Ankle Fracture

with Rehab

ExitCare ImageTwo bones in the ankle, the shinbone (tibia) and the bone of the outer ankle and lower leg (fibula), are susceptible to being fractured. The fracture may be a complete or an incomplete break of the bone. It is also common for the ligaments of the ankle joint to be injured at the same time as a fracture.

SYMPTOMS

  • Severe pain in the ankle at the time of injury and/or when trying to move the ankle.

  • Feeling of popping or tearing in the inner or outer part of the ankle, sometimes as if the ankle joint was temporarily dislocated and popped back into place.

  • Cracking or other sounds may be heard at the time of fracture.

  • Severe tenderness in the ankle.

  • Swelling in the ankle and foot

  • Blisters around the ankle (uncommon).

  • Bleeding and bruising (contusion) in the ankle and foot.

  • Inability to stand or bear weight on the injured foot.

  • Visible deformity if the fracture is complete and the bone fragments separate enough to distort normal leg contours.

  • Numbness and coldness in the foot if the blood supply is impaired.

CAUSES

  • Bones break when subjected to a force that is greater than the their strength. Most fractures are due to direct trauma, such as being hit with an object or falling.

  • Fractured may also be caused by indirect stress, such as twisting, pivoting, or violent muscle contraction .

RISK INCREASES WITH:

  • Sports that require quick changes in direction (football, soccer, or skiing).

  • Sports that require jumping (basketball, volleyball, distance jumping, or high jumping).

  • Walking or running on uneven or rough surfaces.

  • Shoes with inadequate support to prevent the foot and ankle from rolling over when stress occurs.

  • Bony abnormalities (osteoporosis or bone tumors).

  • Metabolic disorders, hormone problems, and nutritional deficiencies and disorders.

  • Poor strength and flexibility

  • Previous ankle injury.

PREVENTION

  • Warm up and stretch properly before activity.

  • Maintain physical fitness:

  • Leg and ankle strength.

  • Flexibility and endurance.

  • Cardiovascular fitness.

  • Wear properly fitted protective equipment (high-top shoes or when appropriate and ankle bracing, taping, or splinting), especially for the first 12 months after an ankle injury.

PROGNOSIS

If treated properly, ankle fractures typically heal well.

RELATED COMPLICATIONS

  • Failure to heal (nonunion).

  • Healing in poor position (malunion).

  • Arrest of normal bone growth in children.

  • Proneness to repeated ankle injury.

  • Stiff ankle.

  • Unstable or arthritic ankle.

  • Infected skin blisters.

  • Prolonged healing time if activity is resumed too quickly.

Risks of surgery, including infection, bleeding, injury to nerves (numbness, weakness, paralysis), and need for further surgery.

TREATMENT

Treatment initially consists of ice and medication to help reduce pain and inflammation. The joint must be immobilized to allow for healing. If the fracture is where the bones are out of alignment (displaced), then surgery may be necessary to realign (reduce) them. Surgery usually involves placing pins and screws in the bones to hold them in place while the fracture heals. After surgery the joint is immobilized. Bone growth stimulators may be used to promote bone growth, but this is uncommon, Strengthening and stretching exercises are usually necessary after immobilization in order to regain strength and a full range of motion. These exercises may be completed at home or with a therapist. If pins and screws are placed in the bone, they are not usually removed unless they become a source of pain.

MEDICATION

  • If pain medication is necessary, then nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen, or other minor pain relievers, such as acetaminophen, are often recommended.

  • Do not take pain medication within 7 days before surgery.

  • Prescription pain relievers may be prescribed if deemed necessary by your caregiver. Use only as directed and only as much as you need.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 2 weeks despite treatment.

  • The following occur after immobilization or surgery:

  • Swelling above or below the fracture site.

  • Severe, persistent pain.

  • Blue or gray skin below the fracture site, especially under the nails, or numbness or loss of feeling below the fracture site. Report any of these signs immediately.

  • New, unexplained symptoms develop (drugs used in treatment may produce side effects).

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Ankle Fracture

These exercises may help you when beginning to rehabilitate your injury. Your symptoms may resolve with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

ExitCare Image RANGE OF MOTION - Dorsi/Plantar Flexion

  • While sitting with your right / left knee straight, draw the top of your foot upwards by flexing your ankle. Then reverse the motion, pointing your toes downward.

  • Hold each position for __________ seconds.

  • After completing your first set of exercises, repeat this exercise with your knee bent.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image RANGE OF MOTION- Ankle Plantar Flexion

  • Sit with your right / left leg crossed over your opposite knee.

  • Use your opposite hand to pull the top of your foot and toes toward you.

  • You should feel a gentle stretch on the top of your foot/ankle. Hold this position for __________ seconds.

Repeat __________ times. Complete __________ times per day.

ExitCare Image RANGE OF MOTION - Ankle Eversion

  • Sit with your right / left ankle crossed over your opposite knee.

  • Grip your foot with your opposite hand, placing your thumb on the top of your foot and your fingers across the bottom of your foot.

  • Gently push your foot downward with a slight rotation so your littlest toes rise slightly

  • You should feel a gentle stretch on the inside of your ankle. Hold the stretch for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image RANGE OF MOTION - Ankle Inversion

  • Sit with your right / left ankle crossed over your opposite knee.

  • Grip your foot with your opposite hand, placing your thumb on the bottom of your foot and your fingers across the top of your foot.

  • Gently pull your foot so the smallest toe comes toward you and your thumb pushes the inside of the ball of your foot away from you.

  • You should feel a gentle stretch on the outside of your ankle. Hold the stretch for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image RANGE OF MOTION - Ankle Alphabet

  • Imagine your right / left big toe is a pen.

  • Keeping your hip and knee still, write out the entire alphabet with your "pen." Make the letters as large as you can without increasing any discomfort.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image RANGE OF MOTION - Ankle Dorsiflexion, Active Assisted

  • Remove shoes and sit on a chair that is preferably not on a carpeted surface.

  • Place right / left foot under knee. Extend your opposite leg for support.

  • Keeping your heel down, slide your right / left foot back toward the chair until you feel a stretch at your ankle or calf. If you do not feel a stretch, slide your bottom forward to the edge of the chair, while still keeping your heel down.

  • Hold this stretch for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

ExitCare Image STRETCH - Gastrocsoleus

  • Sit with your right / left leg extended. Holding onto both ends of a belt or towel, loop it around the ball of your foot.

  • Keeping your right / left ankle and foot relaxed and your knee straight, pull your foot and ankle toward you using the belt/towel.

  • You should feel a gentle stretch behind your calf or knee. Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

STRENGTHENING EXERCISES - Ankle Fracture

These exercises may help you when beginning to rehabilitate your injury. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Progress the resistance and repetitions only as guided.

  • You may experience muscle soreness or fatigue, but the pain or discomfort you are trying to eliminate should never worsen during these exercises. If this pain does worsen, stop and make certain you are following the directions exactly. If the pain is still present after adjustments, discontinue the exercise until you can discuss the trouble with your clinician.

ExitCare Image STRENGTH - Dorsiflexors

  • Secure a rubber exercise band/tubing to a fixed object (table, pole) and loop the other end around your right / left foot.

  • Sit on the floor facing the fixed object. The band/tubing should be slightly tense when your foot is relaxed.

  • Slowly draw your foot back toward you using your ankle and toes.

  • Hold this position for __________ seconds. Slowly release the tension in the band and return your foot to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Plantar-flexors

  • Sit with your right / left leg extended. Holding onto both ends of a rubber exercise band/tubing, loop it around the ball of your foot. Keep a slight tension in the band.

  • Slowly push your toes away from you, pointing them downward.

  • Hold this position for __________ seconds. Return slowly, controlling the tension in the band/tubing.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Ankle Eversion

  • Secure one end of a rubber exercise band/tubing to a fixed object (table, pole). Loop the other end around your foot just before your toes.

  • Place your fists between your knees. This will focus your strengthening at your ankle.

  • Drawing the band/tubing across your opposite foot, slowly, pull your little toe out and up. Make sure the band/tubing is positioned to resist the entire motion.

  • Hold this position for __________ seconds.

  • Have your muscles resist the band/tubing as it slowly pulls your foot back to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Ankle Inversion

  • Secure one end of a rubber exercise band/tubing to a fixed object (table, pole). Loop the other end around your foot just before your toes.

  • Place your fists between your knees. This will focus your strengthening at your ankle.

  • Slowly, pull your big toe up and in, making sure the band/tubing is positioned to resist the entire motion.

  • Hold this position for __________ seconds.

  • Have your muscles resist the band/tubing as it slowly pulls your foot back to the starting position.

Repeat __________ times. Complete this exercises __________ times per day.

ExitCare Image STRENGTH - Towel Curls

  • Sit in a chair positioned on a non-carpeted surface.

  • Place your foot on a towel, keeping your heel on the floor.

  • Pull the towel toward your heel by only curling your toes. Keep your heel on the floor.

  • If instructed by your physician, physical therapist or athletic trainer, add weight at the end of the towel.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Plantar-flexors, Standing

  • Stand with your feet shoulder width apart. Steady yourself with a wall or table using as little support as needed.

  • Keeping your weight evenly spread over the width of your feet, rise up on your toes.*

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

*If this is too easy, shift your weight toward your right / left leg until you feel challenged. Ultimately, you may be asked to do this exercise with your right / left foot only.