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Ankle

Ankle Fractures

The ankle joint is composed of three bones: the tibia, fibula, and talus which are articulated together. The ends of the fibula and tibia (lower leg bones) form the inner and outer malleolus, which are the bony protrusions of the ankle joint that you can feel and see on either side of the ankle. The joint is protected by a fibrous membrane called a joint capsule, and filled with synovial fluid to enable smooth movement.

Ankle injuries are very common in athletes and in people performing physical work, often resulting in severe pain and impaired mobility. Pain after ankle injuries can either be from a torn ligament and is called ankle sprain or from a broken bone which is called ankle fracture. Ankle fracture is a painful condition where there is a break in one or more bones forming the ankle joint. The ankle joint is stabilized by different ligaments and other soft tissues, which may also be injured during an ankle fracture.

Causes

Ankle fractures occur from excessive rolling and twisting of the ankle, usually occurring from an accident or activities such as jumping or falling causing sudden stress to the joint.

Symptoms

With an ankle fracture, there is immediate swelling and pain around the ankle as well as impaired mobility. In some cases, blood may accumulate around the joint, a condition called hemarthrosis. In cases of severe fracture, deformity around the ankle joint is clearly visible where bone may protrude through the skin.

Types of fractures

Ankle fractures are classified according to the location and type of ankle bone involved. The different types of ankle fractures are:

  • Lateral Malleolus fracture in which the lateral malleolus, the outer part of the ankle is fractured.
  • Medial Malleolus fracture in which the medial malleolus, the inner part of the ankle, is fractured.
  • Posterior Malleolus fracture in which the posterior malleolus, the bony hump of the tibia, is fractured.
  • Bimalleolar fractures in which both lateral and medial malleolus bones are fractured
  • Trimalleolar fractures in which all three lateral, medial, and posterior bones are fractured.
  • Syndesmotic injury, also called a high ankle sprain, is usually not a fracture, but can be treated as a fracture.

Diagnosis

The diagnosis of the ankle injury starts with a physical examination, followed by X-rays and CT scan of the injured area for a detailed view. Usually it is very difficult to differentiate a broken ankle from other conditions such as a sprain, dislocation, or tendon injury without having an X-ray of the injured ankle. In some cases, pressure is applied on the ankle and then special X-rays are taken. This procedure is called a stress test. This test is employed to check the stability of the fracture to decide if surgery is necessary or not. In complex cases, where detail evaluation of the ligaments is required an MRI scan is recommended.

Treatments

Immediately following an ankle injury and prior to seeing a doctor, you should apply ice packs and keep the foot elevated to minimize pain and swelling.
The treatment of ankle fracture depends upon the type and the stability of the fractured bone. Treatment starts with non-surgical methods, and in cases where the fracture is unstable and cannot be realigned, surgical methods are employed.

In non-surgical treatment, the ankle bone is realigned and special splints or a plaster cast is placed around the joint, for at least 2-3 weeks.

With surgical treatment, the fractured bone is accessed by making an incision over the ankle area and then specially designed plates are screwed onto the bone, to realign and stabilize the fractured parts. The incision is then sutured closed and the operated ankle is immobilized with a splint or cast.

Post-operative care

After ankle surgery, you will be instructed to avoid putting weight on the ankle by using crutches while walking for at least six weeks.

Physical therapy of the ankle joint will be recommended by the doctor. After 2-3 months of therapy, the patient may be able to perform their normal daily activities.

Risks and complications

Risks and complications that can occur with ankle fractures include improper casting or improper alignment of the bones which can cause deformities and eventually arthritis. In some cases, pressure exerted on the nerves can cause nerve damage, resulting in severe pain.

Rarely, surgery may result in incomplete healing of the fracture, which requires another surgery to repair.

Chronic Lateral Ankle Pain

Chronic lateral ankle pain is an ongoing or recurring pain that develops in the outer side of the ankle from a prior ankle injury that has not healed well. It may develop in cases of sprains, fractures, nerve injury, torn tendons, arthritis, inflammation of the joint lining (synovium) or scar tissue in the ankle region.

The pain is usually intense or may be a dull ache, preventing you from walking or participating in sports. There may be stiffness, swelling, tenderness and buckling of the ankle, causing further injury.

When you present to your doctor’s office with lateral ankle pain, a thorough medical history of previous injuries and treatments, and physical examination is performed to identify the cause of the pain. Tests may be performed to examine nerve sensation. A local anesthetic injection may help your doctor identify the source of the pain. X-rays, CT or MRI scans of both your ankles may be obtained for comparison.

Chronic lateral ankle pain may be treated by conservative means such as anti-inflammatory medications, steroid injections, ankle braces, physical therapy or immobilization in case of fractures. Surgery may be recommended to treat some cases of chronic lateral pain. This includes cleaning the joint surfaces, removing loose fragments, and reconstructing or repairing damaged tendons and ligaments.