Ankle Fracture (Broken Ankle)

Ankle fracture: diagnosis and treatment

An ankle fracture is a break in one or more bones around the ankle joint. It may occur through a twisting injury, fall or higher-energy accident. The key treatment questions are not just which bone is broken, but whether the joint is aligned and stable and whether the skin, nerves or circulation are threatened.

Common fracture patterns

Lateral malleolus: fracture of the lower fibula on the outside of the ankle.
Medial malleolus: fracture of the inner lower tibia.
Bimalleolar or trimalleolar: injury involving two or three malleolar components, often with instability.
Posterior malleolus: fracture affecting the back of the tibial joint surface; its size and shape may affect treatment.
Syndesmotic injury: disruption of the structures holding the tibia and fibula together, with or without a fracture.
Pilon fractures affect the weight-bearing lower tibial joint surface and are usually higher-energy, more complex injuries with a different treatment approach.

Symptoms and urgent warning signs

Fractures can cause immediate pain, swelling, bruising, tenderness, inability to bear weight or visible deformity. Some people can still walk on a broken ankle; ability to walk does not exclude fracture. A deformed ankle, open wound, numb or cold foot, severe increasing pain or compromised circulation needs emergency assessment – go to an emergency department or call 111.

Examination and imaging

The initial assessment checks the skin, circulation, sensation, other injuries and alignment. Ankle X-rays identify most fractures. In selected cases, weight-bearing or stress X-rays clarify stability once it is safe to obtain them. CT is useful for complex joint fractures, especially selected posterior malleolar or pilon patterns. MRI is not routinely required to diagnose an obvious fracture.

Treatment without surgery

Fractures confirmed to be stable and acceptably aligned can often be managed in a boot, splint or cast. Depending on the pattern, weight-bearing as tolerated may be appropriate quite early. If stability is uncertain, further clinical review and weight-bearing X-rays, usually within about two weeks, may be needed. Treatment is individualised; do not assume that all ankle fractures require six weeks without weight-bearing. People with diabetes or reduced feeling in the feet (neuropathy) need particular care, as healing can be slower and longer protection is usually needed.

When is an operation needed?

Surgery is generally considered for an unstable ankle mortise, significant displacement, unacceptable joint incongruity, a fracture-dislocation, an open injury or certain complex fracture patterns. The operation is often called open reduction and internal fixation (ORIF): the bones are put back into alignment and held with plates, screws or other implants. If the syndesmosis remains unstable after the fracture is reduced, it may need stabilisation with screw or suture-button fixation. Not every fracture requires syndesmotic fixation.

Timing and associated injuries

Urgent reduction may be necessary for a dislocated ankle. Fixation is ideally done early, before major swelling develops; if the skin is very swollen or blistered, surgery may be delayed until it is safe. Timing also depends on overall health and fracture complexity. Ankle cartilage injuries can accompany fractures and may contribute to later symptoms. Surgery aims to restore joint congruity and stability but cannot guarantee prevention of post-traumatic arthritis.

Healing and rehabilitation

Most ankle fractures take around 6 weeks to heal enough for the cast or boot to come off, but recovery of strength, balance, mobility and comfort takes longer. Many patients experience swelling for months. Some surgically fixed fractures permit earlier protected weight-bearing than older protocols, although this is inappropriate for certain injuries. Your own fracture pattern and Mr Senthi’s instructions determine when to walk, work, drive or return to sport. As a general guide, most people drive again 6–12 weeks after ankle fracture surgery, and full recovery commonly takes 6–12 months. Contact the rooms promptly if you develop a fever, increasing wound redness or discharge, severe worsening pain or calf swelling after surgery; call 111 for chest pain or breathlessness.

Potential complications

Complications include infection, wound problems, stiffness, numbness or nerve irritation, blood clots, delayed or failed union, malalignment, symptomatic implants, persistent instability and post-traumatic arthritis. Plates and screws do not automatically need removal once the fracture heals.

Common questions

Does every broken ankle need surgery?
No. A stable, well-aligned fracture often heals without an operation.

Can I walk on a broken ankle?
Some stable fractures allow weight-bearing, but an unstable fracture can worsen if loaded before assessment.

Will my metalwork need removing?
Usually not unless there is a specific indication, such as problematic prominence or a complication. Mr Senthi usually removes screws used to hold the syndesmosis once it has healed, although practice varies between surgeons. He will discuss the timing with you.

Can arthritis develop years later?
Yes, especially after injuries involving cartilage damage, malalignment or instability.

Seeking specialist advice

Emergency red flags should be managed urgently. Routine specialist review helps determine fracture stability, the need for surgery and appropriate rehabilitation. Because a fracture is an injury, it is usually covered by ACC once your claim is accepted; see the ACC questions on our Your appointment page.

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