Ankle Fractures

Ankle fractures most commonly occur following some form of trauma and typically present with swelling, bruising and deformities of the bones around the ankle. Inversion (turning ankle inwards) injuries account for 90% of fractures and fractures can occur with simultaneous tears of the ligaments that help support the ankle joint.

Most cases of ankle fractures will require a cast or boot to allow the bones to heal. In cases where the tibia (the main bone that takes the weight in standing) is broken and the bones are not aligned, surgery may be required. Recovery will require a comprehensive rehabilitation programme. We review research on a regular basis and continually update our website to ensure we are giving the best advice by bringing together current evidence with our clinical expertise.

Symptoms usually develop after some form of trauma. The elderly and people taking part in sports involving landing, pivoting and uneven ground are more susceptible to sustaining an ankle fracture. In the older population, osteoporosis has not been proven to be a contributing factor, however falls in the older population are a contributing factor so addressing falls risk is important ⁽⁴⁾.

In the general population, ankle fractures affect less than 0.1% of the population yearly ^(1,7). It is more common in young males (under 50 years of age) ⁽¹⁾. More common in people who are heavily involved in sport, particularly sports that require jumping/landing and walking/running on uneven surfaces such as athletics, rugby and football. Most fractures in the elderly are female (over the age of 50).

Musculoskeletal physiotherapists and other appropriately qualified healthcare professionals can provide you with a working diagnosis by obtaining a detailed history of your symptoms. A series of physical tests might be performed as part of your assessment to rule out other potentially involved structures and gain a greater understanding of your physical abilities to help facilitate an accurate working diagnosis. X-rays are often needed to find out if and where a bone is broken and how much damage there is ⁽²⁾.

Your treating clinician will want to know how your condition affects you day-to-day so that treatment can be tailored to your needs and personalised goals can be established. Intermittent reassessment will ascertain if you are making progress towards your goals and will allow appropriate adjustments to your treatment to be made.

As part of your treatment, your musculoskeletal physiotherapist will help you understand the condition and what needs to be implemented to effectively manage your fractured ankle and provide rehabilitation. This will include activity modification strategies as well as other useful treatments aimed at reducing discomfort.

If you are required to wear a boot or cast, ensure you gently move your toes and bend your knee to ease stiff muscles and maintain healthy blood flow to the affected limb. Regular adherence to a condition-specific rehabilitation programme is important in the management of this condition. It should be noted that rehabilitation exercises are not always a quick fix but if adhered to on a consistent basis (weeks to months), over time they have been shown to yield positive outcomes.

For patients wanting to achieve a high level of function or return to sport, we would encourage a consultation with a physiotherapist as you will likely require further progression beyond the advanced rehabilitation stage. As part of a comprehensive treatment approach, your musculoskeletal physiotherapist may also use a variety of other pain-relieving treatments to support symptom relief and recovery. Whilst recovering, you might benefit from further assessment to ensure you are making progress and establish appropriate progression of treatment. Ongoing support and advice will allow you to self-manage and prevent future reoccurrence.

For more complex fractures, potentially involving multiple bones and soft tissue structures, surgery might be required.

https://www.nhs.uk/conditions/broken-ankle/

https://www.nhs.uk/common-health-questions/accidents-first-aid-and-treatments/how-should-i-care-for-my-plaster-cast/