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What is a broken ankle?
A broken ankle is when one or two of the bones that form the ankle joint get fractured. It is also commonly called an ankle fracture, distal fibula fracture, and distal tibiofibular fracture. (These names refer to the tibia and fibula bones in your ankle.)
This is one of the most common bone breaks in both adults and children. It can happen after an ankle roll or twist, a fall, or a serious trauma like a car accident.
If you suspect a broken ankle, keep the weight off of your foot, and go to urgent care of the ER for treatment.
Ankle fractures generally do not require surgery for treatment. Those that do usually heal at a high rate.
Most common symptoms
A broken ankle usually causes a lot of pain and swelling right after the injury. Pain can be on one or both sides of the ankle, depending on which bones are injured.
People often have a hard time walking on the injured foot. The skin over the ankle might start to look bruised in the hours after the injury.
It’s possible to confuse it with a sprained ankle, which doesn’t involve bone injury. Ankle fractures typically cause significantly more pain, swelling, and deformity, like your foot is angled to the side. Trying to put weight on your ankle will result in shooting pain.
Other symptoms you may have
- Skin bruising
- Skin tear
- Ankle deformity
Causes of a broken ankle
What I listen for as I make the diagnosis: The mechanism of injury—how did they hurt themselves? What position was the ankle in when this occurred? Did they feel or hear a crack? —Dr. Bradley Graw
The ankle is made up of three bones that work together as a complex hinge. A fall or blow to your ankle can break one or more of the bones in your ankle joint—the tibia, fibula, and talus.
Two of these bones, the tibia and fibula, are most prone to getting hurt when the ankle is twisted away from its normal hinge-like motion. The soft tissues (ligaments) surrounding the ankle may also get injured. But the ligaments can be spared even when the bone breaks.
How do I know if my ankle is broken?
Ankle injuries are relatively common. It’s important to figure out if it’s just a sprain or could be a fracture. The treatment plans are very different.
Ankle sprains cause less pain and swelling than fractured ankles. You can usually walk on a sprained ankle after a period of minutes up to several days. Rest, elevation, ice, and over-the-counter anti-inflammatory medications (like ibuprofen or Aleve) usually help lessen the pain as needed.
Ankle fractures usually cause more pain and swelling, and potentially deformity. You may not be able to walk without significant pain. You should limit weight-bearing until your ankle is evaluated by a doctor. Go to an orthopedist's office or urgent care that has the ability to do an X-ray.
Treatment for a broken ankle
Getting an X-ray is a key step in the diagnosis. Your doctor will need to differentiate between stable and unstable injuries. If it’s unstable, you may be non-weight bearing for a period of time—this is important for optimal healing. —Dr. Graw
The goal of treatment is to let the broken bone or bones heal in their correct positions. You’ll see an orthopedic surgeon. They will discuss options like bracing (wearing a removable boot to walk around in), casting, and surgery as ways to keep the fracture in a stable position. The treatment strongly depends on the specifics of the fracture.
Whether you need a cast depends on how bad the break is. The worst breaks usually require surgery. If you don't need surgery, you'll probably get a cast. It will be on for somewhere between 4 to 8 weeks, depending on the type of fracture. For milder breaks, your doctor might just give you a removable boot or splint to wear when you walk around.
If there is significant displacement of the joint, the doctor may put the joint in a more safe position. This is called an ankle joint “reduction” and usually requires some pain control or sedation to be performed comfortably.
Certain kinds of fractures, and open wounds with exposed bone, need surgery. The procedure can usually be done in an outpatient surgical center. The surgeon will use an incision on one or both sides of the ankle and use metal plates and screws to hold the fracture in place for safe healing.
You’ll go home with a splint and pain medications. Your doctor will closely monitor you for possible complications such as infection, hardware malfunction, and poor wound or bone healing.
Generally, it will take the bones 6 to 8 weeks to heal whether or not surgery is required.
- High arches
- Previous ankle sprains
- Extremely flexible joints
- High-impact sports such as soccer, football, and basketball provide more opportunities for injury
The following can lead to weaker bones that break easily and have more difficulty healing.
- Poor bone density
Ask your doctor: How long will it take until I’ll be back to full activities? —Dr. Graw
Unless your ankle fracture is very minor, you’ll need follow-up X-rays to make sure it’s healing. As you’re healing, carefully follow your surgeon’s recommendations for any activities that require weight-bearing, such as walking.
If you had surgery, you may have stitches and a splint that need to be removed. Most fractures heal well.
The best way to prevent an ankle fracture is to keep your bones strong with good nutrition. Calcium and vitamin D are particularly important. Using protection such as an ankle brace or shoes with ankle support can help during high risk activities like tennis, basketball, soccer, and hiking.
Dr. Wang is a resident physician in Orthopaedic Surgery at UCLA Medical Center. He received his undergraduate degree in Chemistry and Biology from California Institute of Technology (2011) and medical degree from Washington University School of Medicine (2016). He will complete his Orthopaedic Surgery residency at UCLA this year and continue his fellowship training in Hand Surgery at New York University. Dedicated to providing personalized care to his patients, he strongly believes in giving power to his patients and providing them the most up-to-date, evidence driven care to achieve their goals.