it to become brittle and susceptible to fractures.

Diagnosing an Ankle Fracture — What To Expect

It’s important you see a podiatrist soon after you fracture your ankle. Because there are several types of fractures, you shouldn’t wait to see if the pain subsides on its own. This will only make the problem worse.

Your doctor will ask questions related to your medical history and activities, and give you a physical exam to check the severity of the injury. He or she will also order an x-ray to check the severity of the fracture, the exact location of the fracture, and to give him or her an idea as to how to treat the problem.

If the injury is not spotted in the x-ray, additional imaging tests such as MRIs may be used.

How Is an Ankle Fracture Treated?

Treating your ankle fracture will begin with a proper diagnosis from a podiatrist. There are several non-surgical and surgical methods of treatment that can be used to help you. A major factor in treating this type of injury is the severity of the fracture.

If the fracture is not severe, you may be required to use the RICE method. RICE stands for rest, ice, compression, and elevation. Your doctor will also want you to stay off your injury as often as possible to ensure that it heals properly.

You may be required to use crutches for two to four weeks as the fracture heals. Your doctor may also prescribe you pain medication and antibiotics to reduce pain and inflammation and to prevent infection.

If you’ve suffered a moderate to major fracture, you may need surgery. When a fracture occurs, there is sometimes damage to the surrounding tissues.

Treatment for fractures usually includes setting the fracture, or fitting the bones back together (in more severe cases). For wounds that are open or displaced, antibiotics are prescribed to prevent infection.

Generally, the person is immobilized with a cast or splint and given crutches to stay off the foot. In most cases, the healing process of a break or fracture takes eight to twelve weeks. If you’ve shattered your ankle bone, your doctor may have to use screws, metal plates, pins, or staples to stabilize the pieces, which may now look like a jigsaw puzzle.

After the immobilization period is over, your doctor will want you to begin using your ankle immediately. This is to avoid muscle atrophy, or the wasting away of a muscle from disuse. Your doctor will have specific advice for your case about when and how to move and exercise your injured ankle.

In some cases fracture does not heal. If this is the case for you, your doctor may need to perform a bone graft surgery to promote healing. During a bone graft small pieces of bone are taken from a bone bank (ribs, spine or hip) and place them around the break.

Occasionally, doctors may use an artificial bone substitute for the graft. Electrical stimulation of the fracture with a weak electric current is sometimes used to speed up the healing process.

What Complications Can Arise from an Ankle Fracture?

If you fracture your ankle and do not seek treatment, complications may arise. For example, if you’ve experienced an open fracture and the bone is sticking out of the skin, an infection is likely to occur.

Bacteria can contaminate the wound and prevent or slow down the healing process. It is also possible for a bone that has been severed to lose its blood supply, causing it to die, collapse, and gradually be absorbed by your body.

Neighboring tissues can also be damaged, which may cause complications. Sharp fragments of bone may compress or sever blood vessels or nerves that are close by.

Another complication that may arise is the broken pieces of bone may begin to rejoin while they are still unaligned. If this occurs, the bones may have to be separated or re-broken and realigned surgically.

Questions to Ask Your Doctor

Here are a few questions you may want to ask your doctor about an ankle fracture:

  • If no complications arise, how long will it take to recover?
  • If symptoms decrease, can I increase the amount of pressure I place on my ankle?
  • How long until we meet again?
  • I injured my ankle previously and still have a walking boot. Can I use that instead of crutches? (if applicable)
  • What changes can I make in my diet to strengthen my bones?

This page was last updated on October 29th, 2015

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