What is a Broken Ankle?
A Broken ankle is defined as any fracture that happens in the distal end of the tibia and the fibula, and the talus bone of the foot. These three bones form the ankle joint and the talus is the only bone that is a part of the ankle joint. The tibia and fibula are parts of the lower leg.
A Broken ankle is a very common injury and the severity of the fracture varies. Ankle fractures may be partial, open or closed and may be as a result of a fall, collision/impact, or accident. Thorough assessment and an x-ray examination and/or CT scan is done by an orthopedic doctor to review the injury and the extent of any damage to the nerves and surrounding tissues.
Broken Ankle Symptoms
The common signs and symptoms of a broken ankle are:
- Painful to touch with limited movement of the ankle
- Swelling and/or bruising of the affected area
- Inability to walk or stand/bear weight on the ankle
- Numbness or tingling sensation in the affected ankle
- Deformity around the ankle
- Broken skin with visible bone particles
Broken Ankle or Sprained Ankle?
In a broken ankle the bone is fractured. In a sprained ankle, the ligaments are over-stretched or torn. The signs and symptoms are often similar. Here are some hints in distinguishing the difference between the two:
- What caused the injury? If your ankle gets twisted or if you lost your balance as you stepped on an uneven surface, it will probably be a sprain. Heavy impact causes bones to break, not twisting.
- If your ankle swells but you are still able to stretch it, it is most likely an ankle sprain.
- If the pain is severe, accompanied by swelling, bruising and tenderness, it is most probably a broken ankle.
- Numbness is indicative of a broken bone.
- Stand up and try to take a few steps. If you are able to walk, it indicates that you have a sprained ankle.
- Look at the affected area. If the joint appears kinked, or uneven, the bone must have been broken.
- Try to move the joint. A broken ankle cannot be moved, a sprained ankle can be moved even if it is painful.
Treatment for a Broken Ankle
Anyone with a broken ankle must be checked by an orthopaedic doctor for the treatment to be established.
The first aim is to minimize the swelling to control the pain and minimize any damage to surrounding tissue. After the X-ray, the doctor can tell how bad the fracture is.
Splinting of the ankle is done initially to immobilize the fracture and it will be kept in place for a few days to give room if the swelling persists. The ankle will be aligned properly prior to splinting.
If the swelling subsides, casting will be done. Casts are made either of plaster or fiberglass. A plaster cast molds better with the skin and is widely used to hold the fractured bone in place. However, if the fracture is unstable and some healing has already taken place, a fiberglass cast may be used. It is lighter and tougher.
Crutches are used to assist in bearing weight as the ankle can not be used for weeks or months depending on the fracture. For severe cases, surgery may be required. The maintenance of the proper alignment of the fractured ankle is of utmost importance for the ankle to heal correctly.
Broken Ankle Surgery
- A general anaesthesia will be given to the patient and then a cut on the skin near the ankle will be made.Special screws and plates will be used to put the two parts of the bone together and hold it in place while it heals.
- Then, the incision will be closed using stitches. A temporary plaster cast will be molded from just below the knee down to the toes to secure the ankle in proper alignment and keep it immobile.
- The wound may be painful and the doctor may give painkillers to ease the pain as well as antibiotics to prevent infection. The surgeon who performed the operation will give instructions as to when the ankle may be moved.
- Some prefer to get the fractured ankle moving before sending the patient home in around 2-3 days. After 10 days, the stitches are removed and the ankle will remain in the plaster cast for approximately six weeks. For the first two weeks, the affected leg should be elevated at rest several times a day to minimize the risk of further swelling as the cast may impede the circulation once the ankle swells.
- Crutches may be used to give support when moving around, avoiding weight on the fractured ankle. Once at home, care should be taken with the fractured ankle. The plaster cast should not be allowed to get wet, cut, or be pressed on. Nothing should be put underneath the cast and the skin inside should not be scratched by anything.
- If the toes turn blue, swollen, and cannot be moved, or if there is numbness or severe pain, go back to the hospital immediately. The screws and plates may or may not be removed but if it becomes uncomfortable, they may be removed 18 months after the operation. If the plaster cracks, or becomes soft and loose, it should be taken back to the plaster technician.
Broken Ankle Recovery
If the broken ankle is clean, there is no shifting of the bone and it doesn’t require surgery, the broken ankle will heal within a six week period with proper medical management. In the case of invasive surgery the broken ankle will heal in about eight to ten weeks. For this long period of recovery, you will need:
- a lot of patience
- emotional support
- lots of pillows
- easy access to food and drinks
- lots of strength
- pain medication
- bath chair
- to remain immobile unless your doctor told you otherwise
Rehabilitation (Physical Therapy)
Rehabilitation is very important when your physician says that you may start moving your ankle again. Physical therapy and home exercises are available and you should start doing them regularly. Eventually, you will also start doing exercises to strengthen the surrounding muscles of the ankle. It may take several months for the muscles around your ankle to become as strong as before the injury took place. Even after the fracture has healed, an ankle brace may still need to be worn for several months. Both of your ankles support almost all of your body weight, so it is very important to get the broken ankle back to full strength again. Here are some therapeutic exercises for the recovering ankle:
This exercise helps move the ankle joint, aids good circulation and loosens ligaments that have been inactive while in the cast. Sit on a chair and take hold of your leg just above your injured ankle, crossed over your healthy leg. Slowly rotate your foot at the ankle, turning it in circles. Only do as much rotation and stretching as you feel comfortable with. If you feel pain, stop and rest.
To help achieve better range of motion in your foot, sit barefoot on a chair and with a hand towel on the floor in front of you. Use your injured foot to scoop the towel from side to side, keeping your leg still. Do this several times a day.
Wall stretches can help the ankle and the muscles associated with it. Stand in front of a wall and extend your arms until your hands are pressing on the wall. Imagine you are going to try to push the wall. Place the injured foot, keeping your leg straight, on the floor behind you and bend your other knee as you lean into the wall. You should feel a stretch in the back of your leg (which has the damaged ankle). Hold and stretch for 10 to15 seconds. Stop if you feel pain.
Broken Ankle Pictures
Picture 1 – Pic of broken ankle anatomy
Image source – empowher.com
Picture 2 – Broken ankle showing swelling, redness
Image source – sciencephoto.com
Picture 3 – X-ray showing broken ankle (tibia, fibula)
Image source – footankle.com
Picture 4 -External fixation of broken ankle (x-ray view)
Picture 5 – Ring fixator for Broken ankle
Marsus proofread this article on 24/8/2012 at 1.00 am.
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