An ankle fracture refers to broken bones around the ankle joint.
Three bones make up the ankle joint. These are the tibia (shinbone), the fibula (a smaller bone in your leg), and the talus (a bone in the foot).
Ankle fractures are very common and happen most commonly from twisting injuries such as during falls or from missteps. These fractures are said to be indirect injuries. Athletes are especially prone to getting ankle fractures of this sort, especially if they play high-impact sports or use improper equipment or technique.
Ankle fractures can also occur from direct impact onto the bones involved. These injuries are most commonly caused by motor vehicle accidents.
If you observe deformity in your foot, or your ankle swelling and pain do not subside after first aid, you should seek medical attention. If you are unable to put weight on the affected foot after an injury, you should also see a doctor immediately.
Your doctor will first conduct a medical interview and focused examination of the injured ankle. You may be asked questions about how the injury occured, and whether there are any open wounds around the ankle. Your doctor may also ask if you are able to stand and walk after the injury.
As part of the examination, you may be asked to put weight on the ankle and walk. The injured ankle will also be palpated (felt) with the aim to look for spots that are painful when touched (tender). If these points of tenderness occur over the bones, this may indicate an underlying fracture. You will also be asked to undergo plain radiographs of the affected ankle (X-rays). Occasionally, CT scans or MRI scans may be necessary as well.
The treatment of ankle fractures depends on whether or not the bones involved are displaced or undisplaced. The risk of subsequent displacement if the fracture is treated non-surgically is also taken into consideration when discussing treatment alternatives. In general, fractures that are undisplaced and at low risk of subsequent displacement may be treated non surgically, whereas fractures that are displaced or at a high risk of displacement are usually managed surgically.
Non-surgical treatment of ankle fractures usually entails the application of a plaster cast. In the first one to two weeks after a fracture, you may be asked to wear a half-cast or backslab, which will subsequently be changed to a full cast. The cast is typically worn for up to 8 weeks, and you will be offered crutches to aid ambulation, and may also be advised to avoid putting weight on the affected ankle for the duration of the casting.
Pain medications such as non-steroidal anti-inflammatory drugs (NSAIDs) may be prescribed to alleviate ankle pain during the initial period of treatment. Frequent X-rays of the ankle will be taken to ensure that no subsequent displacement of the ankle fracture occurs while it is being treated in a plaster cast.
Most ankle fractures that are treated surgically are treated with open reduction of the fractured bones, where the skin over the fracture is incised, and the bones are placed back into their original positions. The bones are then fixed in place with metal implants (internal fixation). This method of treatment is especially indicated for displaced fractures of the ankle.
After surgery, sutures used to close the skin are usually removed after 2 to 3 weeks. There is usually no need for a plaster cast, and most patients may be allowed to place some weight on the injured ankle after a few weeks of rest.
Rehabilitation and Recovery
After the fractures have healed, most patients will find their ankles stiff, and may even be painful when they try to walk on them. You will typically require a short course of ankle therapy to help in your recovery. This will involve curated sessions with a physiotherapist, focused on the range of ankle motion and strengthening of key muscles around the ankle joint. This process may take up to 6 months.
For assessment of your condition, please book an appointment with Dr. Yong Ren.