The tibia (inside anklebone), fibula (outside anklebone) and talus (the bone that the tibia and fibula overlap) bones all meet in your foot and are held together by the ligaments and tissue, including the lubricating, motion-facilitating joint capsule membrane and synovium, to form your ankle joint. Ankles injuries, which are very common, can occur in multiple locations and arise from overextension of the ankle joint beyond its boundaries and can take the form of sprains, in which ligaments tear away from the ankle bones, or fractures, where those bones break. Ligament damage can also arise during ankle injuries. The causes of ankle damage can vary but include hyperextension, rolling, twisting, or high-impact landing resulting from athletics, work or everyday activities or falls. Ankle injuries carry immediate symptoms, including foot pain (that is either localized to the injury or in the general area), significant swelling, and skin deformities or punctures. Bruising may also occur, and in some cases, your foot may become pale, numb and immobile if nerve or blood vessel damage has occurred.
Due to the difficulty of diagnosing an injury as an ankle sprain or ankle fracture, the severe pain, immobility and instability of many injured ankles, and the varying effectiveness of home care (including ice, elevation, painkillers) depending on the severity of the injury, it is generally recommended that those with such injuries seek professional medical assistance. Imaging tests such as x-rays, CT scans, and MRI scans are generally conducted to confirm the presence and severity of an ankle injury. Once a physical and imaging examination have confirmed the fracture, your provider will either cast and immobilize your leg during a multi-week time period for more minor breaks, or will recommend surgery if your injury is more significant. To determine the appropriate type of surgical procedure, your physician will assess where the break occurred (and thus where to make the incision) and whether the fracture was serious enough to require insertion of prosthetic plates and screws in order to encourage reattachment of loose bone particles.
Did You Know? As the baby boomer generation has begun to age and remained active, broken ankles have increased in severity and amount during the past several decades. Over five million ankle injuries occur annually in the U.S., and ankle fractures are one of the most common types of fractures, resulting most frequently in older women and young men.
With a lateral malleolus fracture, a patient has suffered a fibula fracture at a given level (which in turn affects the type of treatment proscribed). A procedure may be undertaken to repair an unstable or dislocated ankle resulting from a fracture, during which time any bone fragments are repositioned and adhered to the outer surface of the bone with screws, metal plates and, in some instances, a screw or rod fitted inside the bone. A medial malleolus fracture involves a tibia break potentially occurring at various levels, with surgery being recommended for unstable ankle, unaligned fractures or to ensure healing occurs. Surgery to repair such a fracture can also involve artificial plates and screws and may also require bone grafting if the fracture is indented or impacted with two bones driven into one another. A posterior malleolus fracture near the ankle joint at the back of the tibia often accompanies a lateral malleolus break given that both share ligament attachments. As with other breaks, an unstable or unaligned ankle, particularly a break with a fragment greater than a quarter of the ankle joint, will often require surgery that entails a prosthetic plate and screws near the ankle or shin areas. When two of the ankle’s malleoli or components are fractured, ligaments have been torn on the inside of the ankle, and the ankle is unstable (frequently from a fibular fracture) and/or dislocated, a bimalleolar break has occurred. Surgery is often pursued for these types of breaks, using the same types of artificial instruments outlined in the preceding sentences. Trimalleolar fractures involves breaks with all three of the ankle malleoli, also generally accompanied by ankle instability and dislocation and also entailing the use of prosthetics to repair the affected area. Another type of injury can be to the syndesmosis joint located near the tibia and fibula and affixed with ligaments that can be the only injured area or that often are damaged along with a fracture. The resulting instability often makes surgical treatment necessary for a full recovery.
While each type of injury carries its own specific recovery time frame, to encourage complete post-surgical recovery, patients should keep their ankle immobilized and avoid placing weight on it and allow six weeks for most fractures to fully heal, with ligament injuries or more serious breaks requiring additional time. While restoring total range of motion and participation in normal activities may take up to four months, undertaking regular exercise with your doctor’s approval may help increase your repaired ankle’s strength and functionality and your comfort and confidence. Short-term pain relief medications may also be prescribed, and your recovery progress will be monitored by your physician via x-rays and other imaging. Once the affected area is fully healed, for many patients, the most common lingering effect is arthritis potentially affecting the reconstructed joint.