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Ankle Fractures Specialist
Dr Poh Seng Yew
MBBS
MRCSEd
MMED (Ortho)
FRCSEd
What are Ankle Fractures?
An ankle fracture is a condition where one or more bones constituting the ankle joint are broken. This means that there is damage in any of the three bones comprising the ankle, which includes the tibia (shinbone), the fibula (smaller bone in the lower leg), and the talus (the bone that connects the foot to the lower leg, situated above the heel bone).
Ankle fractures range from simple, non-impeding breaks to complex fractures causing dislocation and instability.
Types of Ankle Fractures
Ankle fractures can be classified based on which bones and parts of the ankle are affected.
Lateral Malleolus Fracture
This type of fracture occurs in the fibula, typically on the outer side. It is one of the most common types of ankle fractures.
Medial Malleolar Fracture
This fracture affects the tibia, particularly on the inner side of the ankle. It involves a break in the medial malleolus, the small prominent bone on the inner side of the ankle.
Posterior Malleolus Fracture
This fracture occurs in the back portion of the tibia at the level of the ankle joint. It often accompanies other types of ankle fractures due to the ligament attachments in this area.
Bimalleolar Fracture
This involves fractures in two of the three parts of the ankle, typically the lateral and medial malleoli. Due to the involvement of multiple bones, these fractures often result in instability of the ankle joint.
Trimalleolar Fracture
In this type, all three parts of the ankle are broken, including the lateral malleolus, medial malleolus, and posterior malleolus. Trimalleolar fractures are complex and typically require more extensive treatment due to the serious instability they cause in the ankle joint.
Causes of Ankle Fractures
Ankle fractures result from various incidents that put undue stress or impact on the ankle joint. Common causes include:
- Twisting or Rotating the Ankle
This often occurs during activities like walking, running, or sports, where the foot lands awkwardly and causes the ankle to twist. - Rolling the Ankle
This can happen when walking on uneven surfaces or during certain activities, leading to an inward or outward rolling of the ankle. - Traumatic Impact during Accidents
The forceful impact of a car accident can exert stress on the ankles, resulting in fractures. Specific incidents like falls from ladders or slipping on ice are also common causes of ankle fractures. - Tripping or Falling
Falls, especially from a height or on uneven ground, can directly impact the ankle and cause a fracture.
Symptoms and Signs
Common indicators of ankle fractures include:
- Immediate and Severe Pain: The pain is typically sharp and intense, occurring immediately after the injury.
- Swelling: Swelling around the ankle joint is common and can spread to the surrounding areas.
- Bruising: Discoloration and bruising often appear around the injured area.
- Tenderness to Touch: The ankle becomes sensitive and tender when touched or pressed.
- Inability to Put Weight on the Injured Foot: There is often difficulty or inability to bear weight on the affected foot.
- Deformity: In more severe cases, especially with dislocation, the ankle may appear deformed or out of place.
- Numbness or Coolness in the Foot: In some cases, there may be numbness or a cool sensation in the foot, indicating nerve or blood vessel involvement.
Diagnosis
The diagnosis of an ankle fracture often involves a review of medical history, physical examination, and imaging tests.
- Medical History and Symptom Review: The ankle specialist will inquire about your medical history, the nature of your symptoms, and how the injury occurred.
- Physical Examination: A thorough examination of the ankle, foot, and lower leg is conducted to assess swelling, tenderness, and the overall condition of the joint.
- X-rays: X-rays are the primary imaging test used to confirm an ankle fracture. They provide clear images of bone structure, revealing the location and nature of the fracture. In some cases, especially to evaluate the syndesmosis joint, a stress X-ray might be performed while pressure is applied to the ankle.
- CT or MRI Scan: For more detailed cross-sectional images of the ankle, particularly to assess the extent of the injury, a CT scan may be conducted. MRI scans may also be used to detect ligament injuries that might accompany an ankle fracture.
Non-Surgical Treatment Options
Non-surgical treatments can be considered for certain types of ankle fractures, especially if the fracture is small and the ankle remains stable.
Immobilisation |
The ankle specialist may suggest using a cast, walking boot, or brace to keep the ankle stable and to ensure proper alignment during the healing process. |
Crutches |
Crutches are often recommended to avoid putting weight on the injured ankle. |
Anti-inflammatory Medications |
These are prescribed to reduce inflammation and alleviate pain. |
Physical Therapy |
Physical therapy can help regain mobility in the ankle joint and strengthen the muscles necessary for walking and other activities. |
Surgical Treatment Options
Surgical intervention is often necessary for more severe ankle fractures, particularly when the fracture is displaced, involves multiple bones or the ankle is unstable. They aim to reposition and stabilise the bones for optimal healing.
Open Reduction and Internal Fixation (ORIF)
This procedure involves repositioning the bone fragments into their normal alignment and securing them with metal plates and screws.
Screws or Pins
In certain fractures, like medial malleolus or lateral malleolus fractures, the repair might involve placing screws or pins to hold the bone fragments together.
Plates
In cases where the fracture is extensive or involves larger sections of bone, metal plates along with screws might be used to provide stability.
Prevention Strategies
Effective prevention strategies can help reduce the risk of ankle fractures.
- Adjusting the Home to Prevent Falls - Adjusting the home environment can help prevent falls, particularly for older individuals. This includes looking out for hazards such as loose rugs, poor lighting, and unsafe staircases, or installing support handles in bathrooms and ensuring sturdy bannisters.
- Wearing Appropriate Footwear to Support the Ankles - Wearing shoes with good support, broad heels, and non-slip soles can improve stability and reduce the risk of slipping.
- Osteoporosis Management - Those with osteoporosis should engage in regular discussions about treatment plans to improve bone health and reduce the risk of fractures.
- Weight-Bearing Exercise - Engaging in activities like walking or resistance training can strengthen bones and muscles, enhancing balance and reducing the likelihood of falls.
Dr Poh Seng Yew
MBBS
MRCSEd
MMED (Ortho)
FRCSEd
With over 18 years of experience, Dr Poh Seng Yew is an orthopaedic surgeon specialising in hip, knee, shoulder and elbow surgery, sports medicine, and trauma surgery.
- Former Director of Sports Service, Department of Orthopaedic Surgery, Singapore General Hospital
- Clinical Hip and Sports Medicine Fellow, Orthopädische Chirurgie München (OCM), Germany
- Fellow, Royal College of Surgeons of Edinburgh, FRCSEd (Orthopaedic Surgery)
- Master of Medicine (Orthopaedic Surgery), National University of Singapore
- Member, Royal College of Surgeons of Edinburgh (MRCSEd)
- Bachelor of Medicine, Bachelor of Surgery (MBBS), National University of Singapore
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Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road, #08-62/63
Singapore 329563
Weekdays: 9.00am – 5.00pm
Saturdays: 9.00am – 1.00pm
Sundays and Public Holidays: Closed
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Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road, #08-62/63
Singapore 329563
Frequently Asked Questions (FAQ)
Can I Bear Weight on My Ankle After a Fracture?
The ability to bear weight on your ankle after a fracture depends on factors such as the type of fracture, its stability, and the treatment prescribed. In cases of stable or minor fractures, limited weight-bearing might be initially recommended. Immobilisation with a cast or brace is often necessary to protect the fracture. As healing progresses, weight-bearing activities can be gradually introduced under medical guidance.
Will My Ankle Stay Stiff After Healing from an Ankle Fracture?
Stiffness is common after healing from an ankle fracture, particularly if immobilisation was part of the treatment. Physical therapy plays a role in addressing stiffness and improving joint mobility. Exercises and stretches guided by an ankle specialist help restore ankle function and reduce long-term discomfort.
How Long Does a Fractured Ankle Take to Heal?
The healing time for ankle fractures varies depending on the injury’s extent. While many ankle fractures heal within approximately 6 weeks, the time frame may extend for more severe cases.
How Should You Sleep With a Fractured Ankle?
Sleeping with a fractured ankle often requires keeping the ankle elevated to reduce swelling. Using pillows to prop up your leg can be helpful. Follow your ankle specialist’s instructions on immobilisation and movement during the night to ensure proper healing.
What Happens if an Ankle Fracture is Left Untreated?
Leaving an ankle fracture untreated can lead to complications such as improper bone healing (malunion), non-healing (nonunion), and increased risk of arthritis. Seek medical help for an accurate diagnosis and appropriate treatment plan to avoid these complications and ensure optimal recovery.