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Breaking a bone in the ankle is quite a common injury, especially among those who play sport. It can be caused when the ankle is badly twisted or during a fall.
There are a number of different types of fractures of the bone, as per the diagram below. The type of fracture you incur will determine the treatment options available to you, with an x-ray allowing for a complete diagnosis. In considering the ankle breaks can be of the tibia, fibula or in extreme cases, both.
Treatment usually involves immobilising the broken ankle in a plaster cast or ankle support and sometimes surgery. Recovery can take up to twelve weeks. Anyone who suspects they have a fracture should attend the nearest A&E department to be assessed.
Symptoms that may indicate an ankle fracture include:
Sometimes it can be hard to differentiate between a broken ankle and a sprain. An x-ray will confirm the injury and determine the most suitable treatment.
Avoid using the ankle and get a friend to accompany you to the hospital. Applying an ice pack, such as a bag of frozen peas, and keeping the foot elevated can reduce swelling. Ibuprofen and paracetamol, which can be purchased over the counter, may offer some pain relief. If the injury is more severe and there is a compound fracture, an ambulance may be required.
Once doctors have ensured the pain is under control, they will order an x-ray so they can assess the injury. Sometimes the bones are dislocated or misaligned and will need to be manipulated back into the correct position.
A plaster cast and painkillers are used to treat simple fractures. Crutches will be required as it will be important not to put any weight on the joint. Follow-up appointments in the fracture clinic with an orthopaedic doctor will be necessary. An alternative to casting which is often employed is a walker boot. There are various designs available but as an example the Rebound Air Walker is a completely rigid boot with padded lining offering protection to the affected ankle whilst still offering the mobility which casting cannot offer. Mobility is actually a key part of rebailitation following a broken ankle in being able to apply controlled loads to the joint which help tell the body how to heal the bone correctly.
If the broken ankle is severe enough to require surgery it may take place under general anaesthetic. The ankle may need to be held in place internally using plates, screws or wires (Open Reduction and Internal Fixation, ORIF). These will not usually be removed unless they subsequently become a problem for the patient. Very occasionally, the surgeon will need to secure the fracture using an external frame.
A broken ankle may take six to twelve weeks to heal and sometimes longer to return to full range of movement.
It is important to follow the doctor’s advice regarding recovery. Sometimes a broken ankle will require a referral to a physiotherapist, who can provide an exercise programme to aid rehabilitation.
If the pain does not get better or becomes worse, a GP should be consulted. He or she can check the ankle for problems and prescribe stronger painkillers where necessary.
Surgery can increase the risk of deep vein thrombosis when flying. Therefore it is important for the GP to assess risk factors beforehand.
If the ankle becomes more swollen, the foot or toes turn blue, pins and needles develop or the surgical wound becomes red or discharges pus, return to the nearest A&E department as there may be a problem with the nerves around the ankle or a wound infection.
Following a broken ankle, once the cast has been removed, it is helpful to wear a light ankle support until muscle strength returns.