Ankle fractures are among the most common broken bones. They can happen with a twisting injury in sport, a fall on the stairs, a slip or a road accident. Younger people are more often injured in sport and high-energy trauma, older people in falls at home. A fracture affects not only the bone but often the ligaments, cartilage and soft tissues around the joint.
Which fractures affect the foot and ankle?
The ankle joint is formed by the tibia, the fibula and the talus, held together by strong ligaments. The most common injuries are fractures of the inner or outer ankle bones (malleoli), fractures involving two or three malleoli, and injuries to the syndesmosis, the ligament complex linking the tibia and fibula. Fractures of the heel bone (calcaneus), the talus, the Lisfranc joint, the metatarsals and the base of the fifth metatarsal also occur.
Is it broken or sprained? What are the symptoms?
- Severe pain and rapid swelling
- Bruising
- Inability to bear weight, or pain that increases when you do
- Marked tenderness over the bone
- Visible deformity of the ankle
Some people can still walk on a broken ankle, so being able to walk does not rule out a fracture. An obviously bent ankle, an open wound, numb toes or a cold, pale foot need emergency care.
Who is more at risk?
Older age, active sport, balance problems, previous ankle injuries, diabetes, smoking, excess weight and muscle weakness all raise the risk. In older patients, bone quality, circulation and skin condition can affect treatment, so general health is considered alongside the fracture.
How is a fracture diagnosed?
The examination covers how the injury happened, where it hurts, swelling, any wounds, and blood supply and nerve function. X-rays come first and usually show the fracture site, number of fragments, displacement and joint alignment. CT is used for fractures that enter the joint, comminuted fractures, those involving the posterior malleolus, and when surgery is being planned. MRI helps when ligament or cartilage injury is suspected.
Bone anatomy also matters when assessing syndesmotic injuries: Assoc. Prof. Tokgöz co-authored a study comparing distal tibiofibular joint anatomy in patients with and without syndesmotic injury, published in the Indian Journal of Orthopaedics.
When is a cast enough?
Fractures that are not displaced and do not disturb the joint are usually treated in a cast, splint or walking boot, with regular X-rays to make sure the bone stays in position. When you can start putting weight on the foot depends on the type of fracture.
When is surgery needed?
Surgery is usually needed when the bones have shifted, the joint is out of alignment, a ligament injury is present or the fracture is open. The bones are put back in place and held with plates and screws, and syndesmotic injuries can be fixed with screws or flexible fixation devices. If swelling is severe, surgery may be delayed for a few days until the skin settles. In selected patients, cartilage damage inside the joint can be checked arthroscopically during the same operation.
For non-union, malunion and deformity after a fracture, corrective osteotomy and reconstruction may be needed.
How long do recovery and rehabilitation take?
The first two weeks after surgery are the most important for wound healing; keeping the foot raised and controlling swelling help. Some patients may put light weight on the foot early, while others must avoid weight-bearing for several weeks. Bone healing usually takes 6 to 12 weeks. Return to daily life usually takes a few months, and return to sport generally takes longer and is gradual. Long periods of immobilisation used to be routine; today early movement and physiotherapy are preferred where it is safe.
Frequently asked questions
Does the metalwork need to come out?
Not always. If a plate or screw causes discomfort, or if a syndesmotic screw was used, removal may be considered once the bone has healed.
I can walk on it. Could it still be broken?
Yes. Some fractures still allow weight-bearing. Severe swelling, bruising or tenderness over the bone are reasons to have an X-ray.
Will I get arthritis after an ankle fracture?
Fractures that involve the joint surface and heal out of position carry a higher risk of arthritis later. Restoring accurate joint alignment aims to reduce that risk.