Ankle Fracture (Broken Ankle)

This page has been designed to provide you with the right information about ankle fractures and how to manage them from a physiotherapy point of view.

What is an ankle fracture?

Firstly, a fracture is the same as a break. The word 'fracture' is a medical term and a 'break' is more of a common term to describe an injury to a bone that has caused it to break. For the remainder of this information page, we will use the term 'fracture'.

There are many different types of fractures; they all essentially mean the same thing i.e. that one or more of the bones around your ankle joint have been broken.

Is it easy to fracture your ankle?

It really isn’t easy to break a bone in your body. Your bones are incredibly strong and can take an awful lot of knocks, bumps and injuries and will generally not complain. You are more likely to find that you may upset the soft tissues (ligaments, muscles and tendons) following an injury than your bones.

How would you fracture an ankle?

The most common way to fracture an ankle is by ‘turning or rolling’ your ankle. This normally happens whilst walking or running, as your foot goes underneath yourself and your body weight pushes down on the ankle/foot, causing the injury.

Remember, it is very difficult to break a bone, therefore most of the time, an injury to your ankle would result in a sprained ankle (ligament injury) rather than a fracture.

What if I think I’ve actually broken my ankle?

If your ankle is significantly swollen, very painful and you simply cannot take any meaningful weight through your foot since the injury, you may want to seek help via A&E.

If I go to hospital, what will they do?

Often, a diagnosis can be made by asking some specific questions and through a physical examination (if available). However, if the hospital suspects you may have fractured your ankle, they will arrange an X-ray to check your bones.

Hospital building with the work 'Hospital' written on the side

What if they find that I’ve broken my ankle?

If you have been to the hospital and an X-ray has revealed that you have fractured your ankle, you will usually be asked to see a specialist orthopaedic (bone and joint specialist) doctor do discuss your options.

Normally, the two options are non-surgical or surgical management.

This means that your ankle is likely to be placed in a plaster cast or a large plastic boot for support for several weeks, to allow your ankle to heal.

This means that an operation is needed to help your ankle heal. It will normally involve inserting metal screws and/or plates into the bone to hold the fractured pieces together whilst your body heals. It is likely that you will be placed in a plaster cast or large plastic boot afterwards for several weeks to help with the healing.

Can ankle fractures be managed without surgery?

Yes. However, the orthopaedic doctor and their team will decide with you what the best option might be. Certain types of fractures can be managed more easily without surgery and some types of fractures do better with the help that surgery offers.

I’ve had surgery/not had surgery but have a boot/plaster on. What do I do next?

Normally, once you have been discharged from hospital (whether you’ve had surgery or not), you should have been given some advice on what you should be doing. Most often, this will involve how much weight you are allowed/not allowed to take through your injured foot.

If you are unsure how much weight you can put through your injured foot, you should ask the hospital as soon as you are able to.

It is likely that you would have been given something to help you walk whilst you recover, such as a pair of elbow crutches. If you need help on how to use your crutches or walking aid, please see our dedicated page here: Walking Aids

Is there anything I can do for exercise whilst wearing the cast or boot?

Obviously, if your foot is in a plaster/boot, you will have to wait until it is removed before you can exercise your ankle. However, you can exercise your knee, hip and the other leg as much as you like. We have provided a list of exercises that might be suitable to try whilst in your plaster/boot at the bottom of the page.

By keeping the movement and strength going in the rest of your leg, you may find that once your plaster/boot is removed, your progress may be a little quicker.

Is there anything I shouldn’t be doing?

Whilst in your plaster or boot, you should stick with the advice from the hospital regarding how much weight you can take through your foot.

It is likely to be frustrating and you may feel that you can do more than you’ve been allowed or want to progress faster, but normally, a boot or plaster will only stay on for a matter of weeks and it's important to help your ankle heal properly.

What can I expect when the boot comes off?

For most people, the plaster/boot is likely to be kept on for between 4-6 weeks.

You will normally be seen or spoken to by the hospital before removing the cast. Sometimes, you will have another X-ray to check the progress of your ankle, but this is not always the case.

If you have had your cast off, it is important for you to know what is normal as we understand it can sometimes be a worrying time.

First and foremost, ankle fractures can be quite sore. As you might expect, the discomfort you get from an ankle fracture can be different from person to person. Sometimes they can be very sore and sometimes they may only hurt a little. It is very normal for your ankle to be sore after a fracture and it is just as normal for that soreness to still be there for some time afterwards (weeks possibly into months).

After an ankle fracture, it is very likely your ankle will swell. This is your body’s way of starting the healing process. The swelling helps to ‘stiffen’ your ankle temporarily and helps keep all of the ‘healing cells’ where they need to be to help your ankle recover. You might find the swelling lasts for a long time and may even still be there when the pain has settled and you are feeling better, this however this doesn’t necessarily mean anything is wrong.

Whilst your ankle is sore and swollen, you can expect to find that moving your ankle will be difficult. Again, this is normal and will actually help the early stages of your healing. Once you are ready, it is important to get your ankle moving as soon as you feel that you can, as this will make sure your recovery is started nice and early.

For all the reasons listed in the other sections, walking is likely to be very difficult immediately following an ankle fracture.

Most people find that their skin is very dry after having a cast/boot on for some time. This is very normal and will improve with time, washing and using a moisturiser.

Sometimes, people may find that their skin, or their scar if they had an operation, can be a little sensitive once the cast/boot has been removed.

Your muscles are designed to work. If they have not been able to work normally because of the cast/boot, it is very common to find that your muscles (especially your calf or lower leg) will be smaller than before the injury.

What else can I expect after having the cast/boot off?

Often, but not always, after you have had your cast/boot off, you will be told by the hospital that you can now take more weight through your foot.

If you are unsure what you were told about this, please contact the hospital as it will be important for your rehabilitation, and is not always passed onto the physiotherapy team from the hospital.

Is my ankle healed now?

Fractures typically heal within about 6-8 weeks. There are things that might influence this, such as any pre-existing health conditions e.g. diabetes or if you smoke, but typically once you pass the 6-8 week timescale, you can consider your ankle healed.

Unfortunately, just because the fracture itself might be healed (a higher level of healing goes on for several months but you won’t be aware of this), does not mean that any pain will stop or the movement will come back by itself. This is where rehabilitation and physiotherapy can help.

Can I expect my ankle to go back to exactly how it was before I broke it?

This is a really good question. Once you have broken a bone, especially if it is close to a joint, you have effectively changed its anatomy. You may find that after a fracture, your ankle may not be able to go back to everything you did before. The good news is that if you work hard, are patient and kind to yourself and give it the right amount of time, you will make the best recovery that you can.

Ok, what can I start doing to help my ankle get better?

Any type of pain, no matter where it is, is unpleasant and can sometimes become a bit concerning. We have designed this page specifically to give you the right information about ankle fractures and hopefully some reassurance that even if your ankle is rather sore, it is an amazingly strong and robust piece of kit, and even if it's sore and hard work, you are doing the right things to help yourself get better.

Interestingly, after any type of injury, including ankle fractures, it is important to recognise that sometimes there can be an emotional part to the injury and your recovery. After an ankle fracture, you might not feel confident to use your foot or may feel that it will let you down or that you might injure it again. Accepting that you need to work on this as part of your rehabilitation, will help you get a better overall outcome.

Your foot is designed to be walked on, therefore it is important to try and get some weight going through it as soon as you can. It is likely to be sore, but you will not make it worse by using it. In fact, it will help your ankle start to get better more effectively. You may need to take more breaks or choose different shoes to help you succeed in taking weight through your foot comfortably in the first stages, but it is something that improves relatively quickly for most people.

One of the best things for most aches and pain is normal, confident movement. Your ankle will be sore, stiff and swollen after an ankle fracture and it might feel like the last thing you might want to do is to move it, but movement is the best medicine for your ankle. Us physios like to say, ‘motion is lotion!’. When you are ready, try moving your ankle as far as you are comfortable, as regularly as you can. You will not injure your ankle or upset the healing process by moving it.

We have a selection of exercises to help you get moving at the bottom of this page.

Once you have started to take weight on your foot and are starting to feel the movement coming back, you might want to add some other exercises into your rehabilitation to help you make the best recovery.

Working on the strength and balance of your ankle is normally useful in helping you get a good outcome after an ankle fracture. We have a selection of exercises at the bottom of this page to provide you with some ideas.

Is there anything else I can do?

As mentioned previously, ankle fractures can be sore. Some people will choose to manage this pain with pain relief, whereas others may choose to avoid medication. If you need pain relief and either don’t have any or what you have isn’t working, please speak with your GP or pharmacist. Applying something cold to your ankle may also be useful in helping with some of the pain (do remember to wrap your frozen peas in a towel before applying them to your skin to avoid cold burns).

Getting your ankle moving is key to getting a good result after an ankle fracture and helping to reduce any swelling. Some people may find resting their foot on a stool or chair useful to help with the swelling. It is worth remembering that swelling will often ‘hang around’ for some time (possibly into weeks or months), but this doesn’t necessarily mean anything is wrong. If your ankle is hot, red and swollen, you should seek help from your GP or hospital consultant.

As mentioned previously, getting your ankle moving as soon as you can is important to getting a good outcome after your ankle fracture. It is likely to be sore and difficult to move your ankle to begin with, but you will not injure your ankle again by moving it. Anything is better than nothing when it comes to movement.

Just like getting your ankle moving early, getting some weight going through your ankle as soon as you can is also important for a good recovery. It is very likely to be sore and difficult to walk to begin with, but it is some of the best medicine for your ankle.

It sometimes takes a bit of time to remember how to walk normally and to trust your ankle again.

If you need to, try these simple tips to help you get walking again:

Don’t overthink it (thinking too much about what you’re ‘meant to do’ will often make you walk stiffly and slightly robotic!).
Try to take the same length steps with each foot (make sure you step past with each foot).
Think ‘heel toe’ (as you step, make sure your heel hits the floor first and your toe comes off last).

Fracturing your ankle can be traumatic and for some people, really quite upsetting. You may feel that your confidence has been reduced and you might even find yourself scared to use it. These are entirely normal reactions to an injury.

Any progress you make will likely take time and the ‘road to recovery’ is often bumpy (meaning it will take effort, energy and perseverance). Adjusting things that you find sore, asking for help if you can, being realistic about the difficulties you are having and what you expect from yourself can all be helpful in making your rehabilitation easier.

Is there anything I should look out for?

After a fracture or a period of time where your foot/ankle hasn’t been able to move (in a cast or boot), it is important to look out for the following symptoms:

man in a checked shirt and backpack with binoculars looking out over a countryside scene.

Significant pain in the back of your calf or groin
Redness in the calf (possibly to the foot)
Poor healing of your wound (only applicable if you have had an operation) – wet, oozing wound, especially if accompanied by a fever or feeling generally unwell
Gross levels of pain that is not easily controlled with pain relief
Significant swelling of your calf or entire leg (especially if pressing it leaves a finger mark)
Any of the above, especially if you have had a history of Deep Vein Thrombosis (DVT).

If you have any concerns about any of the symptoms listed above, you should speak with your GP, 111 or seek help from A&E.

What exercises should I be doing to start with?

In the earliest stages of your recovery, i.e. within the first two weeks, it is recommended that you simply try to gently move the ankle as well as you can, and as far as is comfortable. We have provided a selection of suitable exercises below.

Can I do any other type of exercise to help my ankle?

Yes, although you may find certain types of exercises easier than others after an ankle fracture. Often, people find that exercises like swimming or cycling easiest to start with.

Frequently asked questions

Q: My ankle feels tight and a bit strange. Is that normal?

A: It is not unusual to find that your ankle feels strange after a fracture. It is normal to feel tight, stiff, or even a bit loose, but these things often ease with time and some gentle exercises.

Q: My ankle is still swollen after all this time. Is this normal?

A: Swelling can sometimes be the last thing to ease after injuries. It can sometimes hang around for weeks into months after the injury, however, if you are feeling better, moving better and doing more, it is not something you should be worried about.

Q: When can I drive again?

A: It is generally advised that you can return to driving six weeks after a left ankle fracture or allow eight weeks after a right ankle fracture, due to the power required to brake. However, it is each individual’s responsibility to ensure they are fit to drive. You should ensure you can confidently and without any hesitation perform an emergency stop, before even considering driving on public roads.

It is always recommended to contact your insurance company one month before you return to driving to ensure your insurance is valid. This advice is the same if you drive an automatic car.

Q: When can I get back to sport?

A: This will be dictated by your ankle and your sport. Most people will find their ankle feels better after a few weeks/months. By working on the movement, strength and balance exercises, as well as being patient, you may find that going back to most sports within about 3 months will be successful (this can be variable).

Q: I’ve finished with my crutches, what should I do with them?

A: If you have been loaned the crutches from the James Paget University Hospital, you should call the following numbers to arrange for collection:

For patients in Suffolk please call 01502 470360

For patients in Norfolk please call 0300 1000716

If you have been loaned the crutches from East Coast Community Healthcare, you can return these to the physiotherapy clinic. To find out which clinics can accept returns, please call 01493 809977.

Exercises

Exercises whilst in the cast/boot:

Movement Exercises

You should try to complete these little and often throughout the day. Try to move your ankle as far as is comfortable.

Strengthening Exercises

You should aim to complete the exercises (as many or as few as you want to), about 3 to 4 times a week.

Each exercise should be completed between 8-12 times (or repetitions) for 3 to 4 sets. Make sure you have about 1 minute's rest in between each set.

For the strengthening exercises, remember, in order to change your muscles, you need to challenge them. In other words, you should really feel the effort with each set of exercises and should not really be able to do more than 12 each time around.

Balance Exercises

You should try to complete these little and often throughout the day, or dedicate a few minutes in a day where you try to practice as much as you can.

Download our blank gym programme here.

Need more help? Refer yourself here.