The ankle joint is composed of three bones: the tibia, fibula and talus, which articulate with each other. The ends of the fibula and tibia (lower leg bones) form the inner and outer malleolus, which are bony protrusions of the ankle joint that you can feel and see on either side of your ankle. The joint is protected by a fibrous membrane called a joint capsule and filled with synovial fluid to enable smooth movement.
Ankle injuries are very common in athletes and in people performing physical work, often resulting in severe pain and impaired mobility. Ankle pain occurs from an ankle sprain, which is characterized by a torn ligament or from an ankle fracture. Ankle fracture is a painful condition where there is a break in one or more bones forming the ankle joint. The ankle joint is stabilized by different ligaments and other soft tissues, which may also be injured during an ankle fracture.
Ankle fractures occur from excessive rolling and twisting of the ankle, an accident or activities such as jumping or falling that can cause sudden stress to the joint.
Following an ankle fracture, you may experience immediate swelling and pain around the ankle as well as impaired mobility. In some cases, blood may accumulate around the joint, a condition called hemarthrosis. In cases of severe fracture, deformity around the ankle joint is clearly visible where the broken bone may protrude through the skin.
Ankle fractures are classified according to the location and ankle bone that is involved. The different types of ankle fractures are:
The diagnosis of the ankle injury starts with a physical examination, followed by X-rays and CT scan of the injured area for a detailed view. Usually it is very difficult to differentiate a broken ankle from other conditions such as a sprain, dislocation or tendon injury without an X-ray of the injured ankle. In some cases, special X-rays are taken after applying pressure on the ankle. This procedure is called a stress test. This test is employed to check the stability of the fracture, to decide if surgery is necessary or not. In complex cases, where detail evaluation of the ligaments is required, an MRI scan is recommended.
Immediately following an ankle injury and prior to seeing a doctor, you should apply ice packs and keep the foot elevated to minimize pain and swelling.
The treatment of ankle fracture depends upon the type and stability of the fractured bone. Treatment starts with non-surgical methods, and in cases where the fracture is unstable and cannot be realigned, surgical methods are employed.
In non-surgical treatment, the ankle bone is realigned, and special splints or a cast is placed around the joint for at least 2-3 weeks.
With surgical treatment, the fractured bone is accessed by making an incision over the ankle area and then specially designed plates are screwed onto the bone, to realign and stabilize the fractured parts. The incision is then sutured closed and the operated ankle is immobilized with a splint or cast.
After ankle surgery, you will be instructed to avoid putting weight on the ankle by using crutches while walking for at least six weeks.
Physical therapy of the ankle joint will be recommended by the doctor. After 2-3 months of therapy, the patient may be able to perform their normal daily activities.
Risks and complications that can occur with ankle fractures include improper casting or improper alignment of the bones, which can cause deformities and eventually arthritis. In some cases, pressure exerted on the nerves can cause nerve damage, resulting in severe pain.
Rarely, surgery may result in incomplete healing of the fracture, which would require another surgery to repair.