Broken Ankle: causes, symptoms and treatments

Updated 1/9/2024
Dr. Baravarian discusses ankle fractures, their treatment, and way to avoid complications.

The ankle consists of three bones: tibia (shin bone), fibula, and talus (ankle bone). If any of these bones are fractured, you have a broken ankle. If only the ligaments give way, you have an ankle sprain.

 

Under-treated ankle fractures are one of the most common orthopedic injuries and have led to an alarming increase in early-onset ankle instability, arthritis, and permanent range of motion issues. 

 

Getting the right diagnosis and medical advice can make all the difference in your outcome. When it comes to your ankle, it’s better to be safe now than sorry later.

What can cause a broken ankle? 

Many things can cause a broken ankle. These are often related to sudden trauma or stress on the ankle bones and include:

 

Falls 

Falling, especially when it involves twisting or rolling the foot, can lead to a broken ankle. This is common in everyday situations, such as tripping on uneven ground or more severe falls, such as from a ladder or height.

 

Impact or trauma 

Direct blows to the ankle, such as being struck by an object or being involved in a car accident, can cause fractures. High-impact sports, like football or hockey, also pose a risk of ankle fractures due to collisions.

 

Overuse or stress fractures 

Repetitive stress on the ankle, often seen in athletes, can lead to stress fractures. These are tiny cracks in the bone that occur over time.

 

Missteps or uneven surfaces 

Walking or running on uneven surfaces can result in missteps that place unusual stress on the ankle, potentially causing fractures.

 

Osteoporosis or weakened bones 

In people with osteoporosis or other conditions that weaken bone strength, even minor stresses and strains can lead to ankle fractures.

 

 

How is a broken ankle diagnosed? 

The symptoms of a broken ankle are basically the same as a sprain. Even if you cannot bear weight while walking because of severe pain, it does not tell us what is wrong. From the outside, sprains and fractures appear very similar

 

It is wise always to treat serious ankle injuries as if they are broken until you get a diagnosis from a foot and ankle specialist. Getting the proper diagnosis for your injured ankle is essential for proper treatment and avoiding future complications.

 

University Foot & Ankle Institute’s podiatrists have a full toolbox of diagnostic tools to discover if your ankle is broken.

 

Medical history and symptom assessment 

How did the injury occur, and what are the symptoms you are experiencing? We’ll want to know about the nature of the pain, swelling, any sound heard during the injury, and your ability to bear weight on the affected leg.

 

Physical examination 

During the physical exam, our doctor will look for tenderness, swelling, bruising, and deformity in the ankle area — all of which could indicate a fracture. They will also assess your ankle’s range of motion and check for signs of nerve or blood vessel damage.

 

Imaging tests 

X-rays are the most common and initial imaging test used to diagnose a broken bone. For more complex fractures, a CT scan may be ordered. It provides detailed images of the bone and can help in assessing fractures that are difficult to see on X-rays. Though less common for initial diagnosis, an MRI might be used to assess associated injuries to ligaments, tendons, or other soft tissues around the ankle.

 

Stress test 

In some cases, we might do a stress test to see if surgery is needed. This involves gently applying pressure to the ankle and taking an X-ray to see if the bones move apart.

 

Assessment of other injuries 

To make sure we’re thoroughly treating your problem, our doctor will also check for any other injuries to the foot, heel bone, lower leg, or knee, especially if the trauma is significant.

 

What are non-surgical treatments for a broken ankle? 

Ankle fractures that don’t have gapping or angulations/rotation at the fracture site usually don’t require surgery. Instead, we treat them with an ankle brace and possibly physical therapy

 

The goal of non-surgical treatment is to help alleviate ankle pain and let the joint heal. Depending on the extent of the break, our doctor may recommend:

 

  • Rest: Stay off the ankle as much as possible to prevent further injury and reduce foot pain.
  • Ice and compression: Cold compresses (ice packs) are most effective the first 24 hours after the injury to decrease swelling and shorten the time that you can begin weight-bearing.
  • Elevation: To help limit swelling, pain management, and decrease swelling of ankle bone breaks, we often recommend non-steroidal anti-inflammatory drugs such as Ibuprofen.
  • Immobilization: Restriction with a walking boot, cast, or splint holds the joint in place so it heals properly and doesn’t suffer further damage.
  • Crutches: Crutches help you walk around without bearing weight on the injured ankle.

 

What are the surgical treatment options for a broken ankle? 

Fractured ankles often require surgical repair to replace the fractured pieces to normal anatomic alignment and put the ankle joint in the correct position. There are several reasons why an ankle fracture will require surgery. 

 

An angulated or displaced fracture — a fracture where the ankle joint is no longer aligned — will require surgery to realign the ankle joint. It is essential to align the ankle fracture to within 2 millimeters of the original position for optimal long-term results. 

 

Ankle fractures will require surgery if the ankle is broken in several places (called a bi-malleolar or tri-malleolar fracture). These types of ankle fractures are very unstable and will require surgery to stabilize the joint. If these injuries are not stabilized with surgery, the bones will likely shift, causing a malalignment of the joint, which may lead to post-traumatic arthritis in the ankle.

 

Ankle reconstructive surgery

Post-traumatic foot and ankle reconstruction refers to a set of surgical procedures aimed at restoring the normal function, alignment, and appearance of the foot and ankle following a traumatic injury or damage caused by severe conditions. Trauma to the foot and ankle can result from accidents, sports injuries, or degenerative diseases, leading to deformities, fractures, dislocations, or joint damage.

 

Sometimes, your body heals bones or ligaments improperly. Your bones may no longer line up properly, tendons could be improperly aligned, or the tendons are too loose. Any of these can then cause more injuries such as chronic ankle instability and an increased risk of future ankle issues. 

 

The main goals of post-traumatic reconstruction of the foot and ankle are to:

 

Restore alignment and stability 

Proper alignment and stability are crucial for normal foot and ankle function. Surgeons use various techniques to correct deformities and repair fractures or dislocations, such as internal fixation (screws, plates, rods) or external fixation (pins and wires with an external frame).

 

Repair or replace damaged joints 

Depending on the extent of the injury, surgeons may perform joint fusion (arthrodesis) to eliminate joint motion and relieve pain, or replace damaged joints with artificial ones (arthroplasty).

 

Preserve or restore motion 

In some cases, preserving or restoring motion in the foot and ankle is necessary for optimal function. Tendon transfers, ligament reconstructions, or other soft tissue procedures can be performed to improve mobility.

 

Manage chronic pain and inflammation 

Post-traumatic reconstruction can help manage pain and inflammation. This may involve removing bone spurs or inflamed tissues or addressing nerve issues, such as decompression or nerve release.

 

Improve appearance 

While the primary focus is on functionality and not cosmetic foot surgery, reconstructive surgery can also improve the cosmetic appearance of the foot and ankle, helping patients feel more comfortable and confident.

 

The specific procedures and techniques used in post-traumatic reconstruction of the foot and ankle depend on the patient's unique situation, the type and severity of the injury or condition, and the desired outcome. The recovery process can vary significantly and may involve physical therapy, pain management, and ongoing follow-up care to ensure the best possible outcome.

 

Why UFAI is your Best Choice for foot and ankle care 

Using the most advanced techniques, some of which we helped develop, has allowed us to maintain the highest success rates in the nation for ankle injuries. Our goal is to quickly get you back on your feet, utilizing the least invasive treatments possible.

 

Patients are our number one priority. Beginning with the ease of making your appointment, our family-friendly office staff is with you every step of the way. We have our own X-ray, musculoskeletal ultrasound, and even an MRI and 3D CT at many of our facilities.

 

We also offer orthotic and brace manufacturing as well as on-site physical therapy services and state-of-the-art operating rooms. This means you will rarely have to go from one specialist to the next, cutting down on your travel needs and wasted time.

 

While most orthopedic surgeons focus on all the bones and joints in the body, only spending a fraction of their time on the foot and ankle, UFAI's surgeons choose to treat foot and ankle conditions as their lifework.

 

Podiatric foot and ankle surgeons concentrate exclusively on the foot and ankle from day one of medical school. After medical training, they begin a rigorous three-year surgical residency. What sets podiatric surgical residents apart from general orthopedic residents is they specialize in the foot and ankle while most (though not all) ortho residents do not.

 

Years of training and decades of experience and research are why the foot and ankle surgeons at UFAI have the highest success rates in the United States, literally helping thousands get back on their feet and back to their lives.

 

To schedule a consultation, please call (855) 872-5249 or make an appointment online.

 

University Foot and Ankle Institute is conveniently located throughout Southern California and the Los Angeles area. Our foot doctors are available at locations in or near Santa Monica, Beverly Hills, West Los Angeles, El Segundo, Northridge, Downtown Los Angeles, Westlake Village, Santa Barbara, and Valencia.

 

 

 

Broken ankle FAQs

 

 

Ankle fracture FAQs

 

What are the different types of ankle fractures? 

Here are some of the common types of ankle breaks:

 

Lateral Malleolus Fracture: This is a fracture of the fibula, the smaller of the two bones in the lower leg. It's the most common type of ankle fracture and often occurs when the foot rolls inwards or outwards.

 

Medial Malleolus Fracture: This involves a break in the tibia at the medial malleolus, the bony prominence on the inside of the ankle. It may occur alone or with other ankle fractures.

 

Posterior Malleolus Fracture: This type of fracture affects the back portion of the tibia at the level of the ankle joint.

 

Bimalleolar Fractures: A bimalleolar ankle fracture occurs when there is a break to both the medial malleolus (inner side of the ankle) and the lateral malleolus (outer side of the ankle). Because both sides of the ankle are injured, the ankle joint becomes unstable and is susceptible to damage and early ankle arthritis if left untreated. 

 

Trimalleolar Fracture: In this severe type of fracture, all three malleoli parts of the ankle (lateral, medial, and posterior) are broken. It usually results from a high-impact trauma and often requires surgical repair.

 

Pilon Fracture: This is a fracture of the weight-bearing part of the tibia and can involve significant damage to the soft tissue and the ankle joint. It is typically caused by high-energy impacts such as a fall from height or a car accident.

 

Syndesmotic Injury: Also known as a "high ankle sprain," this involves injury to the syndesmosis, the ligaments connecting the tibia and fibula. While not a fracture, it's often associated with ankle fractures and can complicate the healing process.

 

Avulsion Fracture: This occurs when a small piece of bone is pulled off by a tendon or ligament. It's common in sports injuries.

 

Stress Fracture: A stress fracture in the ankle is a small crack in the bone that develops from repetitive force, often due to overuse in sports.

 

Open fracture: Also known as a compound fracture, an open fracture occurs when the broken bones penetrate through the skin. This type of injury requires immediate medical attention (a trip to the emergency room) and often necessitates surgical treatment. The urgency stems from the fact that the exposed wound permits external materials, dirt, and debris to enter and contaminate the fracture site, significantly elevating the risk of infection.

 

  • Foot and Ankle Surgeon at University Foot and Ankle Institute
    Dr. Justin Franson, DPM, University Foot and Ankle Institute, Foot and Ankle Surgeon

    Dr. Justin Franson, DPM, is a Board Certified Podiatric Foot and Ankle Specialist and Diplomate of the American Board of Podiatric Surgery. He attended the School College of Podiatric Medicine in Chicago, graduating in 2001. Dr. Franson then accepted a three-year residency program at the Greater Los Angeles VA and UCLA County Hospital. 

     

    Dr. Franson specializes in several areas including total ankle replacement and sports medicine. Treating athletes and weekend warriors like himself brings him a lot of joy. Dr. Franson keeps active with running marathons, triathlons, hiking, basketball, and golf.

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