Broken Ankle (Fractured Ankle)

A broken ankle, or ankle fracture, is one of the most common causes of ankle pain. An ankle fracture happens when you break one or more bones in your ankle joint.

Your ankle joint consists of your tibia, fibula and talus. Your tibia is the big bone in your lower leg and is sometimes called your shinbone. Your fibula is a smaller, thinner bone in your lower leg (your calf bone). The lower ends of your fibula and tibia come together and butt up against your talus. Your talus is the main link between your leg and your foot.

You can break one or more ankle joint bones at the same time. Serious fractures require ankle surgery. It can take several weeks to a year to fully recover from a broken ankle.

Types of ankle fractures

There are several types of fractures that can affect different parts of your ankle. Ankles are complicated. They’re made up of three bones and four ligaments, each doing a different job to keep your ankle in good working order. The different types of fractured ankles include:

• Lateral malleolus fractures. This injury happens when you break the bony knob on the outside of your ankle (lateral malleolus). This is the most common type of ankle fracture.
• Medial malleolus fractures. This fracture happens when you break the bony knob on the inside of your ankle (medial malleolus).
• Bimalleolar fracture. This fracture occurs when you break both bony knobs on your ankle. This is the second most common type of ankle fracture.
• Bimalleolar equivalent fracture. This fracture happens when you break one of your ankle bones and you damage ligaments inside your ankle.
• Posterior malleolus fracture. This injury occurs when you break your posterior malleolus, a bony section on the back of your tibia.
• Trimalleolar fracture. This type of fracture happens when you break all three of your ankle bones.
• Pilon fracture. Your tibia ends in a section called the roof of your ankle. When you break this section, it’s called a pilon fracture.
• Maisonneuve fracture. This fracture happens when you sprain your ankle and break the upper part of your fibula, near your knee.
• Syndesmotic injury. A syndesmotic injury happens when you have a fracture in your tibia or fibula and you sprain ligaments in your syndesmotic joint, located between your fibula and tibia.

Symptoms of a broken ankle

It’s not always easy to know if that pain in your ankle means your ankle is sprained or broken, or something else. And if your ankle is broken, you probably won’t know if you’ve broken more than one bone until a healthcare provider can take a look at it.

Broken ankle symptoms may include:

• Sudden, severe pain in your ankle
• Inability to put weight on your ankle
• Pain when you touch your ankle
• Bruising
• Swelling

Ankle fractures causes

Most people break their ankles after taking a direct hit to one of them. They might fall hard or be struck by something that causes their ankle to break. Broken ankle causes include:

• Being in a motor vehicle accident
• Playing sports, particularly sports where you’re likely to be hit on your ankle or you make sudden moves that twist your ankle
• Falling from a significant height
• Tripping and falling
• Taking a misstep and “rolling" your ankle

How doctors diagnose fractured ankles

A healthcare provider will use several tests to diagnose ankle fractures and determine the extent of your injury. Tests your provider might use to examine your fracture include:

• Physical examination
• X-ray
• Computed tomography (CT) scan
• Magnetic resonance imagery (MRI)
• Bone scan

How are ankle fractures treated?

Ankle fracture treatment depends on factors like the number of ankle bones broken and the severity of the injury. Not all broken ankles require surgery, but all ankle fractures require some level of care to heal.

You probably won’t need surgery if you have a stress fracture or the fractured ankle is non-displaced. That means the bones aren’t out of place (they’re still lined up correctly). You might need a brace, cast or walking boot to support your ankle while it heals. More serious fractured ankles require closed reduction or surgery.

A closed reduction is when healthcare providers reposition your broken bones to correctly align your ankle. You’ll receive local anesthesia to numb your ankle.

When does a broken ankle need surgery?

A broken ankle that’s displaced typically requires surgery. “Displaced” means the bones are out of place (not in line). Surgeons use pins, wires, screws and sometimes plates to surgically repair fractured ankles. They’ll likely perform an open reduction and internal fixation.

What can I do to prevent ankle fractures?

Many ankle fractures happen after traumatic events such as motor vehicle accidents, falling or being injured playing sports.

But you can fracture your ankle simply by taking a misstep while walking, stepping off a curb or stumbling over something in your home. You can limit this kind of risk by:

• Taking extra care when walking on uneven surfaces and curbs
• Eliminating clutter in your home that can cause you to trip over and fall
• Wearing the right protective equipment for all activities and sports

How long does a broken ankle take to heal?

It takes time for a broken ankle to heal. If you have surgery to repair more than one ankle bone, it could be two years before your ankle is back to normal. If you don’t need surgery, your ankle might heal within 12 to 16 weeks.

An ankle fracture will temporarily affect your quality of life, regardless of whether or not you have surgery. You may be in a cast or walking boot, taking medication or keeping weight off your ankle for several weeks to months. Your broken ankle recovery time can vary based on all of these factors.

When should I contact my healthcare provider?

You should contact your healthcare provider or go to the emergency room if you have:

• Uncontrolled pain
• Numbness
• Tingling
• Increased swelling
• You can’t put weight on your ankle
• Signs of infection like fever, chills, redness or your cut (incision) is draining

What questions should I ask my healthcare provider?

Questions you may want to ask your provider include:

• What kind of ankle fracture do I have?
• Do I need surgery?
• How soon can I put weight on my injured ankle?
• How long before my ankle is completely healed?

What follow-up appointments will I need after my surgery?

Here are typical post-surgery follow-up appointments:

• Your surgeon will see you a week after surgery to take X-rays to confirm your ankle bones are healing appropriately.
• They’ll remove your cast about six weeks after your surgery.
• Your surgeon might recommend additional surgery to remove the metal pieces that supported your ankle while it was healing.
• They might recommend physical therapy to strengthen your ankle ligaments.

Can you walk on a broken ankle?

If you have a minor fractured ankle, you should still be able to walk on it. You might not even know you’ve broken it. But more severe fractures will require you to keep off your foot for several months. After treatment, as your ankle begins to heal, you can gradually return to walking.