Ankle & Foot Fractures

The ankle consist of three bones: shinbone (tibia), the smaller lower leg bone (fibula) and the small bone that sits between the heel bone and the tibia and fibula known as the talus. The midfoot is made up of a cluster of small bones that form the arch of the foot. It is from this cluster of bones that the metatarsals extend to the phalanges (toe bones).

A fracture is a term used to describe a break in a bone. A fracture can range from a hairline crack through to complete displacement of the bone.  Also a fracture can result in multiple pieces of bone (comminuted). 

A fractured ankle or foot means there is a break in one or more bones of the ankle or foot.

The ankle contains ligaments that connect the bones in the ankle joint. Ligaments are strong fibrous tissues that stabilise the joint and keep the bones in place whilst allowing movement.

A sprained ankle occurs when the ligaments in the ankle are overstretched and tear. The severity of a sprained ankle can range from a minor tear in the ligament fibers to a complete tear through the ligament. Most tears occur in the ligaments on the outside of the foot.

Fractured and sprained ankles can be caused by:

• Twisting or rolling your ankle
• Tripping or falling
• Direct impact such as a car accident
• Falling from a height

Fractured foot or toe bones are often caused by:

• Direct impact such as kicking something hard or dropping something heavy on your foot
• Stress fractures resulting from repetitive activity
• Falling from a height
• Sports injuries such as kicking a ball

Fractures and sprains in the ankle or foot are associated with:

• Acute pain
• Difficulty walking or weight-bearing
• Swelling, bruising and tenderness over the affected area

If you are experiencing any of the symptoms above following an injury to your ankle or foot, you should see your doctor or present to the emergency department.

Your doctor will ask you questions about the nature of your injury and your symptoms. An examination of the ankle, foot and lower leg will also be performed.

An Xray is usually performed to confirm a fracture to any of the bones in the ankle or foot.

A CT (computed tomography) scan may be required if an x-ray does not show the fracture lines clearly.

A MRI (magnetic resonance imaging) scan may also be done to identify injuries to other structures such as ligaments.

Initial treatment

Where there is a visible deformity, severe pain or inability to weight bear, medical assistance should be sought as soon as possible. Where there is no visible deformity in the ankle or foot and putting weight down through the foot is possible, initial treatment should involve:

• Rest
• Ice – apply ice for 20 minutes at a time, taking care not to apply directly to the skin.
• Compression – applying light compression can help reduce swelling and provide support
• Elevation – will help minimse the swelling

If symptoms persist despite these measures a review by a doctor is required.  The doctor will assess the injury to determine what additional medical treatment is required.

Treatment of ankle sprains

Ankle sprains do not usually require surgery. Non-surgical treatment include:

• Medication to control pain and inflammation
• Avoid weight bearing – this may require the use of aids such as crutches
• Immobilisation – a supportive bandage or in some cases an ankle brace, cast or “moon boot” may be required
• Physiotherapy – to assist with exercises that improve control, strength and balance and also prevent stiffness.

Occasionally ankle sprains do not heal with non-surgical treatment and your surgeon may recommend surgery.

Surgery may be required to repair or reconstruct the damaged ligaments to prevent ongoing pain and instability of the ankle.  Arthroscopic or keyhole surgery may also be required in some cases. In this procedure a small camera is used to look into the ankle joint through a small incision and enables damage within the joint, such a loose pieces or cartilage flaps, to be repaired.

Treatment of fractures of the ankle and injuries to the midfoot

If a fracture has occurred at the ankle joint and the bones and joint are lined up perfectly (undisplaced fracture) surgery may not be required.  Similarly fractures that involve the bones of the foot, if undisplaced, may not require surgery.  Often these types of undisplaced fractures can be treated with a period of immobilisation in a cast, brace or moon boot.  The type of cast or brace and length of time required in it will depend on the type and severity of the injury.  Also there may be a period of time that placing weight through the affected limb is not allowed. 

Ankle and midfoot fractures that are displaced (bone ends not aligned) or comminuted (bones in several pieces) will generally require surgery.  Also injuries that involve fractures and dislocation of the bones and joints of the ankle and foot surgery. 

Your surgeon will align the bones and fix them together using internal metal plates, screws and/or wires if necessary.  Sometime it may be necessary to fix your bones with and external frame to help the soft tissues and swelling settle down.  This is used in more severe injuries. 

Your doctor may also recommend surgery if there is a risk of the fracture not healing (nonunion).