■ ■ ■ Description

An ankle fracture is a complete or incomplete break of one or both of the bones of the ankle, the tibia (inner side) and the fibula (outer side). These fractures are very common. A temporary dislocation and rupture of ligaments of the ankle joint may also accompany this injury. The full extent of injury may not be recognized immediately.

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■ ■ ■ Common Signs and Symptoms

• Severe pain in the ankle at the time of injury and when trying to move the ankle

• Feeling of popping or tearing in the inner or outer part of the ankle, sometimes as if ankle joint was temporarily dislocated and popped back into place

• Cracking or other sound may be heard at the time of fracture

• Severe tenderness in the ankle

• Swelling in the ankle and foot; occasionally blisters

• Bleeding and bruising in the ankle and foot

• Inability to stand or bear weight on the injured extremity

• Visible deformity if the fracture is complete and the bone fragments separate enough to distort normal leg contours

• Numbness and coldness in the foot if the blood supply is impaired

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■ ■ ■ Causes

• Injury causing a force greater than the bone can withstand, usually due to a direct blow, fall, or stress imposed from either side of the joint

• Indirect stress caused by twisting, pivoting, or violent muscle contraction

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■ ■ ■ Risk Increases With

• Sports that require quick changes in direction, such as football, soccer, and skiing

• Sports that require jumping, such as basketball, volleyball, distance jumping, and high jumping (participants often accidentally land on the side of the foot or on someone else’s foot or someone lands on their foot)

• Walking or running on uneven or rough surfaces, such as roads or grass fields with potholes

• Shoes with inadequate support to prevent the foot and ankle from rolling over when stress occurs

• Bony abnormalities (including osteoporosis), tumors of the bone

• Metabolic disorders, hormone problems, and nutritional deficiencies and disorders

• Poor physical conditioning (strength and flexibility)

• Previous ankle injury

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■ ■ ■ Preventive Measures

• Appropriately warm up and stretch before practice or competition. 

• Maintain appropriate conditioning:

  • Leg and ankle strength

  • Flexibility and endurance

  • Cardiovascular fitness

• Wear proper protective equipment (high-top shoes when appropriate and ankle bracing, taping, or splinting), especially for the first 12 months after ankle injury.

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■ ■ ■ Expected Outcome

This injury is usually curable with appropriate treatment.

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■ ■ ■ Possible Complications

• Failure to heal (nonunion)

• Healing in poor position (malunion)

• Arrest of normal bone growth in children

• Prolonged healing time if activity is resumed too quickly

• Proneness to repeated ankle injury

• Stiff ankle

• Unstable or arthritic ankle

• Infected skin blisters

• Risks of surgery, including infection, bleeding, injury to nerves (numbness, weakness, paralysis), and need for further surgery

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■ ■ ■ General Treatment Considerations

Initial treatment consists of medications, elevation of the leg, and ice to relieve pain and reduce swelling. Treatment requires cast or brace immobilization or surgery to place pins, rods, plates, or screws to fix the fracture. The decision to operate is based on the type of fracture, the bone involved, whether the bone is out of position, and the age and general condition of the patient. Surgery is performed to help reposition or hold the bone in the proper position. After surgery, casting or brac- ing is usually needed. Keeping off the leg with the broken ankle and elevating the leg for the first few weeks after the injury or surgery will help reduce pain and swelling. Bone stimulators, which provide electrical currents to the bone, may be used, but this is uncommon. After immobilization (with or without surgery), stretching and strengthening of the injured and weakened joint and surrounding muscles (due to the injury and the immobilization) is necessary. This may be done with or without the assistance of a physical therapist or athletic trainer. The plate or screws usually do not need to be removed.

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■ ■ ■ Medication

• Nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen (do not take within 7 days before 

• surgery), are used to reduce inflammation. Take these as directed by your physician. Contact your physician immediately if any bleeding, stomach upset, or signs of an allergic reaction occur. Other minor pain relievers, such as acetaminophen, may also be used.

• Narcotic pain relievers may be prescribed by your physician for severe pain. Use only as directed.

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■ ■ ■ Notify Our Office If

• Symptoms get worse or do not improve in 2 weeks despite treatment

• The following occur after immobilization or surgery:

  • Swelling above or below the fracture site

  • Severe, persistent pain

  • Blue or gray skin below the fracture site, especially under the nails, or numbness or loss of feeling below the fracture site

           Report any of these signs immediately.

• New, unexplained symptoms develop (drugs used in treatment may produce side effects)​