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.
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.
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.
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.
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?
Is there anything else I can do?
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:
- 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.
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.