Ankle Fracture: General Facts

An ankle fracture can range from a mild twisting injury to a severe injury caused by car crashes or high falls, called “high energy trauma”.. Ankle fractures from sports such as basketball, soccer, or football, are considered “low energy trauma”. More severe injuries often damage the cartilage inside the joint and may lead to worse long-term outcomes. For successful recovery, it is important that the bones are aligned and there is minimal damage to the joint cartilage.

The Role of Arthroscopy in Treating Ankle Fracture

In a February 2019 issue of Inside AANA eNewsletter, the Arthroscopy Association of North America, published articles discussing the role of arthroscopy in ankle fracture treatment.

As a member of the Arthroscopy Association of North America, Dr. Carreira supports the use of arthroscopy in treating many ankle fractures. PDFs of such research in support of this are attached below.

Arthroscopy’s Role in Treating Ankle Fractures » (PDF)

Debate of Arthroscopy for Acute and Chronic Ankle Fractures – Pro » (PDF)

Because good results after ankle fractures depend partly on treating cartilage damage, arthroscopy can improve recovery outcomes in many cases.

Patient-Focused Study: Use of Narcotics in Treatment

In 2018, Dr. Carreira and his colleagues at Peachtree Orthopedics began studies related to ankle fracture recovery and treatment outcomes.

One study examined the use of narcotic pain medications after surgery and tested a new educational program about pain medication use. This is an important topic of research given the national abuse epidemic.

Another study by the Multicenter Arthroscopy Study of the Ankle and Foot (MASTAF), of which Dr. Carreira is a founding member, involved patients who underwent arthroscopy during ankle fracture surgery as part of a larger research project.

Patients may choose whether or not to participate in these research studies.

Dr. Carreira continues to help develop new treatments and research in foot and ankle surgery.

Video of an Ankle Fracture

The above video shows the fracture of an ankle caused by a skate boarding fall.

Treatment of an Ankle Fracture

If the ankle bones do not heal in the correct position, the cartilage lining of the ankle can become damaged and may lead to arthritis.

The goal of broken ankle treatment is to place the bones back into their normal position and hold them there using plates and screws, preventing arthritis.

Surgery may involve incisions on one or both sides of the ankle depending on the severity of the injury. Arthroscopy can also be used to treat cartilage damage and remove loose pieces of cartilage during the same surgery. Arthroscopy typically adds just a few minutes to the procedure and does not prolong recovery.

Inpatient vs. Outpatient Surgical Treatment of Ankle Fractures

A study from Northwestern University’s Feinberg School of Medicine found possible medical benefits for outpatient ankle fracture surgery in some patients, meaning that the patients leave the hospital the same day of surgery as opposed to staying overnight.

Postoperative Recovery Following Ankle Fracture Surgery

• After surgery, patients wear a bulky splint until stitches or staples are removed about two weeks later.
• Patients with a left ankle injury may drive once they are off narcotic pain medicine. Patients with a right ankle injury may usually drive after 4 to 6 weeks.
• Patients are usually not allowed to put weight on the ankle for 4 to 6 weeks.
• At 4 weeks after surgery, exercises in a swimming pool or on a bike may begin. Activity levels slowly increase after 6 weeks.

Photos of Ankle Fracture

Before and After X-Rays Showing Ankle Fracture Repair

Talus (Ankle) Fracture Treated with Arthroscopic Assistance

The above photo shows a talus (ankle) fracture treated with arthroscopic assistance. Of note, the screw fixation is noted on the X-ray.

Ankle Fracture Physical Therapy Protocol

This protocol gives general recovery guidelines, but treatment may change depending on the patient’s age, injury, and activity level.

Please fax progress notes and evaluations to the office with Fax #: 855-270-3558.

Full recovery may take up to one year. Occasional pain and aches may continue during that time, and swelling could occur for several months.

FOR PATIENTS

• Recovery at a glance:
  • Compression stockings, ice, and elevation may help reduce swelling after surgery.
  • Physical therapy usually begins 2 to 3 weeks after surgery.
  • Patients with right ankle surgery may begin driving at 6 to 8 weeks. Patients with left ankle surgery may drive earlier once they stop taking narcotics. Test your ability to drive in a parking lot!
• Gentle running and higher-impact activities may begin around 12 weeks after surgery.
• Once you can come up and down on your toes (heel rise) on the surgical side or you can hop on the surgical foot, you can return to sports and all activities. This may take 6 months to 1 year.

FOR PHYSICAL THERAPISTS

Acronyms for Physical Therapy Guidance

1. DF and PF: Dorsiflexion and Plantar Flexion- the commonly understood movement of the ankle, up and down
2. PROM: Passion Range of Motion
3. DF Stretches: Dorsiflexion stretches
4. BAPS: Biomechanical Ankle Platform System- a balancing board used in physical therapy to improve balance, proprioception, and neuromuscular control in the ankle, knee, and hip.
5. FWB: Full weight-bear
6. A/AA/PROM: Active, Active assist, and passion range of motion
7. CKC Theraband: Closed kinetic chain Theraband- a way of strengthening

Detailed recovery and rehabilitation protocol:

Phase I: Weeks 1-3

Goals

• Patients should safely use crutches or walkers
• Incision care- keep clean and dry. Use a shower boot or wrap with saran warp while showering until the incision is closed. If there is concern about the wound, please take a picture and return to our office.
• Edema control/ swelling control
• Maximize ankle motion

Guidelines

• Maintain ankle motion with toe crunches; ankle alphabet; ankle pumps.
• Leg elevation.
• Safe use of crutches/knee-walker.
• Increase safe ADL (activities of daily living).
• Keep incision clean/dry.
• Sutures or staples removed at 14 – 21 days.

Phase II: Weeks 3-6

Goals

• Maintain ankle motion with toe crunches, ankle alphabet, and ankle pumps
• Leg elevation
• Use crutches/knee-walker
• Increase safe ADL (activities of daily living)
• Keep incision clean and dry
• Sutures or staples removed at 14-21 days

Guidelines

• Gait training level surfaces with proper tibia advancement, quads activation, symmetrical weight-bearing
• Stationary bike
• Grade 1-2 joint mobilizations ankle joints
• PROM into restricted ranges
• REtrograde massage for edema
• Continue DF stretches
• Theraband DF/PF in open chian
• Seated helel raises and BAPs
• Manual resistance in open chian for DF/PF motion
• Leg extension, curl, press, wall stretch with knee flexed and extended
• When FWB:
  • Standing BAPS 2 leg
  • Standing bilateral heel raise
  • Minisquat
  • One leg balance on the floor

Phase III: Week 6 +

Goals

• Wean from CAM boot and into regular shoe wear between 6-12 weeks

Guidelines

• Full ankle and subtalar A/AA/PROM, flexibility
• Restore gait on level surfaces, hills, stairs

Phase IV:  Week 8+

Guidelines

• CKC TheraBand exercises (stand on involved leg and perform hip flex/ext/abd/add with uninvolved LE)
• BAPS knees bent, eyes closed, on one leg.
• Continue Phase III exercises.
• Stairmaster.
• Agility exercises.
• Continue gait training.
• Continue modalities prn.
• Sport and Job – specific training.

Download Ankle Fracture Physical Therapy Protocol (PDF)