Have You Suffered An
Ankle Fracture?

An ankle fracture is a common type of ankle injury. If you've fractured your ankle you may have many questions. Does a fracture of the ankle always mean surgery? If you have had surgery, how long will it take for you to recover? Is there anything you can do to help your recovery?

Ankle Anatomy

The ankle is made up of three main bones: the tibia, the fibula and the talus. The tibia is the weight bearing bone, or the bone on which we literally stand. It is located on the medial or inside aspect of the lower leg. The fibula, located on the lateral or outside of the leg, functions as an attachment point for ligaments and tendons of the lower leg. The talus completes the ankle joint and is the bone that helps to allow for ankle mobility.

ankle anatomy

Ankle Fracture Causes

Most often, fractures of the ankle occur secondary to trauma. An auto accident, a football tackle, or landing from a jump playing basketball. With a ankle fracture, ligament injuries are also common. Although the bones of the joint warrant the most attention initially, damage to the ligaments can mean long term issues with ankle stability.

Types of Fractures

Bone fractures of the ankle can occur in isolation or as a group. An isolated fibula fracture is most often associated with inversion ankle sprains. An avulsion fracture of the fibula occurs when a small piece of bone is pulled off by the tearing of a lateral ankle ligament. An isolated tibia fracture can also occur, generally involving the most distal aspect of the bone. A talar dome fracture can occur when the top of the talus is injured, generally occurring from a forceful landing from a jump.

Often the bones of the ankle are injured as a group. Commonly fractures of both the tibia and fibula occur together.

Ankle Fracture

In some cases, when the force is significant, injury to the ligament that connects the tibia and fibula can occur. With this type of ankle fracture (called a Snydesmotic injury), surgery is required to both fix the bone fractures and reconnect the two bones to provide for joint stability.

Ankle Syndesmotic injury

Another type of fracture that can occur, generally without trauma, is a stress fracture. These fractures typically occur with overuse such as with running. These fractures are frequently missed by typical x-rays as they can take up to six weeks to become visible. The only way to diagnose a stress fracture immediately is via a bone scan. Most stress fractures heal well with rest, with no surgery required.

Who Needs Surgery?

The decision as to if surgery is necessary will be based on factors including the size, location of the fracture, and stability of the fracture and joint. Most commonly when both the tibia and fibula are fractured, surgery will be required.

Some fractures, such as hairline fractures, avulsion fractures, and many talar dome fractures will not require surgery. For these types of fractures, treatment will include immobilization, crutches, and rest.

What Should I Expect Following Surgery?

Both for post-operative injuries and those fractures that do not require surgery, the use of an immobilizer boot will be required. Depending on the nature of the ankle fracture you may or may not have to keep all weight off the leg as it heals. Fractures in general take six to eight weeks to completely heal. Follow up x-rays will monitor your progress and be used to help determine how long immobilization will be required and when you will be allowed to put weight on your ankle.

As with any surgery, swelling, pain, and limited joint strength and mobility will occur. Possible complications include failure of the fixation devices and infection.

One potential complication following fracture fixation surgery relates to the pins and screws themselves. After healing of the fracture has occurred, with time and movement of the ankle, these small pins or screws can start to move out of the bone. Because the soft tissue around the ankle is quite thin, these pins and screws can be aggravating. Do not be alarmed. If they become painful, removal of the screw is quite easy and generally done during a typical doctor’s office visit.

Physical Therapy

Once healing of the ankle fracture has occurred, physical therapy will be greatly helpful in returning you to normal function. The goals of physical therapy will include returning you to normal walking, reducing swelling, restoring normal range of motion, and improving strength. Utilizing ice therapy and elevation of the ankle is a simple thing you can do to minimize swelling. Being consistent with following home exercise recommendations will also speed your recovery.

Restoring normal ankle mobility and range of motion often requires manual joint mobilizations by the physical therapist. The length of immobilization following a fracture will reduce the ability of the bones of the ankle to glide and slide as they should. The physical therapist will assist in restoring this normal ankle motion.

Ankle Mobilization

Depending on your level of activity, incorporating balance and agility activities will also be helpful in returning you to function. If your fracture was associated with ligament involvement, the use of a brace for sports may be necessary, at least initially.


• The tibia, fibula, and talus can all sustain isolated or combined fractures.

• Fractures most often are caused by trauma or are associated with lateral ankle sprains.

• Fractures do not always require surgery. Size, location, and stability of the fracture will determine of you are a surgical candidate.

• Fractures will require immobilization and six to eight weeks to heal.

• Physical therapy will play an important role in returning you back to normal function.

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BMC Musculoskelet Disord. 2011 Jul 5;12:148.EXACT: EXercise or Advice after ankle fraCTure. Design of a randomised controlled trial.Beckenkamp PR, Lin CC, Herbert RD, Haas M, Khera K, Moseley AM; EXACT Team

Cochrane Database Syst Rev. 2008 Jul 16;(3):CD005595.Rehabilitation for ankle fractures in adults.Lin CW, Moseley AM, Refshauge KM

J Am Acad Orthop Surg. 2010 Sep;18(9):546-56.Management of common sports-related injuries about the foot and ankle.Anderson RB, Hunt KJ, McCormick JJ

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