Jordi Sanchez-Ballester

FRCSEd FRCS Trauma & Orth

Consultant Foot, Ankle & Knee Surgeon

Fairfield Independent Hospital, St Helens

Spire Cheshire

Fairfield Independent Hospital

Crank Rd

St Helens

Merseyside WA11 7RS

01744 739311

Spire Cheshire Hospital

Chris Davies

Fir Tree Close

Warrington WA4 4LU

0845 602 2500

Medico Legal

Nuria Roig

07894 717377

St Helens & Knowsley

Claire Lomax

0151 290 4234

Ankle Fracture

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).

Conservative Management

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.

DOWNLOAD: Ankle Fracture Patient Information leaflet