A broken ankle is a relatively common injury, often caused by twisting the ankle, falls or a sports injury. It may be treated with a plaster cast or surgery and full recovery usually takes between 8 and 12 weeks.
If you suspect a broken ankle, go immediately to your nearest medical emergency center.
How do I know if my ankle is broken or cracked?
Doctors refer to breaks or cracks in bones as fractures. If you injure your ankle, the following may indicate a fracture:
- pain - particularly in the bones around the ankle
- you are unable to walk
- swollen ankle
- a 'crack' sound
- the ankle is a funny shape (dislocated)
- there is bone poking out of the skin (open or compound fracture)
If the injury is not severe it can be difficult to tell if your ankle is broken or just sprained (see sprains and strains). An X-ray is needed to confirm a broken ankle and help decide the appropriate treatment.
Because of the shock and pain of breaking your ankle, you may feel faint, dizzy or sick.
What you can do
Try to avoid putting any weight on the ankle. Ask a friend or relative to drive you to hospital and support your weight as you walk on your other foot. Raising the leg and applying an ice pack (try a bag of frozen peas wrapped in a tea towel) can help reduce pain and swelling.
You can take over-the-counter painkillers to help relieve the pain. Ibuprofen is a good choice.
If the ankle is dislocated, or you can see bones outside the skin, the pain will be very severe and you should call an ambulance.
How a broken ankle is treated
The doctors will first ensure your pain is controlled with tablets or stronger medication through a drip. Sometimes gas and air is used.
An X-ray is needed to confirm the fracture and to help decide on the appropriate treatment.
If your ankle is dislocated or the bones are badly misaligned (displaced) the doctors may decide to push them back into place (reduction).
You will be given strong painkillers or sedation to ensure your comfort during the procedure. Simple fractures where the bones have not moved do not require reduction.
Realigning the bones helps with pain and ankle swelling and reduces the risk of complications from the fracture.
Simple ankle fractures can be treated with a plaster cast. You will not be allowed to put weight on the broken ankle so crutches are needed to walk with. Painkillers will be provided and an appointment should be made with a fracture clinic. Orthopedic doctors will then take over the management of your broken ankle.
At the fracture clinic, a lighter plaster will be put on, which stays on for six to eight weeks. After four weeks you may be able to put some weight on the ankle or change the plaster for a special removable boot.
You will be seen regularly at the fracture clinic and have further X-rays to monitor the healing.
More severe fractures often require surgery to realign the bones and fix them. A general anesthetic is normally used (where you are put to sleep).
The surgeon makes cuts in the skin near the ankle and the bones are put back into position. A combination of plates, screws and wires may be used to hold the bones together, and the wound is closed using stitches. This procedure is called open reduction and internal fixation (ORIF). Normally, the metalwork is not removed unless it becomes a problem.
In rare cases, the surgeon may use an external frame to hold the broken bones together. This is called external fixation.
Most people will stay in hospital for two or three days after surgery for a broken ankle.
It takes about six to twelve weeks for a broken ankle to heal, but it make take longer to regain full movement of the lower leg and foot.
How soon you can return to work depends on how badly you fractured the ankle and the type of work you do, but you will probably be off for at least four to six weeks.
Follow your surgeon's advice on moving and resting the ankle. It is important to attend all follow-up clinic appointments after you have been discharged from hospital.
Ask friends or family to go shopping for you, as you won't be able to do this yourself. You will, however, be able to move around your home on crutches and manage stairs. You may be referred to a physiotherapist, who will show you exercises that may speed up your recovery.
If you have a plaster cast, don't get this wet.
When to see your doctor
Check the ankle regularly and see your doctor if:
- The pain gets worse or is not relieved by ordinary painkillers. Your doctor may be able to prescribe a stronger painkiller.
- You develop any other medical problems or want advice about returning to work.
- You are planning on flying after ankle surgery. Having recent surgery is a risk factor for deep vein thrombosis (DVT) and your doctor may assess your risk.
When to go back to hospital
Go back to your nearest emergency department if:
- You have pins and needles or numbness in your toes.
- There is a foul-smelling discharge from the surgical wound of your ankle.
- The skin around your ankle or foot has turned blue.
- The ankle becomes very swollen.
The above signs may indicate an infection or a problem with the nerves or blood supply to the ankle.