What could be my problem?

A fractured or broken ankle can range from a simple break in one bone, which may not stop you from walking to several fractures, which forces your ankle out of place and may require that you not put weight on it for a few months. There may be ligaments damaged as well. The ligaments of the ankle hold the ankle bones and joint in position.

Three bones make up the ankle joint:

  • Tibia: shinbone
  • Fibula: smaller bone of the lower leg
  • Talus: a small bone that sits between the heel bone (calcaneus) and the tibia and fibula

The tibia and fibula have specific parts that make up the ankle:

  • Medial malleolus: inside part of the tibia
  • Posterior malleolus: back part of the tibia
  • Lateral malleolus: end of the fibula

Doctors classify ankle fractures according to the area of bone that is broken. A fracture at the end of the fibula is called a lateral malleolus fracture, or if both tibia and fibula are fractured, a bi-malleolar fracture.

Two joints are involved in ankle fractures:

  • Ankle joint: where the tibia, fibula, and talus meet
  • Syndesmosis joint; the joint between the tibia and fibula, which is held together by ligaments. Multiple ligaments help make the ankle joints stable.

What causes a fractured or broken ankle?

  • Twisting or rotating your ankle
  • Rolling your ankle
  • Tripping or falling
  • Forceful impact, such as during a car accident

When to see a foot and ankle doctor about a fractured ankle:

Because a severe ankle sprain can feel the same as a broken ankle, every ankle injury should be evaluated by a foot and ankle specialist.

  • Immediate and severe pain
  • Swelling
  • Bruising
  • Tender to touch
  • Cannot put any weight on the injured foot
  • Deformity (out of place), particularly if the ankle joint is dislocated as well

If I have a fractured or broken ankle, what are my treatment options?

Depending on the type and placement of your ankle fracture, a podiatrist (or foot and ankle specialist) will determine the best treatment plan, which could involve one or more of the following:

Lateral Malleolus Fracture

A fracture of the fibula. The level of fracture may direct treatment.

Non-Surgical: 

If the ankle is stable (broken bone is not out of place)

  • Short leg cast
  • Repeat x-rays to endure broken bones have not moved out of place during healing process
  • Pain management
  • Physical therapy
  • Rest
  • Non-weight bearing

Surgical:

With an unstable ankle (fracture is out of place) surgical treatment is needed to reposition (reduce) into their normal alignment.  Special screws and metal plates are attached to the outer surface of the bone to hold them in place.  In some cases, a screw or rod inside the bone may be used to keep the bone fragments together while they heal.


Medial Malleolus Fracture 

A break in the tibia at the inside of the lower leg.

Ankle fractures can occur at different levels of the medial malleolus and often occur with a fracture of the fibula (lateral malleolus), a fracture of the back of the tibia (posterior malleolus), or with an injury to the ankle ligaments.

Non-surgical:

When the fracture is not out of place:

  • A short leg cast or removable brace
  • Non-weight bearing for approximately six weeks
  • Repeat x-rays during healing process to ensure fracture does not change position.

Surgical: 

Unstable ankle, fracture out of place:

A medial malleolus fracture can include impaction or indenting of the ankle joint.  Impaction occurs when a force is so great it drives the end of one bone into another one.  Repairing an impacted fracture may require bone grafting.  This graft acts as scaffolding for new bone to grow on and may lower any later risk of developing arthritis.

Bone fragments may be fixed using screws, a plate or different wiring techniques.


Posterior Malleolus Fracture

A fracture of the back of the tibia at the level of the ankle joint.

In most cases of posterior malleolus fracture, the lateral malleolus (fibula) is also broken. This is because it shares ligament attachments with the posterior malleolus. There can also be a fracture of the medial malleolus.

Non-surgical:

When the ankle is stable and the fracture is not out of place:

  • Short cast or removable brace
  • Non-weight bearing up to 6 weeks

Surgical:

When the ankle is unstable or fracture is out of place

  • Screws placed from the front of the ankle to the back and vice versa
  • A plate and screws placed along the back of the shin bone

Bi-Malleolar Fractures

“Bi-malleolar” means that two of the three parts of the ankle is broken. “Malleoli” is plural for malleolus. In most cases of bimalleolar fracture, the lateral malleolus and the medial malleolus are broken and the ankle is not stable.

Non-surgical: 

These injuries are considered unstable and surgery is usually recommended unless you have significant health problems or if you usually do not work. 

  • Splint to immobilize the ankle until the swelling goes down
  • A short leg cast 
  • Repeat x-rays to ensure ankle stays stable as it heals
  • Non-weight bearing for six weeks

Surgical:

  • Screws placed from the front of the ankle to the back and vice versa
  • A plate and screws placed along the back of the shin bone

Tri-Malleolar Fracture

Trimalleolar fracture means that all three of the malleoli of the ankle is broken. These are unstable injuries and they can be associated with a dislocation.

Non-surgical:

These injuries are considered unstable and surgery is usually recommended unless you have significant health problems or if you usually do not work.

  • A splint to immobilize the ankle until the swelling goes down.
  • A short leg cast
  • Repeat x-rays to ensure ankle stays stable as it heals.
  • Non-weight bearing for six weeks.

Surgical:

  • Screws placed from the front of the ankle to the back and vice-versa A plate and screws placed along the back of the tibia