What is an ankle fracture?
The ankle joint (talocrural joint) is a joint between the talus bone in the foot and the lower ends of the tibia and fibula bones of the lower leg. An ankle fracture is a break in one or more of the bones of the ankle.
What causes an ankle fracture?
Ankle fractures are most commonly caused by trauma e.g. a fall or trip, road traffic accident, rolling the ankle or a sporting injury. You can be more likely to sustain a fracture if you have osteoporosis (brittle bones). The severity of the fracture can be from mild with only one bone being involved and being able to weight bear to severe with all three bones being involved. With a severe fracture the ligaments (strong bands of tissue that help hold the bones in place) are likely to be injured as well and the ankle may be displaced/dislocated.
What are the symptoms of an ankle fracture?
The symptoms depend on the severity of the fracture and whether it is a stable or unstable fracture but includes some or all of the following:
- Immediate and severe pain
- Tender to touch
- Unable to weight bear
- Deformity of the ankle particularly if dislocated
- A crack sound during the injury
- Bone poking out of the skin (a compound or open fracture)
- Feeling faint, dizzy and sick due to the shock and pain
Diagnosis of an ankle fracture
An X-ray will confirm diagnosis of a fracture. Due to the severity of some ankle sprains the symptoms can be the same as an ankle fracture therefore you should always seek immediate medical advice and attend your nearest accident and emergency. A computed tomography (CT) scan may also be carried out to give a cross section of the injury especially if it extends into the ankle joint. Or magnetic resonance imaging (MRI) may be used to ascertain the extent of ligament damage.
A physiotherapist can assess your ankle to diagnose an ankle sprain or if they feel you may have sustained a fracture and need to rule out a bony injury they will advise you on having an X-ray. A thorough subjective and objective assessment will enable your physiotherapist to make a correct diagnosis to enable timely and appropriate treatment and recovery.
If you have been referred to physiotherapy following an ankle fracture they will carry out a thorough assessment to ascertain your rehabilitation needs and personal goals to return you to normal daily activities and hobbies and sports. An assessment will include all or some of the following; observation of function and gait (walking), foot position and biomechanics, range of motion, strength, flexibility, joint mobility, balance and proprioception, palpation and specific special tests e.g. for ligament damage.
Physiotherapy treatment for an ankle fracture
Physiotherapy treatment will depend on the assessment findings and your personal needs and goals. The aims of treatment will be to reduce pain, restore normal range and flexibility, re-gain strength, improve balance and proprioception, restore normal function and return you to your sports and hobbies and enable self-management. Treatment will include some or all of the following:
- Gait re-education
- Joint mobilisations
- Soft tissue mobilisations
- Taping and bracing
- Balance and proprioception re-training
- Sports specific re-training including plyometrics
- Core stability training
- Self-management strategies including home exercises
- Re-injury prevention strategies
When to seek help from a physiotherapist
If you experience sudden and intense pain and are unable to weight bear you should seek medical advice immediately to rule out or confirm an ankle fracture.
If you have had treatment for an ankle fracture e.g. conservative treatment of a plaster or surgical fixation, physiotherapy rehabilitation is essential following removal of the plaster or following surgical fixation to regain normal function.
If you sustained a fracture and did not have any physiotherapy at the time and have not returned to normal function it is advisable to see a physiotherapist as soon as possible.