Ankle fractures occur when one or more bones in the ankle joint break due to twisting, falling, or high-impact injuries. Some fractures are minor and heal with rest, while others require surgery to realign the bones and restore function. This guide explains the different types of ankle fractures, the symptoms to look for, and how they are treated.
Common Types of Ankle Fractures
Lateral Malleolus Fracture
A break in the fibula, the thinner bone on the outer side of the lower leg. This is the most common type of ankle fracture and often results from twisting the ankle or landing awkwardly.
Symptoms: Swelling, bruising, and tenderness along the outer side of the ankle. Some people may still be able to walk, but putting weight on the foot can be painful. Stiffness and reduced ankle movement may develop as swelling increases.
Treatment: If the bones remain in place, a cast or walking boot is used for several weeks to allow healing. If the bones have moved or the ankle is unstable, surgery with plates and screws may be required to realign and secure the bone. Physiotherapy may follow immobilisation to improve movement and strength.
Medial Malleolus Fracture
A break in the inner side of the tibia, the larger of the two lower leg bones. This type of fracture is less common on its own and often occurs alongside other ankle injuries.
Symptoms: Pain, swelling, and bruising on the inner ankle, sometimes with a feeling of instability. In more severe cases, the ankle may look misaligned, and walking may be difficult.
Treatment: Small, stable fractures may heal with a cast or boot to keep the bone in place while it fuses. If the bone has moved or the ankle is unstable, surgery may be needed to secure the bone with screws or plates. Weight-bearing is usually restricted during recovery, followed by gradual rehabilitation exercises to improve mobility and prevent stiffness.
Bimalleolar Fracture
A fracture involving both the inner (medial malleolus) and outer (lateral malleolus) ankle bones. This type of break is often caused by a high-energy injury, such as falling awkwardly, twisting the ankle forcefully, or direct trauma.
Symptoms: Pain, swelling, and difficulty putting weight on the foot. The ankle may look deformed, and bruising can develop quickly. In some cases, the ankle joint may shift out of position, making movement difficult.
Treatment: Most cases require surgery to realign and stabilise the bones using plates and screws. After surgery, the ankle is typically immobilised with a cast or boot, and weight-bearing is gradually reintroduced. Without proper treatment, this fracture can lead to long-term instability, joint stiffness, or arthritis.
Trimalleolar Fracture
A severe injury involving fractures in three parts of the ankle: the inner (medial malleolus), outer (lateral malleolus), and back of the tibia (posterior malleolus).
Symptoms: Severe pain, rapid swelling, bruising, and a noticeable deformity in the ankle. The joint may feel unstable, and attempting to put weight on the foot can cause sharp pain or difficulty maintaining balance.
Treatment: Surgery is typically required to stabilise the ankle joint, using plates and screws to hold the bones in place while they heal. Recovery may involve a period without weight-bearing, followed by gradual movement and strengthening exercises. If untreated, stiffness, instability, or arthritis may develop over time.
Pilon Fracture
A high-impact fracture of the lower tibia, often affecting the ankle joint surface. This injury is commonly seen in car accidents or falls from height.
Symptoms: Pain, swelling, and difficulty moving the ankle. Bruising may be extensive, and open wounds can occur if the bone breaks through the skin. Cartilage damage can lead to long-term stiffness or reduced movement.
Treatment: Due to the severity of swelling, initial treatment may involve stabilising the leg with an external fixator (a frame outside the leg) before surgery. Once swelling has decreased, surgery is performed to reconstruct the joint and restore alignment. Recovery may take longer than other fractures, often requiring physiotherapy to regain movement and strength in the ankle joint.
Maisonneuve Fracture
A less common type of ankle fracture that occurs when a strong twisting force causes a break in the fibula near the knee, along with ligament damage in the ankle.
Symptoms: Pain and swelling in both the ankle and upper shin. Weight-bearing may be painful or impossible. Some people may experience tenderness along the length of the fibula, which may not initially seem related to the ankle injury.
Treatment: Because the fracture occurs higher up in the leg, diagnosis may require imaging of both the ankle and the upper fibula. If the ankle ligaments are severely damaged, surgery is often required to stabilise the joint and restore function. Recovery typically involves a period of non-weight-bearing, followed by a gradual return to activity with rehabilitation exercises.
When to Seek Medical Attention
Medical attention is recommended for severe pain, swelling, or difficulty walking after an ankle injury. Signs of a fracture include an inability to put weight on the foot, rapid bruising, or a visible deformity. If you heard a cracking or popping sound during the injury, or if numbness and tingling develop, an assessment can determine the extent of the damage. If symptoms do not improve with rest, an X-ray can confirm whether a fracture is present and guide treatment.
Conclusion
Ankle fractures vary in severity, ranging from minor breaks that heal with immobilisation to complex injuries requiring surgery. Treatment depends on the type of fracture, how much the bones have shifted, and whether the ankle remains stable. Seeking medical evaluation ensures the right treatment approach, helping to restore movement and prevent long-term joint problems.
If you have ankle pain or suspect a fracture, book a consultation today for an assessment, diagnosis, and treatment discussion.
