Ankle Fracture

Introduction

A broken or fractured ankle is a relatively common injury, often caused by twisting the ankle, a fall, or a sporting accident.

It may be treated with a cast or surgery and usually takes between six and 12 weeks to heal.

How do I know if my ankle is broken?

If you injure your ankle, the following can be signs of a fracture:

pain and tenderness – particularly in the bones around the ankle
being unable to walk or put any weight on the ankle
swelling and significant bruising
a 'crack' sound during the injury
the ankle being a funny shape (dislocated)
bone poking out of the skin (open or compound fracture)

Because of the shock and pain of breaking your ankle, you may also feel faint, dizzy or sick.

If the injury is not severe it can be difficult to tell if your ankle is broken or just sprained. An X-ray is needed to confirm whether the ankle is broken and help determine the most appropriate treatment.

What you should do

If you think you may have broken your ankle, go to your nearest accident & emergency (A&E) department as soon as possible.

If it feels like only a minor fracture and it is not an emergency, it may be more appropriate to go to a minor injuries unit.

Try to avoid putting any weight on the ankle. Ask a friend or relative to drive you to hospital and support your weight as you walk on your other foot.

Raising the leg and applying an ice pack (try a bag of frozen peas wrapped in a tea towel) can help reduce pain and swelling while you make your way to hospital. You can also take over-the-counter painkillers, such as ibuprofen or paracetamol, to help relieve the pain.

Call 999 for an ambulance if the ankle looks like it might be dislocated, or you can see bones poking through the skin.

How a broken ankle is treated

If your ankle is dislocated or the bones are badly misaligned (displaced) the doctor or paramedic may decide to manipulate them back into place (reduction). This is to avoid potential problems with the blood and nerve supply to the foot.

A splint will then usually be applied to protect your ankle and keep the bones in the correct position while you are transferred to an accident and emergency department. You will be given strong painkillers or sedation to ensure your comfort during this procedure.

At the hospital, your doctor will then decide whether you need surgery or if you just need a cast to support your ankle as it heals naturally.

An X-ray is needed to confirm the fracture and to help decide on the appropriate treatment.

Cast

Most ankle fractures will need to be put in a plaster cast or splint for around six weeks.

You'll usually be advised not to put any weight on the broken ankle for at least the first few weeks so you will need to use crutches to support yourself. This will depend on your fracture and in some cases you will be advised to walk on the ankle.

Over the next few weeks, you'll normally be asked to attend follow-up appointments with an orthopaedic surgeon (a specialist in problems affecting the bones and joints) at a fracture clinic.

Your doctor can advise you about things you can do to help your ankle heal and further X-rays may be carried out to make sure it's healing correctly. They may also replace your original plaster cast with a lighter one or a special removable boot as you recover.

Surgery

More severe fractures often require surgery to realign the bones and fix them in position. This is usually carried out under a general anaesthetic (where you are put to sleep).

The surgeon makes cuts in the skin near the ankle and the bones are put back into position. A combination of plates, screws and wires may be used to hold the bones together, and the wound is closed using stitches. The metalwork is not normally removed later on unless it becomes a problem.

Most people will stay in hospital for one or two days after surgery. A plaster cast will be placed over the ankle to protect it before you go home.

Recovering

It takes about six to 12 weeks for a broken ankle to heal, but it may take longer to regain full movement and return to all of your normal activities. Swelling can sometimes take a few years to improve.

Ask friends or family to go shopping for you, as you won't be able to do this yourself. You will, however, be able to move around your home on crutches and manage stairs.

How soon you can return to work depends on how badly you fractured your ankle and the type of work you do, but you will probably be off for at least four to six weeks.

Follow your doctor or surgeon's advice on elevating, moving and resting the ankle, and make sure you attend all follow-up appointments after you have been discharged from hospital. If necessary, you may be referred to a physiotherapist who can show you exercises that may help speed up your recovery.

Read more about caring for a plaster cast.

When to see your GP

Check the ankle regularly and see your GP if:

the pain gets worse or is not relieved by ordinary painkillers – your GP may be able to prescribe a stronger painkiller
you develop any other medical problems or want advice about returning to work
you are planning on flying after ankle surgery – having recent surgery can increase your risk of developing deep vein thrombosis (DVT) and your GP can advise you whether it's safe to fly

When to go back to hospital

Go back to your nearest A&E department if:

you have pins and needles or numbness in your toes
the skin around your ankle or foot has turned blue
the ankle becomes very swollen
you’re having problems with your plaster cast
there is a foul-smelling discharge from a surgical wound on your ankle

These signs may indicate an infection or a problem with the nerves or blood supply to the ankle.

Credits & Documentation references

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