It can happen in a few seconds and lead to excruciating pain. One wrong step or slip, and just like that, there’s a fractured ankle. When the injury occurs, how is an ankle fracture treated?

Anthony Romano, D.P.M., a podiatric surgeon with South Florida Orthopaedics & Sports Medicine, says ankle fractures are some of the most frequent injuries he treats within his practice. 

“Ankle fractures can happen for a variety of reasons,” says Dr. Romano. “The fracture is usually caused by some type of slip and fall or another trauma to the ankle. We put a treatment plan in place based on what type of ankle fracture the patient has.”

The foot and ankle contain 26 bones; 33 joints; and more than 100 muscles, tendons, and ligaments (in fact, 25% of the bones in our bodies are in our feet). Treatment for a fractured ankle depends on how much damage is done to a bone and the tendons and ligaments around it.

What Is a Stable Ankle Fracture?

An ankle fracture can be stable or unstable. The stable ankle fracture is usually easier to treat, and it normally leads to faster recovery time. Dr. Romano says the South Florida Orthopaedics & Sports Medicine team usually uses a more conservative care approach with a stable fracture.  This allows the patient to get back on his or her feet fairly quickly.

Dr. Romano explains how the stable ankle fracture treatment works. “If we diagnose a patient with a stable ankle fracture, we get them into a hard cast or a walking cast right away. If the fracture is stable, the patient may be able to put weight on the foot on the same day they are injured, after we treat them.”

Doctors also refer to a cast boot as a walking cast, walking boot, air cast, or stabilizer. The orthopaedic boot gives support to the calf, ankle, or foot during recovery from a fracture. It limits the movement of the ankle while walking. The cast boot is lighter than a cast and usually easier to walk in. The patient’s doctor will recommend how many hours a day he or she should wear a walking cast, based on the injury and recovery plan.

What Is an Unstable Ankle Fracture?

An unstable ankle fracture can involve bones and joints being out of place, and the causing injury can involve damage to stabilizing ligaments that support the ankle.

The ankle includes three bones:

  • the tibia forms the front, back and inside of the ankle area
  • the fibula forms the ankle’s outside area
  • the talus is located between the tibia and fibula and the heel bone

Dr. Romano points out an unstable ankle fracture usually leads to surgery to put the ankle joint back into place and to stabilize the bones to heal correctly.

“If the patient has an unstable fracture, we will get that patient into the operating room as quickly as possible,” says Dr. Romano. “We make sure the bones and the joint are back in their proper anatomical position. Then we set up a physical rehabilitation plan that best meets the patient’s needs so they can make a full recovery.”

A surgeon might insert metal plates, screws, or both into the ankle during surgery for a severe unstable fracture to hold the bones in place. Rehabilitation normally follows the surgery to eventually get the person back to his or her normal daily routines and favorite exercises and sports.

What Does Ankle Fracture Rehabilitation Involve?

Ankle FracturesDr. Romano says it’s important for people to know that surgery for an unstable fractured ankle can require a patient to stay off their feet for a few weeks, which can help reduce the time the patient will need to spend in a rehabilitation plan. He says surgery, combined with a physical therapy plan, usually helps the patient have more success with the ankle joint after the recovery process.

Physical therapy after ankle surgery can begin three to 12 weeks after the procedure, based on the severity of the injury and the podiatric surgeon’s treatment plan. The therapist will work with the patient, trying to achieve a full range of motion in the ankle and foot, to strengthen ankle muscles, and to help him or her walk normally again.

What Is the Long-Term Prognosis for Ankle Fracture Patients?

Dr. Romano explains patients with severe ankle fractures sometimes return to their doctor several years later for additional treatment. The surgeon says, over time, many patients can develop arthritic changes within the ankle joint.

At that point, he will review options with the patient and put a new treatment plan in place.  Dr. Romano says he might choose to use cortisone injections into the ankle to reduce inflammation. The shots normally combine a corticosteroid with an anesthetic.

Fortunately for patients, there is a full range of treatment options to treat ankle fractures over time. These treatments depend on the severity of the ankle fracture and how successful a patient is during the initial recovery process.