While we tend to talk about the ankle as if it were a single joint, it is actually two joints. The portion that we usually mean when we refer to the ankle is called the true ankle joint. It is the coming together of three bones: the fibula of the shin on the outside of the ankle; the tibia, also of the shin, on the inside of the ankle and that talus bone underneath them. It is responsible for the up and down movement of the foot.
The subtalar joint is the second part of the ankle. It is the coming together of the talus above and the calcaneus (heel bone) below. This joint allows the ankle to move from side to side.
These joints, along with the ligaments that hold the bones together absorb all the stress your ankle receives as you walk, run or jump. They carry the weight of your body and help keep you balanced on uneven ground.
When any of these bones are broken, you are said to have an ankle fracture. The most common fracture is to the bony bump on the outside of the ankle, the lateral malleolus. The lateral malleolus is the bottom of the fibula, the smaller lower leg bone. The bump on the inside of your ankle, the medial malleolus, is less commonly fractured.
Ankle fractures can be either:
Nondisplaced, where the bone cracks but the joint stays in place with your talus between the tibia and the fibula, or
Displaced, where the broken bones are pulled out of their normal alignment in the joint (dislocated). Fortunately, most ankle fractures occur without a dislocation.
Symptoms
In comparison to a sprain, where you can usually walk on your ankles, ankle fractures tend to be very painful. Most people with a fractured ankle can't put weight on it. A fractured ankle or significant sprain causes immediate swelling and the ankle cannot be moved. The key difference is that sprains tend to heal in a week or two and the pain diminishes. A fracture will hurt until it is treated.
Causes and Risk Factors
Ankle fractures most often happen when your foot lands an uneven step, floor or playing field, and tilts. If the ankle does not get straightened in time, it can be severely twisted out of position and the bones can fracture.
The peroneal muscles running along the outside of lower leg and across the ankle are responsible for supporting your ankle. If they are weak, your chances of fracturing or spraining an ankle go up.
Diagnosis
Your doctor will generally ask how you hurt your ankle, how it has felt since the injury, and whether you have injured your the ankle before and ask about your physical and athletic goals to help decide the best course of treatment.
Doctors often can diagnose an ankle fracture by pressing around the ankle to see if there are any tender spots, bumps in the bones or swelling. Your doctor may move your ankle up, down, side-to-side and around in a circle to which positions are most painful.
X-rays usually are ordered first to see whether the anklebones have been fractured. X-rays can show cracks in the bones and bone chips on the bone surface. In growing children, sometimes the fracture occurs through the growth plate and is invisible on the X-ray. A magnetic resonance imaging scan (MRI) may be needed to see if there is damage to the cartilage or associated soft tissues, ligaments or tendons. A computed tomography (CT) scan may be needed to get a clear picture of your bones. These may show fractures missed by X-rays.
Treatment
Broken bones can range from common mishaps in childhood to extremely complex, joint threatening injury. Treatments will vary based upon the type of break, the location of the break and what kind of additional damage may be present.
Treatment options include Casting, immobilization, or Surgery
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Get medical advice as soon as possible if you think you've broken your ankle. It may need treatment to heal properly.
Do not worry if you're not sure if your ankle is broken, dislocated or sprained. Get it checked by a doctor.
Urgent advice: Get help from NHS 111 if:
You've injured your ankle and it:
- is painful, bruised or swollen
- hurts when you put weight on it
- feels stiff and is difficult to move
You can call 111 or get help from 111 online.
You could also go to your nearest urgent treatment centre.
Immediate action required: Go to A&E if:
You've had an injury and:
- your ankle is at an odd angle
- a bone is sticking out of your ankle
- you have a bad cut or wound on your ankle
- you're in severe pain
- your toes look blue or white, or feel numb
If you cannot get to A&E by yourself, call 999 for an ambulance.
Find your nearest A&E
What we mean by severe painSevere pain:
- always there and so bad it's hard to think or talk
- you cannot sleep
- it's very hard to move, get out of bed, go to the bathroom, wash or dress
Moderate pain:
- always there
- makes it hard to concentrate or sleep
- you can manage to get up, wash or dress
Mild pain:
- comes and goes
- is annoying but does not stop you doing daily activities
While you're waiting to see a doctor
If you think you’ve broken your ankle, there are some things you can do while you’re waiting to see a doctor.
You should:
- raise your ankle if possible
- gently hold an ice pack (or a bag of frozen peas) wrapped in a towel on your ankle for 15 to 20 minutes every 2 to 3 hours
- stop any bleeding – put pressure on the wound using a clean cloth or dressing
- wrap your ankle loosely in a bandage to help support it (if your ankle is not at an odd angle)
- remove any jewellery on your ankle or toes
- take paracetamol
- not take ibuprofen until you have seen a doctor
- not eat or drink anything in case you need surgery
- not move or put weight on your ankle if possible
Treatments for a broken ankle
You'll usually have an X-ray to check if your ankle is broken and see how bad the break is.
If you have a very minor break, you may not need any treatment.
For a more serious break, you may need:
- a special boot to help support your ankle
- a plaster cast to hold your ankle in place while it heals
- the bones to be moved back into place by a doctor (they'll give you an injection to numb your ankle)
- surgery to fix the broken bones
You'll usually have follow-up appointments to check your ankle is healing properly.
Recovering from a broken ankle
A broken ankle usually takes 6 to 8 weeks to heal, but it can take longer.
The doctor will tell you:
- how long you'll have to wear the boot or have the plaster cast on
- how much weight to put on your ankle – you may be given crutches or a walking frame to help keep weight off it
Once it's healed, use your ankle as normal. Moving it will stop it getting stiff.
You may need to see a physiotherapist. They can help you with exercises to get your foot and ankle gently moving again.
Ask your doctor when you can return to contact sports or other activities that put a lot of strain on your ankle.