The ankle represents the joint between the tibia and fibula (leg bones) with the talus bone (in the foot). This joint is critical for providing stability while walking on level ground, as well as maneuvering on irregular terrain or performing athletics. Although there is a moderate amount of stability to the bones of the ankle, there are important tendons and ligaments that also help stabilize the ankle joint. These include the anterior and posterior tibio-fibular ligament, the deltoid ligament, and the anterior talofibular ligament (ATFL). The ATFL is the lateral (outside) of the ankle and most commonly injured with an ankle sprain.
Fractures of the ankle are typically caused by rotational injuries, such as twisting or trauma. The most common signs of an ankle fracture are pain, inability to bear weight, swelling, bruising, and tenderness to touch. In severe fractures there can be deformity of the ankle or foot and even lacerations of the skin. The most important characteristic of ankle fractures is stability, which can only be assessed by a physician. X-rays are always obtained, and in some cases special “stress” x-rays are needed to determine whether the bones are stable or require surgical treatment. In some cases when the bones have not moved surgery is not required.
The treatment of ankle fractures depends on stability of the fracture. Because the ankle is an important joint that bears the weight of the body during walking, it is important that bones and ligaments heal in the proper position. Sometimes, a special boot or cast can be used to allow for fracture healing. However, in other cases, surgery may be required to re-align the bones using a combination of plates and screws. The specific treatment for your fracture should be discussed with your orthopaedic surgeon.
Rehabilitation and physical therapy play a critical part in your recovery either after surgery or with non-operative treatment. Your surgeon will advise on any restrictions, such as not putting weight on your ankle. In the early recovery period, physical therapy exercises are prescribed to decrease pain and swelling and to maintain ankle range of motion. In addition, therapy is important for proprioception, which is the body’s ability to sense its location in space, which can help prevent future injuries. As you progress with your therapy, strengthening and special training exercises can help your reduce your risk for repeating the same injury. Exercises should be performed in a supervised setting, as well as at home on your own time. Your commitment to rehabilitation is key to a successful outcome.