Ankle Fractures: Types, Symptoms, Treatment, and Rehabilitation

What Are Ankle Fractures?

An ankle fracture occurs when any of the bones that make up the ankle joint break or crack. The ankle joint is formed by three bones:

• Tibia: The larger bone in the lower leg, also known as the shin bone.

• Fibula: The smaller bone in the lower leg that runs parallel to the tibia.

• Talus: The bone that sits between the tibia and fibula and helps form the joint.

Fractures can occur in any of these bones, and the severity of the injury depends on the force and direction of the impact.

Types of Ankle Fractures

Ankle fractures are categorized based on which bones are broken, the type of break, and the location of the injury. The most common fractures involve the tibia, fibula, or talus. Below are the different types of ankle fractures:

1. Lateral Malleolus Fracture (Fibula Fracture)

This is one of the most common ankle fractures and involves a break in the fibula, the bone on the outside of the ankle. Lateral malleolus fractures can vary in severity, from a small crack in the bone to a complete break. They are often caused by twisting motions or a blow to the outside of the ankle.

• Symptoms: Pain, swelling, and bruising on the outer side of the ankle. You may have difficulty bearing weight on the injured foot.

2. Medial Malleolus Fracture (Tibia Fracture)

A medial malleolus fracture involves a break in the tibia, which is the bone on the inner side of the ankle. This type of fracture often occurs when there is a twisting motion or trauma to the ankle. Medial malleolus fractures are commonly seen in sports injuries, falls, or accidents.

• Symptoms: Pain, swelling, and bruising on the inner side of the ankle. In severe cases, the fracture may cause the ankle joint to be unstable.

3. Bimalleolar Fracture

A bimalleolar fracture occurs when both the lateral malleolus (fibula) and medial malleolus (tibia) are broken. This type of fracture typically results from significant trauma, such as a fall or a motor vehicle accident.

• Symptoms: Swelling and bruising on both sides of the ankle. The joint is usually very unstable, and there may be difficulty in moving or bearing weight on the injured foot.

4. Trimalleolar Fracture

A trimalleolar fracture involves a break in the lateral malleolus (fibula), medial malleolus (tibia), and the posterior malleolus (back of the tibia). This type of fracture is more severe and often results from high-impact injuries, such as car accidents or falls from a height. It usually requires surgical intervention to properly realign the bones and restore ankle function.

• Symptoms: Severe pain, swelling, bruising, and difficulty walking. The ankle may appear deformed, and there may be signs of instability.

5. Pilon Fracture

A pilon fracture involves the talus bone at the base of the ankle. This fracture often occurs from high-energy impacts, such as falling from a height or in severe car accidents. The talus plays a critical role in ankle movement, and fractures in this bone can severely affect ankle function.

• Symptoms: Intense pain, swelling, and bruising around the ankle and foot. Due to the location of the fracture, pilon fractures may require surgery to restore the joint's function.

6. Syndesmotic (High Ankle) Sprain

While not technically a fracture, a syndesmotic sprain involves injury to the ligaments that hold the tibia and fibula together above the ankle. This type of injury is sometimes called a "high ankle sprain." It can occur in combination with fractures and is commonly seen in sports injuries, particularly football and skiing.

• Symptoms: Pain above the ankle, especially when walking or running, and swelling around the lower leg.

7. Stress Fracture

A stress fracture is a small crack in the bone, usually caused by repetitive stress or overuse. These fractures are common in athletes or individuals who participate in high-impact activities, such as running. Stress fractures are typically seen in the tibia or fibula, and they may not be as immediately painful as other fractures.

• Symptoms: Mild pain that worsens with activity, swelling, and tenderness in the area of the fracture. Stress fractures may take time to diagnose since they don't always show up on X-rays immediately.

Symptoms of Ankle Fractures

The symptoms of an ankle fracture can vary depending on the severity and type of fracture. Common symptoms include:

• Severe Pain: Especially when moving or touching the injured area.

• Swelling: Swelling is common around the ankle, often starting immediately after the injury.

• Bruising: Discoloration around the ankle is typical.

• Deformity: In severe fractures, the ankle may look deformed or misaligned.

• Inability to Bear Weight: Difficulty walking or standing on the injured foot.

• Instability: If the fracture causes the ankle joint to be unstable, it may feel weak or unable to support your weight.

Diagnosis of Ankle Fractures

Clinical Examination:

A physiotherapist or doctor will first perform a physical examination to assess the symptoms. This may include palpation of the area to identify tenderness, swelling, and deformity.

Imaging:

• X-rays: X-rays are typically used to confirm the presence of a fracture and determine its location. This is the primary method for diagnosing ankle fractures.

• CT Scan or MRI: In complex fractures, a CT scan or MRI may be needed to get a more detailed view of the bone and soft tissue damage, especially for fractures involving the talus or syndesmosis.

Treatment Options for Ankle Fractures

Treatment for ankle fractures depends on the type and severity of the fracture. Treatment options include:

Non-Surgical Treatment:

• Rest: Rest is essential to allow the fracture to heal. Weight-bearing should be avoided, and crutches may be required to keep pressure off the foot.

• Ice: Ice can help reduce swelling and manage pain in the early stages of recovery.

• Elevation: Elevating the ankle above the level of the heart helps reduce swelling.

• Immobilization: A cast or brace may be used to immobilize the ankle and allow the bones to heal in proper alignment.

Surgical Treatment:

For more severe fractures, surgery may be necessary. Surgery is typically required for:

• Trimalleolar Fractures: These fractures often require open reduction and internal fixation (ORIF) to stabilize the bones.

• Pilon Fractures: These fractures may require complex surgery to realign the talus bone.

• Bimalleolar Fractures: Surgery may be needed if the bones are misaligned or unstable.

After surgery, rehabilitation will be needed to restore strength and mobility to the ankle joint.

Rehabilitation at Palms Physiotherapy & Allied Health

Rehabilitation is essential after an ankle fracture, whether treated conservatively or surgically. Our expert physiotherapists will guide you through a structured rehabilitation plan that includes:

• Pain Management: Techniques like ice therapy, heat therapy, and electrical stimulation are used to reduce pain and swelling.

• Range of Motion Exercises: Gentle stretching exercises to improve ankle flexibility and reduce stiffness.

• Strengthening: Gradual strengthening exercises for the ankle muscles to restore function and prevent future injuries.

• Balance and Proprioception: Exercises to improve coordination and balance, essential for returning to sports or daily activities.

Preventing Ankle Fractures

While not all ankle fractures can be prevented, there are steps you can take to reduce your risk:

• Wear Proper Footwear: Choose shoes that provide good support, especially during physical activities.

• Warm Up and Stretch: Proper warm-up and stretching can prepare your muscles and ligaments for physical activity and reduce the risk of injury.

• Strengthen the Ankle: Regular strengthening exercises for the ankle muscles can provide stability and support.

• Avoid Uneven Surfaces: Be cautious when walking or running on uneven ground to prevent twisting your ankle.

For personalised rehabilitation and support with your ankle fracture, contact us today to schedule a consultation with our expert team.