What is a broken 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, your fibula and your 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. 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. The more bones you break, the more serious the injury. Serious fractures require ankle surgery. It can take several weeks to two years to fully recover from a broken ankle.
Symptoms and Causes
How can I tell if my ankle is broken?
It’s not always easy to know if that pain in your ankle means your ankle is sprained or broken. And if your ankle is broken, you probably won’t know if you’ve broken more than one bone until your healthcare provider can take a look.
Here are some symptoms you might experience if you have a broken ankle:
- You have sudden, severe pain in your ankle.
- You can't put weight on your ankle.
- It hurts when you touch your ankle.
- Your ankle is bruised.
- Your ankle is swollen.
Can I walk on a broken ankle?
It would be difficult and painful to walk on a broken ankle. Beyond that, walking on a broken ankle could damage your tendons and ligaments supporting your ankle.
How do ankle fractures happen?
Most people break their ankles after taking a direct hit on their ankle. They might fall hard, or be struck by something that caused their ankle to break. Here are some ways that an ankle fracture can happen:
- Being in a motor vehicle accident.
- Playing sports, particularly sports where you are 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.
Can an ankle sprain cause a broken ankle?
A sprained ankle happens when you stretch or damage your ankle ligaments through overuse or injury. Think of a piece of elastic that’s been through one too many cycles in the washer and dryer. You can have an ankle sprain because you have a broken ankle, but a sprained ankle won't cause your ankle to break.
Diagnosis and Tests
How do healthcare providers diagnose ankle fractures?
Your healthcare provider has several tests they use to diagnose ankle fractures and determine the extent of your injury. Tests your provider might use to examine your fracture can include:
- Physical examination.
- Computed tomography (CT) scan.
- Magnetic resonance imagery (MRI).
- Bone scan.
Are there different types of ankle fractures?
There are several types of ankle fractures affecting 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. Here are the different types of ankle fractures:
- Lateral malleolus fractures: This injury can happen when you break the bony knob on the outside of your ankle. 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.
- Bimalleolar ankle fracture: This fracture happens 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 both bony knobs on the outside of your ankle and you damage ligaments inside your ankle.
- Posterior malleolus fracture: There's a bony section on the back of your tibia. This is your posterior malleolus.
- Trimalleolar fracture: In this case, all three parts of your ankle are broken.
- 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: The syndesmosis joint is located between your fibula and tibia (shinbone) and anchored by ligaments. A syndesmotic injury happens when you have at least one fracture in your tibia or fibula and you sprain ligaments in your syndesmotic joint.
What is the difference between a stress fracture and a bone fracture?
When you’ve hurt your ankle, it can be hard to tell if you have a stress fracture or a bone fracture.
A stress fracture is a tiny crack in your bone. Generally speaking, you have a stress fracture if the pain in your ankle gets worse over time. A bone fracture is when a fracture changes the shape of your bone.
Management and Treatment
How are ankle fractures treated?
Ankle fracture treatment depends on factors such as the number of ankle bones broken. Not all broken ankles require surgery, but all broken ankles require some level of care to heal.
You probably won't need surgery if you have a stress fracture. You might need a brace or cast to support your ankle while it heals. More serious ankle fractures require reduction or surgery.
Reduction is when healthcare providers manipulate your ankle to line up the ends of your broken bones. You’ll receive local anesthesia to numb your ankle.
What surgery is done to treat broken ankles?
Ankle fractures are treated with surgery called open reduction internal fixation (ORIF). In ORIF, surgeons open up your injured ankle and line up the ends of your broken bones. They might also install metal plates, wires or screws to keep your ankle bones stable while the bones heal.
What happens before ORIF surgery?
You'll receive general anesthesia. To prepare for general anesthesia, you should:
- Avoid food and drinks for eight hours before you go to the hospital unless directed.
- If you smoke, quit smoking at least two weeks before your surgery to improve your heart and lung health. Even quitting for one day before your surgery helps your heart and lungs.
- Stop taking herbal supplements and anti-inflammatory drugs for one to two weeks before the procedure as directed by your healthcare provider.
- Stop taking Viagra® or other medications for erectile dysfunction for at least 24 hours before the procedure.
- If you take certain (but not all) blood pressure medications, talk to your healthcare provider about taking your medication with a sip of water.
What happens during ORIF surgery for an ankle fracture?
- Your surgeon makes incisions to open your ankle joint to access your broken ankle bones.
- They line up your ankle's broken pieces. This is called reduction.
- Your surgeon uses tools such as metal plates, screws or wires to connect your ankle's broken pieces. This is called internal fixation.
- They close the incision.
- Your surgeon will put your ankle in a cast or brace.
What are the complications with ankle fracture surgery?
Complications can include:
- Acute compartment syndrome (ACS): In this syndrome, pressure building in your muscles keeps your blood from getting to your muscles and tissues. ACS can cause permanent muscle and nerve damage.
- Malunion: This is when your broken bones don't line up so they can heal correctly.
- Bone infection (osteomyelitis): This happens if you have an open fracture. An open fracture is where your bone breaks through your skin, creating the risk of bacterial infection.
- Nerve or blood vessel damage: An ankle fracture can damage nerves and blood vessels.
How long does it take to recover from ankle fracture surgery?
Ankle fractures can take a long time to heal. Recovery depends on how much damage was done when you fractured your ankle. Most people can put weight on their ankle within 16 weeks after surgery. But it can take as long as two years for an ankle fracture to heal completely.
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 cause you to trip over and fall.
Outlook / Prognosis
How long does a broken ankle take to heal?
It takes time for a broken ankle to heal. If you had surgery to repair more than one ankle bone, it could be two years before your ankle is back to normal. If you didn't need surgery, your ankle might heal within 12 to 16 weeks.
How soon can I go back to work or school?
An ankle fracture affects your quality of life, regardless whether or not you had surgery. There are several things to consider before you go back to work/school:
If you didn't need surgery:
- You'll be in a cast or walking boot, which could make it difficult for you to get around at work or school.
- You might be taking medication for pain that could affect your ability to work or go to school.
- You might not be able to drive until your ankle is strong enough to control your vehicle brake and accelerator.
If you had surgery:
- You'll have to keep your injured ankle elevated for at least two weeks after your surgery.
- You won't be able to put weight on your injured ankle for six weeks after surgery.
- Once you can put weight on your ankle, you’ll be in a cast or walking boot, which could make it difficult for you to get around at work or at school.
- You might be taking medication for pain that could affect your ability to work or go to school.
- You won't be able to drive until your ankle is strong enough to control your vehicle brake and accelerator.
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 will 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.
When should I contact my healthcare provider or go to an emergency room?
You should contact your healthcare provider or go to the emergency room if you have:
- Uncontrolled pain.
- Increased swelling
- Any change in your ability to put weight on your injured ankle.
- Signs of infection such as fever, chills, redness or your incision is draining.
- Re-injured your ankle.
What questions should I ask my doctor?
- What kind of ankle fracture do I have?
- Do I have to have surgery?
- Will I need to wear a cast or a brace?
- Will I need to have physical therapy?
- How soon can I put weight on my injured ankle?
- When can I play sports?
- How long before my ankle is completely healed?
A note from Cleveland Clinic
It's important to remember you can re-injure your broken ankle if you move too quickly to resume activities. You might get frustrated or anxious waiting for your ankle to heal. Talk to your healthcare provider about your concerns. They will have suggestions and recommendations about programs and services that might help you.
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