Thankfully, there are good options to get back on the road to recovery, according to Dr. Keith Heier, an Orthopedic Foot and Ankle Surgeon on the medical staff at Texas Health Center for Diagnostics and Surgery in Plano, Texas.  

“Ankle fractures are fairly common, and patients generally do very well,” he said.

If you have ankle pain and suspect it could be a fracture, it’s important to seek treatment as quickly as possible. For many patients, treatment starts in an urgent care clinic or emergency room. Depending on how the bone has broken you may be referred to an orthopedic specialist for ankle surgery.

If you do need surgery, it’s important choose an experienced orthopedic surgeon with deep knowledge of the complex workings of the bones, tendons, ligaments and muscles of the foot and ankle. Due to the complexity of the ankle joint, improper management of an ankle fracture can lead to problems down the road, such as unstable ankle joints, or complications such as ankle arthritis and dysfunction.[3]

Dr. Heier, who treats about a hundred patients with ankle fractures every year, is highly skilled in the latest treatments and surgical techniques for even the most difficult-to-treat fractures.

ANATOMY OF AN ANKLE FRACTURE

The ankle joint is made up of bones, muscles, cartilage, ligaments and tendons. The ligaments form a strong band of tissue supporting and stabilizing the ankle bones; when these are stretched or torn, that’s a sprain. Sprains typically happen when you roll, twist or turn your ankle in an awkward way.[4]  

An ankle fracture occurs involves one or more of the bones of the ankle. It can range from a simple, single break, to fractures affecting several bones at once.[5]

Three bones make up the ankle joint: the shinbone (tibia), the smaller bone of the lower leg (fibula) and a third bone, the talus, that sits between the heel bone and the tibia and fibula. Doctors classify an ankle fracture according to the area that is broken.[6]

“Basically, you can break your ankle in three places -- the medial malleolus (inside part of the tibia), the back of the tibia (posterior malleolus) and the end of the fibula (lateral malleolus),” said Dr. Heier.

The most common causes of a broken ankle include:[7]

• Falls.  The patient tripped and fell, or landed on their feet after jumping down, sometimes from just a slight height. Statistically, more than half of all ankle fractures are due to falls.

• Car accidents. The crushing injuries common in car accidents can break the ankle and require surgical repair.

• Blunt force. A hard fall, or heavy object falling on the foot or ankle can cause a fracture.

• Missteps.  Sometimes, the patient simply put their foot down wrong, rolling the ankle in or out, twisting it from side to side, or over-flexing or over-extending the joint in a way that fractures the bone.

The foot and ankle contain many bones intricately working together. If just one of these bones is fractured, that can cause extreme ankle pain and impaired mobility.  

DIAGNOSING AN ANKLE FRACTURE

Sometimes, when a patient sustains an injury, the presence of a fracture is obvious. Sometimes, it is not. Symptoms of an ankle fracture that might indicate a fracture will include throbbing pain; bruising, inflammation, redness and tenderness; increased pain during activity, which subsides during rest; a visible deformity of the bone in the foot and/or ankle; or difficulty walking or bearing weight.[8]

The treatment process begins with an assessment, in which an orthopedic specialist determines the severity of the injury and the best course of treatment. The doctor will examine the ankle to check for points of tenderness and pain and may move the foot into different positions to check range of motion. The patient may also be asked the patient to walk for a short distance, allowing the doctor to analyze the patient’s gait.

If your signs and symptoms suggest a break or fracture, the doctor may order one or more imaging tests, such as:[9]

X-rays. In most cases, ankle fractures can be visualized on X-rays. The technician may need to take X-rays from several different angles to get a clear view. In some cases, stress fractures don't show up on X-rays until the break actually starts healing.

Bone scan. This test can help diagnose fractures that don't show up on X-rays. A technician injects a small amount of radioactive material into a vein. The radioactive material is attracted to the patient’s bones, especially the parts that have been damaged. Damaged areas, including stress fractures, appear as bright spots on the resulting image.

Computerized tomography (CT). CT takes X-rays from many different angles and combines them to create cross-sectional images of the internal structures of the body. CT scans typically reveal more detail about the injured bone and the soft tissues surrounding it.  

Weightbearing CT. This is a relatively new imaging technology that helps the surgeon visualize the joint under natural load, providing more information. The image is taken while the patient is standing or otherwise placing weight on the injured joint.[10]

Magnetic resonance imaging (MRI). MRI combines radio waves and a strong magnetic field to create detailed images of the ligaments that help hold your ankle together, helping identify fractures that may not be visible on X-rays.

FIRST LINE OF TREATMENT FOR ANKLE FRACTURES

There are a number of different types of ankle fractures, ranging from small hairline fractures to traumatic bone breaks. Doctors classify ankle fractures in several different ways. In a comminuted fracture, the bone is broken into more than two pieces. An extra-articular fracture is a break that does not extend into the joint, as opposed to an intra-articular fracture, in which the break does affect the joint. In an open fracture, the fractured bone breaks through the skin.[11]

Treatment depends on the severity of the fracture and where the injury has occurred.

The good news: in many cases, an ankle fracture doesn’t require surgery. That’s usually the case where the fracture is mild and non-displaced (meaning the bone hasn’t shifted out of place).

“The majority of people with an ankle fracture can be treated with a cast or a boot, and they're going to do okay,” Dr. Heier said. “But if the fracture is displaced, or there is ligament damage, then we typically fix that with additional treatment and sometimes surgery.”

A boot or cast immobilizes the broken bone, enabling it to heal. Other supportive care for non-displaced injuries might include over-the-counter pain relievers (such as acetaminophen or ibuprofen) or therapy to loosen up stiff muscles and ligaments after the bone has healed. In addition, the physician may recommend the patient follow the classic R.I.C.E. treatment: rest, ice, compression, elevation.  

For a displaced fracture -- meaning the two ends of the fracture are not aligned well – the doctor may need to manipulate the pieces of the bone back into their proper positions. This process is called reduction. Depending on the amount of pain and swelling, the patient may take a muscle relaxant, a sedative or a local anesthetic to numb the area before this procedure.

SURGICAL TREATMENT

If the ankle fracture is displaced, or has caused misalignment of the bones, the orthopedic surgeon will need to reassemble the bones back into the correct position using specialized hardware such as plates, screws or pins. In some cases, bone grafting may be used to reconstruct soft tissues such as ligaments and tendons.[12]

“Usually, it takes something called open reduction, which is surgery where we open up the bones, we put the bones back together with some clamps and then we put plates and screws on it,” said Dr. Heier. “Patients typically do very well with that and it can be life changing for sure.”

Dr. Heier has the expertise to treat complex cases, including broken bones that haven’t healed properly (called non-union) and other types of traumatic fractures.

Depending on the severity of the injury, an ankle fracture can take anywhere from several weeks to several months to fully recover. Your physician can advise you as to what to expect in the recovery process.[13]

Be prepared -- healing takes time. Even after the pain wears off, you may need to adjust your activities and take it easy. Ask your doctor for guidance on when and how you may resume normal activity. In some instances, the doctor may recommend physical therapy to rebuild strength in healing bones, muscles, ligaments and tendons. Your doctor will create an individualized recovery plan to ensure you receive the best possible outcome and quickest recovery.

In addition to providing surgical treatment options for foot and ankle injuries the physicians on the medical staff at Texas Health Center for Diagnostics and Surgery offer a variety of treatment options for various medical conditions including endoscopic spine surgery, artificial disc replacement, hip replacement surgery, knee replacement surgery, ENT services, and urology services for men and women.  

Need more information?  Contact us using the link below. 

References: 

[1] Ankle Injuries: Treatment and Prevention. WebMD. https://www.webmd.com/fitness-exercise/guide/ankle-injuries-causes-and-treatments

[2] Broken Ankle, Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/21644-broken-ankle

[3] Life Impact of Ankle Fractures. Life impact of ankle fractures: Qualitative analysis of patient and clinician experiences. BMC Musculoskeletal Disorders 2012. https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/1471-2474-13-224

[4] Ankle Sprains, Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/sprained-ankle/symptoms-causes/syc-20353225

[5] Ankle Fracture (Broken Ankle.) American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org/en/diseases--conditions/ankle-fractures-broken-ankle/

[6] Ankle Injuries. American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org/en/diseases--conditions/ankle-fractures-broken-ankle/

[7] Broken Ankle. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/broken-ankle/symptoms-causes/syc-20450025

[8] Ankle Fracture (Broken Ankle.) American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org/en/diseases--conditions/ankle-fractures-broken-ankle/

[9] Xrays, CT Scans and MRIs. American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org/en/treatment/x-rays-ct-scans-and-mris/

[10] J Am Acad Orthop Surg 2020. Weight-bearing CT Scans in Foot and Ankle Surgery. https://pubmed.ncbi.nlm.nih.gov/32692095/

[11] Ankle Fracture Treatments, Penn Medicine. https://www.pennmedicine.org/for-patients-and-visitors/find-a-program-or-service/orthopaedics/foot-and-ankle-pain/foot-fracture-and-ankle-fracture-treatments

[12] Ankle Fracture Treatments, Penn Medicine. https://www.pennmedicine.org/for-patients-and-visitors/find-a-program-or-service/orthopaedics/foot-and-ankle-pain/foot-fracture-and-ankle-fracture-treatments

[13] Broken Ankle, Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/21644-broken-ankle