How to deal with Ankle Fractures?

Sporting events demand a lot of physical exertion from each player. With repeated workouts, practice sessions, and above all stress, in innumerable instances, an unfortunate turn of events leads to a lingering sports injury that takes away months of hard work in a wink. Double Olympic and World 800m record holder, athlete David Rudisha was benched for 16 weeks after he twisted his ankle at home which turned out to be a fracture. English Cricketer Jonny Bairstow had to miss out on the T20 World Cup last year due to a broken fibula bone fracture after a freak accident. 

Closer home double Olympic medallist shuttler PV Sindhu bowed out from the World Tour Finals due to a stressed ankle injury. And at this year’s ongoing Football World Cup Group match Neymar’s pesky ankle injury sent the whole world into a frenzy about Brazil’s chances of winning the cup. An ankle fracture can change fortunes not just for a player but also for an entire country. While these hits and misses are a part of the process, let us understand the impact and extent of the injury on our bodies.

What do You Mean by Ankle Fracture?

A broken ankle signifies one or more of the bones that make up the ankle joint are broken. It can be of different types:

• A slight break in one bone may not impact your mobility
• Several breaks in the bone need restoration via surgery

In the latter, it may lead to disabling movement. Mostly it is advised that you do not put weight on your ankle for a few months, which is why you have restricted movements w.r.t. walking, driving, playing sports, and overall work.

What are the Areas Affected by an Ankle Fracture?

The ankle joint is made up of 3 bones: the shinbone (tibia), the smaller bone of the lower leg (fibula) and the small bones in between the heel bone (calcaneus), tibia and fibula.

Apart from these, there is the Medial malleolus at the end of the tibia on the inner end of the ankle. The posterior malleolus is behind the tibia and the Lateral malleolus is the prominent bone at the end of the fibula on the outer side of the ankle. All of these share the ankle joint which gives mobility to the ankle and the syndesmosis joint which provides stability.

Orthopaedic experts classify fractures based on the area broken or the part of bone displaced. The fracture at the end of the fibula bone will be called a lateral malleolus fracture. And if the tibia is also broken this will be called a bimalleolar fracture. Similarly, if a bone is displaced it is a displaced fracture and if the bone comes out through the skin it is called an open fracture.

Ligaments in our body connect bone to bone to build stability in the joints. When you get a sprain in your ankle, the ligament gets injured. If torn, it is linked to an adjoining fracture. The deltoid ligament, found on the inner part of the ankle, lends stability to the ankle. If it is torn the ankle becomes unstable.

In our ankle joint two or more bones are cushioned by a lining between the bones, called cartilage. If the cartilage starts thinning or damages the cushioning, it leads to arthritis or inflammation in the joint.

What Causes a Broken Ankle?

The main causes of a broken ankle are:

• Rotational injury, i.e., twisted ankle, turned or rolled ankle while walking or running
• Injury due to high-force impact or trauma due to a fall or collision

Based on the event that leads to the injury, broken ankles can be attributed to:

• Stress fracture: Caused by repetitive stress on the ankle over time. It usually occurs when someone starts a new activity or sport like hiking or running, or when an active person quickly scales up the rigour of the activity, like a jogger prepping for a marathon run. This can impact the tibia and fibula majorly and also affect the navicular bone under the talus bone
• Traumatic fracture: Caused due to a sudden specific incident that leads to the fracture. This can impact any bone in the ankle and leg region. Usually depends on where the trauma has impacted

What are the Symptoms of a Broken Ankle?

In the case of a broken ankle, the only symptoms are pain and swelling, either in the ankle region itself or spread towards the foot or knee. Although the symptoms for sprain are similar, in the case of a fracture, the pain will feel 100x more when the injured person puts weight on their ankle.

You Can Also Read:  Common foot and ankle injuries amongst athletes

How to Recover from an Ankle Fracture?

Diagnosis:

In order to ensure proper recovery, the first step is diagnosis. With the help of various imaging tests, the bone structure and point of impact can be ascertained for proper diagnosis. Your orthopaedic will suggest X-rays of the region, to ascertain whether the pain is due to a broken bone, soft-tissue injury or sprain. In case of a traumatic incident, other radiology imaging, like a CT scan or MRI will be suggested.

If the results confirm a fracture, immediately approach an orthopaedic surgeon. The surgeon will be able to tell you whether or not surgery is needed. 

Surgery:

There are different types of ankle breaks. Some of these do not require surgery. But when they do, it is important that the surgery is conducted by a skilled foot and ankle specialist. Timely and appropriate surgical intervention will help the ankle joint heal effectively. A shoddily executed surgery in the long term can lead to further complications, such as:

• additional corrective surgeries 
• gradually leading to ankle instability
• over time develop arthritis 
• the subsequent need for ankle replacement

Treatment:

The ultimate goal is to restore bone alignment and ensure stability in the ankle joint. A good orthopaedic surgeon will ensure that the broken bones heal as close to perfectly as possible. Since a malalignment of even 2mm may lead to arthritis. It is easier to heal fractures than treat arthritis.

Mild ankle breaks that are stable and have no displacement can be managed non-surgically with the help of a splint, leg cast, or walking boot. In cases where that is not possible due to the delicate placement of the mild fracture, patients are advised to use crutches to restrict the pressure from weight bearing. For serious fractures, where the bones or their fragments become misaligned, surgery is required. 

You Can Also Read: Best Food for strong bones and joints

Can an Ankle Fracture Heal on Its Own?

An ankle fracture, which does not involve surgical intervention, can heal on its own. Some of these are: 

• Non-displaced medial malleolus fracture: Usually treated using a short leg cast or walking boot, in this case, patients are restricted from putting weight on their ankle for several weeks. The progress of the healing will be monitored via periodic X-rays
• Non-displaced lateral malleolus fractures: These are usually treated with a short leg cast or a walking boot. Isolated lateral malleolus fractures are usually stable enough to allow weight-bearing on the ankle joint
• Posterior malleolus fracture: These are very small injuries and do not need surgical intervention. Patients are usually prescribed a short leg cast or removable brace. The fracture heals by itself
• Stable Bimalleolar fracture: These fractures are treated with cast immobilisation. This is done for several weeks, during which patients cannot put weight on their ankles. The orthopaedic will observe healing progress with periodical X-rays to ensure no misalignment happens

Rest and Rehab, Help Speed Up Recovery

Postoperative care is highly essential in the case of orthopaedic surgeries, the same applies to ankle repair. A good orthopaedic surgeon will ensure minimal discomfort and maximum gains for the patient. Some precautions are necessary for patients to follow:

• Avoid weight bearing for 4 to 6 weeks. 
• Pain management is independent of opioid medications. 
• Wear protective gear like a splint and elevate limbs for 90% of the day in weeks 1 & 2. 
• Leg to be placed into a removable boot by weeks 3 & 4 to allow showering & moving ankle. 
• Finally, based on the x-ray reports of week 6, gradual weight bearing and physiotherapy are suggested.

At the CK Birla Hospital, we use the latest surgical innovations to ensure every patient gets a shorter healing time but gets complete and effective recovery. This patient-centric approach not only helps the patients heal better but also ensures zero to minimal chances of postoperative complications. In case you are facing any of the symptoms do reach out to us, or book a direct appointment at the CK Birla Hospital.

FAQ’s

1. Can you Walk on an Ankle Fracture?

Depending on the extent of the fracture, treatment is prescribed. For a full-blown fracture, the patient cannot walk before 6 weeks. And can only be allowed to walk when all their x-rays indicate full bone healing. Weight-bearing and walking would be gradual depending on the progress in physiotherapy. 

If the fracture is non-displaced, then a sling or a cast is given to the patient for basic mobility. However, walking can only start when the X-ray indicates complete healing and zero misalignments. 

2. Does a Fractured Ankle Need a Cast?

Yes. It will need a cast or splint if the recovery is non-surgical for up to 4 to 8 weeks, depending on the recovery as visible from subsequent x-rays. Without any complications, in 4 weeks the fracture heals enough to come out of the cast. 

3. Is a Fractured Ankle Worse Than a Break?

A fracture without misalignment or no fragments heals faster than a trauma fracture. So no, a fractured ankle is not worse than a break. 

4. Can I Walk After 3 Weeks of an Ankle Fracture?

Walking after an ankle fracture is dependent upon the severity of the fracture. If it is a clean break it will take at least 8 weeks to heal properly to enable the patient to start walking wearing crutches or support. However, if the fracture is treated non-surgically, shows no alignment issue and subsequent x-ray shows complete healing, the cast can be removed. Walking is usually not advised before week 4.