Ankle fracture

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at May 5, 2016
StartDiseasesAnkle fracture

Ankle fractures are a very common injury, particularly among runners and other active people. While this kind of injury often occurs during exercise, anyone can experience an ankle fracture as the result of an accident. The severity of an ankle fracture can range anywhere from a tiny crack to a total break in one or more bones in the ankle, and the prescribed treatment will largely depend on the extent of the damage.

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Definition & Facts

An ankle fracture is a break in one or more ankle bones that can range from a slight crack to a complete break, leaving the bone in two or more parts. They are typically caused by accidents (tripping, falling, rolling or twisting the ankle, car crashes, etc.) or repetitive stress from running or other similarly high-impact activities. Conditions like osteoporosis, which weaken the bones, can also increase the risk of experiencing an ankle fracture.

Symptoms & Complaints

While a mild fracture can easily be confused with a less serious source of ankle pain, there are a number of symptoms that characterize ankle fractures. Depending on how severe the fracture is, the symptoms may include swelling, tenderness, bruising, pain that becomes more severe as a result of activity, difficulty walking, difficulty getting feet in and out of shoes, and immediate throbbing pain after the injury.

In the most extreme cases, the broken ankle bone may also protrude through the skin. Anyone who experiences ankle pain that persists for more than a few days or excessive pain while walking should consult a doctor, even if other symptoms are minor or do not present themselves at all.

Causes

Most ankle fractures fall into one of two categories: ones caused by repetitive stress and ones caused by accidents. Stress fractures in the ankles are a common injury for runners, as running regularly puts a lot of stress on the weight-bearing bones in the feet and ankles. Stress fractures are of particular concern in older men and women, as osteoporosis can lead to the weakening of the bones in this area of the body, making them more susceptible to cracks and breaks.

Accidents, on the other hand, can happen to almost anyone (though some people are more at risk). Unexpectedly stepping on something can twist the ankle in a way that leads to a fracture, as can tripping or falling. Another common cause of fractures is the impact from dropping something heavy on the foot (though this is more likely to impact other bones in the feet, rather than the ankle). Car accidents can also lead to ankle fractures, and they are often the cause of fractures that are severe enough to require surgery.

Diagnosis & Tests

Doctors have a variety of tests that they can use to help diagnose an ankle fracture. In most cases, the doctor will begin by going over a patient's medical history, including current symptoms and details of how the injury happened, and conducting a physical examination of the ankle, foot, and leg. From there, the doctor will likely subject the area to one or more imaging tests in order to examine the extent of the damage.

The most common test is an X-ray, which provides the doctor with a look at the bone, and should show any damage, whether it is a small fracture or a complete break. Typically, the doctor will want to X-ray the entire lower leg, just to be certain that there is no additional damage beyond the ankle. However, X-rays are no longer the best tool that doctors have for getting a look at internal injuries, so he or she may order a magnetic resonance imaging (MRI) scan or a computed tomography (CT) scan in place of or in addition to an X-ray.

MRI scans are particularly useful when the doctor suspects that there may be ligament damage in addition to a fracture, as it offers a high-definition look at the bones and the surrounding tissue. CT scans, on the other hand, provide a cross-section view of the ankle and are most useful for identifying fractures within the ankle joint

Treatment & Therapy

Depending on the severity of the fracture, doctors may recommend anything from resting the ankle to surgery. The options largely depend on the stability of the ankle after the injury, which can be determined with an imaging test like an X-ray or a CT scan. If it is stable, the doctor may prescribe resting the ankle, possibly with a cast or a splint to protect the ankle and keep it in one place.

Doctors typically recommend avoiding putting any weight on the ankle for six to ten weeks, although in some cases he or she may allow for putting weight on it immediately. In any case, it is important to schedule follow-up appointments, so the doctor can reexamine the ankle and make sure it remains stable and does not get any worse.

In more severe cases, surgery may be required. In the event that the bone breaks entirely, the doctor may also have to realign the bones first, so they can heal properly. A surgeon can then stabilize the bones by inserting screws, plates, or pins to hold them in place. Once the bones have healed, it may be possible to have any stabilizers (screws, etc.) removed.

Prevention & Prophylaxis

As many ankle fractures occur as the result of an unforeseen accident, they can be difficult to prevent. However, there are several steps that individuals can take to help decrease their risk. They include:

  • Building muscle strength in and around the ankles
  • Maintaining strong bones by consuming foods and beverages with lots of calcium, like milk and other dairy products
  • Wearing supportive shoes during exercise and other strenuous activities
  • Mixing up exercise routines, or cross-training, to avoid putting too much stress on the ankles or any other single area of the body
  • Avoiding tripping hazards by keeping your home clean, or running on well-maintained trails or pavement