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Ankle Injury

A broken ankle is a relatively common yet complex type of injury, and may be the result of being in a car or motorcycle accident, a slip and fall on a dangerous floor, a fall from heights, or other trauma due to another person’s carelessness (“negligence”). Suspected ankle fractures are one of the most common fractures seen in emergency rooms. Over 1.2 million people go to an emergency room each year with an ankle injury.

The ankle is a hinge-type joint that connects the leg to the foot. It forms where three bones come together. These three bones are the tibia (shinbone), the fibula (the lower leg bone), and the anklebone, called the talus. These bones fit together snugly and are supported by strong ligaments to form your ankle joint. The ends of the leg bones (the tibia and the fibula) form a scooped pocket around the top of the anklebone (the talus). The tibia and the fibula are above the ankle joint, while the talus is below it. When a doctor talks about an ankle fracture, he or she is usually talking about a broken bone of the tibia or fibula.

There are many different types of ankle fractures, and every ankle fracture must be treated individually. The severity of a broken ankle can vary from tiny cracks in a single bone to severe, shattering breaks of multiple bones that break the skin. More than most bones of the body, ankle injuries require the most individualized type of treatment. The treatment for a broken ankle depends on the exact site and severity of the fracture. A severely broken ankle may require surgery to implant wires, plates, rods, or screws into the broken bone to maintain proper alignment during healing. High-impact ankle injuries are especially dangerous if the bone breaks through the skin and is exposed to the air. The open wound lets bacteria in to contaminate the broken bone, greatly increasing the risk of infection. In such a case, you will be prescribed a course of antibiotics to stave off any infection.

Ankle fractures result when the ankle is forced inward or outward past its normal range of motion. Fractures result from the same causes as sprains. The diagnosis of an ankle fracture is suspected when a patient gives a history of “turning” or “rolling” his or her ankle, accompanied by sudden pain and swelling. The physical exam will reveal tenderness over the involved bones. Deformity and severe swelling may be present. X-rays of the ankle from several views are needed to confirm the fracture and plan for treatment. Sometimes the doctor will put pressure on the ankle and take a special X-ray called a “stress test.” This is done to see whether certain ankle fractures need surgery. A CT scan or an MRI may occasionally be ordered to assess whether there has been any injury to the cartilage and tendons around the article.

If you have a broken ankle, you may experience the following signs and symptoms:

  • A snapping or popping sound at the time of the injury
  • Bone piercing through the skin (an open wound)
  • Loss of function (it hurts to move the ankle)
  • Immediate, severe throbbing ankle pain
  • The ankle is tender to the touch
  • Pain that increases with activity and decreases with rest
  • Severe swelling at the site of the fracture
  • Severe ankle bruising or discolored skin, which appears hours to days after the injury
  • Severe tenderness over the bones of the ankle
  • Deformity (“out of place”) of the ankle joint caused by the displacement of bones
  • Inability to walk or bear weight on the affected leg, i.e., to stand on the ankle
  • Inability to move the ankle
  • Cuts, puncture wounds, or protrusion of bone fragments through the skin

You should seek immediate care from your doctor or at an emergency room if you have any of the following:

  • The bone has pierced your skin and is exposed to the air (a compound fracture)
  • There is a gross deformity of your ankle bones, indicating displacement of the bones
  • You cannot put weight on the ankle
  • Intolerable pain persists despite over-the-counter pain medications
  • You are unable to move your toes
  • You cannot move your ankle at all
  • You have partial or total numbness of your ankle or foot
  • Your foot is cold or blue

If you suspect you have a fractured ankle but it does not need emergency care, you should call your doctor’s office and make an appointment to see him or her within two to three days. Until you get to the doctor’s office, you should do the following:

  1. Stay off the injured ankle so you do not injure it further;
  2. Restrict the movement of your ankle and foot;
  3. Apply ice to the area for 20 minutes at a time with a break of 45 to 60 minutes between icing for the first 24 to 48 hours; this will help to reduce swelling.
  4. Apply compression to the injured area by wrapping it in an elastic or ACE bandage.
  5. Keep your ankle and foot elevated above heart level. This takes pressure off the ankle and foot and also helps to reduce swelling.
  6. Take over-the-counter pain killers like acetaminophen (Tylenol), or non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) or naproxen (Aleve) to keep the swelling down.

At the emergency room, if X-rays show that your ankle is indeed broken, they will ordinarily put a splint on the affected leg. In serious breaks, a splint is often used for only a few days, until a cast is put on. The splint will allow more room than a cast in case there is continued swelling. If the ankle fracture is not badly displaced, the splint may be put on without moving the broken ankle. If the break is a displacement fracture, a “reduction” will be performed. After the victim is given anesthesia, the ankle fracture will be re-set to improve the alignment and displacement of the broken bones.

A plaster or fiberglass cast is usually put on after several days, unless the swelling is minimal, in which case the cast may be made sooner. If the anklebone cannot be aligned perfectly before it is ready for a case, surgery to align the bones properly may be necessary. Plaster casts mold to the skin better and are generally preferred if the cast is needed to hold the broken bone in place. If the fracture is not unstable, or if some healing has already taken place, a fiberglass cast may be used. Fiberglass casts are lighter and more resilient to wear than plaster casts. After the cast is removed—usually six to eight weeks later—your doctor will most likely prescribe a course of physical therapy to improve the leg’s strength and ankle’s range of motion before you can resume your normal activities.

The doctor may order you to use crutches to get around to help immobilize the injury and ensure you do not put weight on it for several weeks to as much as several months. Determining when you can place weight on the broken ankle depends on the type and severity of the fracture. Only the doctor will be able to tell you when you can start putting weight on the mending ankle.

Although some ankle fractures are healed by immobilization alone, many ankle fractures require surgery. The need for surgery depends on the appearance of the ankle joint on X-rays and the type of fracture. If the fracture is out of place or the person’s ankle is unstable, it may be necessary to treat the fracture with surgery. You may need surgery to implant internal fixation devices such as wires, plates, nails, or screws to keep your bones in their proper position so they heal correctly. Surgery may be necessary if you have any of the following:

  • Multiple fractures
  • An unstable or displaced fracture
  • Loose bone fragments that could enter a joint
  • Damage to the surrounding ligaments
  • Fractures that extend into a joint

If the shape and anatomy of the ankle are not accurately restored, the cartilage lining of the ankle will be disturbed, inevitably leading to arthritis. Therefore, the goal of treating all ankle fractures is to re-position the bones to prevent the occurrence of arthritis. Some minor ankle fractures can be treated in a boot or case without surgery. Many ankle fractures, however, require surgical treatment. Screws and/or a metal plate or wires or rods are inserted into the bones in order to re-align the bone fragments and keep them together as they heal. Different techniques for surgery can be used. Following surgery, a bandage with plaster is applied to the ankle and remains until the stitches are removed, usually two weeks or so later. At that time, gentle exercise activities may be started. No walking on the ankle is permitted for approximately six weeks. At that time protective walking (with a removable boot or a brace) may be allowed. Physical therapy exercises, swimming, and biking are important parts of the recovery process, as they strengthen the leg and develop movement of the ankle. If the ankle is not repaired correctly or does not heal well, arthritis or deformity of the ankle may occur, necessitating a second surgery.

To reduce pain and inflammation, the doctor may recommend an over-the-counter pain reliever, such as aspirin, acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve). If these don’t provide sufficient relief from your pain, your doctor may give you an opioid medication containing codeine, such as Vicodin or Norco.

After your cast or splint is removed, you will probably need to loosen up stiff muscles and ligaments in your ankle and foot. Your doctor may prescribe a course of physical therapy for you, where not only will the physical therapists treat you, they will also instruct you on a program of stretching, strengthening, and range of motion exercises for you to do at home. If you did not have surgery on your ankle or foot, it usually takes a few weeks of physical therapy for your ankle to fully recover. If you had surgery and your cast was on for more than six weeks, your rehabilitation will be longer.

There are certain times during the treatment phase of your broken ankle that you should contact your healthcare provider immediately. These include:

  • You have swelling above or below the site of the fracture
  • Your toenails or feet turn grey or blue and stay grey or blue when your leg is elevated
  • You have numbness or complete loss of feeling in the skin below the fracture
  • You have lingering pain at the site of the fracture under the cast, or you experience increasing pain not helped by elevation or pain medication
  • You have a burning pain under the cast

When can you return to performing your normal activities? Everyone heals at a different rate and the healing will involve the site and severity of the fracture. Return to your normal activities will be determined by how soon your ankle recovers, not by how many days, weeks, or even months it has been since your injury occurred The goal of rehabilitation is to get you back to your normal activities as soon as is safely possible. If you return to soon you may worsen your injury. You may safely return to your normal activities when you have full range of motion in the injured leg compared to the uninjured leg, you have full strength in the injured leg compared to the uninjured leg, and you can walk straight ahead without pain or limping.

If you suffered a broken ankle or other serious foot injury due to another person’s carelessness—such as a car accident, a slip-and-fall—you should contact an experienced personal injury lawyer as soon as possible. The attorney may be able to suggest an orthopedic surgeon who has experience in treating broken ankles, and will be able to start an investigation into the cause of your accident as soon as possible. An experienced personal injury law firm will work on your behalf to recover monetary damages for all of your injuries and losses, including medical expenses, pain and suffering, lost wages, and other damages. Call now or submit your case for a free review.