FRCSEd FRCS Trauma & Orth
Consultant Foot, Ankle & Knee Surgeon
Fairfield Independent Hospital, St Helens
Merseyside WA11 7RS
Spire Cheshire Hospital
Fir Tree Close
Warrington WA4 4LU
A fracture is the same as a break. The ankle is a joint involving a bone in the foot (talus) and the two long bones of the lower legs (tibia and fibula). Ankle fractures are common injuries. An ankle fracture is a break of one or more of these bones. There may be ligaments damaged as well. The usual cause of an ankle fracture is an injury caused by a fall, twist or a direct impact.
How will I know I have fractured/broken my Ankle?
The injuries may not be obvious and every ankle injury should be evaluated
by a clinician.
The common symptoms following an ankle fracture are:
Pain straight after an injury
Swelling, mostly over the injured area
Inability to weight bear
Deformity - the ankle may look out of place
What treatment will I receive?
You will be seen by a doctor or nurse in the Emergency Department, who will
examine your ankle and order an X-ray to confirm that there is a break. The subsequent treatment will depend on the type of fracture, number of bones broken, if the fracture is out of place or not and your general condition.
If your ankle is out of place, then it will need realigning by a reduction procedure. In general, there are two types of treatment: conservative (non operative) management and surgery (operative).
If the fracture is stable and is aligned in its original position, you may be
treated with a plaster cast below the knee or simply with a special walking
boot or ankle brace. You may be asked to avoid weight bearing or advice to full weight bear on the injured foot depending on the type of fracture. You may need crutches or a walking frame for walking around with. The duration of the plaster or boot or brace will depend on how well your bones heal but usually is for a period of 6 weeks.
If the fracture is unstable or out of position, surgery may be required to fix the
bones together with plates and screws. The doctor will explain this to you in
detail. Sometimes the operation may be delayed to allow the swelling to subside ( it may take sometimes a week) . If so, you should keep your injured leg elevated to help reducing the swelling. Your lower leg will be in a plaster after surgery. You may be able to go home on the day of surgery, sometimes you will need to be in hospital for a few days.
Preparing for Surgery
Prior to the surgery, the doctor may manipulate your injured ankle under
anaesthesia to put it into a better alignment. This will help to reduce the
swelling and pain, and most importantly decrease the likelihood of future
complications. Your injured leg will be elevated and ice may be applied to reduce the pain and swelling. The anaesthetist will talk to you about your anaesthetic during the operation and the doctor will explain the surgery to you.
What Are The Risks Of Surgery?
Anaesthetic complications; your anaesthetist will be able to discuss the possible complications
Bleeding during or after surgery
Poor wound healing
The fractured bones may fail to unite back together or unite into a faulty position
Damage to the small nerves around the operated area can also occur, which may result in numbness and / or painful scarring
Blood clot (deep vein thrombosis) is a rare complication caused by you having to be less mobile following your ankle surgery.
You can help to prevent this by elevating your foot when you sit (with your heel above your hip level) plus carrying out frequent ankle exercises and knee bending exercises to keep your circulation moving.
Metal work may need to be removed if it becomes problematic
For Ward Admissions Prior to Discharge
You will be assessed by the physiotherapist and possibly occupational therapist prior to discharge. The physiotherapists will check that you can safely mobilize with crutches and if required a stair assessment. They will give you advice to guide you through rehabilitation and help you work on walking normally again. The occupational therapist will check if you need any adaptations at home to ensure your safety.
Your follow up appointment will normally be at 2 weeks from the date of the operation. If you need a sick note please let us know.
How Long will My Ankle Take to Recover?
Your recovery will depend on the type of fracture, the method of treatment and your general well-being. The bones may take longer to heal if you are a smoker or suffer from diabetes. It usually takes six to eight weeks for broken bones to heal, but up to a year before you regain good movement and strength of your lower leg and foot. The doctor may arrange additional X-rays to see how well the bones are healing. You should follow the doctor’s advice on when you can start putting weight on your injured leg.
What Should I Expect When My Cast Is Taken Off?
You may experience the following symptoms after the cast is removed:
Pain or discomfort
Decreased ankle strength
Loss of muscle bulk
It is common to experience any of these symptoms when your plaster cast is
initially removed because your ankle has been still for a number of weeks.
If your ankle is swollen, you should try the following to minimise the swelling:
Sit with your leg up to elevate your foot
In bed, rest your foot on a few pillows so that it lies above the level of your heart
Ice may be used to reduce swelling and pain.
To optimise your recovery, you should start the exercises indicated in this leaflet as soon as the cast is removed. You may be given an appointment to
see the physiotherapist to progress you.
When Should I Go Back To Hospital?
You should contact the hospital immediately if you develop any of the following symptoms:
Extreme pain, swelling and tenderness in one of your legs, calves or thighs
Numbness or pins and needles in your toes
The skin around your ankle or foot turns blue or becomes very cold
Foul smelling discharge from the wound
Pain, greater than expected and not eased off with pain-killers
Your foot, toes or leg swell significantly
What To Expect?
Your ankle’s movement and strength will improve over several months. It is
important to carry on with these exercises. It is normal to feel some discomfort when moving your ankle initially, but this should reduce with time. Mild discomfort during exercise is normal and acceptable as long as it settles throughout the day. You should not drive until you regain good ankle movement. You can return to work once you feel you can carry out your normal job duties.