An ankle fracture can seriously restrict your ability to perform functional tasks such as walking and running. The injury can result in loss of lower extremity strength, range of motion, and pain, making the performance of daily activities challenging or even impossible. Fortunately, physical therapy can help you recover and return to your previous degree of activity. Suarez Physical Therapy is transforming the way Las Vegas thinks about orthopedic and sports rehabilitation. Our proficient physical therapists can take time to treat your fractured ankle and develop a rehabilitation plan for sustainable results to achieve your goals and a new degree of performance.
An Overview of the Ankle Fracture
Ankle fracture is a common joint and bone injury. Typically, the level of pain, concern that you might have a broken bone, and the inability to walk might make you seek emergency medical attention.
A fractured ankle is an injury to your bone. You can break your ankle from a twisting injury stemming from a fall or misstep or direct trauma in a traffic accident.
The severity of the ankle fracture varies. Generally, fractures range from small cracks in the bone to breaks that pierce the skin. That means treatment depends on the seriousness of the injury and the precise site of injury.
The Anatomy of Your Ankle
Your ankle joint consists of three bones coming together, namely:
- Tibia — The prominent bone of your lower leg, making up the inside (medial) of your ankle joint
- Fibula — A smaller bone that parallels your tibia in your lower leg, making up the outside (lateral) of your ankle joint.
- The ends of the fibula and tibia are called malleoli. They form an arch that sits on top of your talus, a bone in your foot.
The above bones form the body elements of your ankle joint.
A fibrous membrane known as a joint capsule lined with synovium encases your joint. Your joint capsule contains the synovial fluid produced by the synovium. The synovial fluid facilitates the smooth movement of your joint surfaces.
Ligaments are fibers that hold your bone in place, stabilizing your ankle joint.
Causes of Ankle Fracture
Usually, a twisting injury causes an ankle fracture. It could also be due to a direct blow to your ankle.
Some of the causes of the ankle fracture include:
- Car collisions — The crushing injury typical in car crashes might result in breaks that need surgical repair.
- Missteps — Sometimes, putting the foot down wrongly might lead to twisting injuries.
- Falls — A trip and fall could break your ankle bones.
You might also be at a higher likelihood of suffering from a fractured ankle if you:
- Are a smoker — A smoker is at a greater risk of developing osteoporosis. Additionally, a study conducted by R.A.Patel, R.F. Wilson, etl. reveals that healing following a fracture might take longer in smokers.
- Suffering from specific health conditions — Having osteoporosis (decreased bone density) can increase the risk of ankle bone injuries.
- Sudden increase of the activity level — An ankle stress fracture can happen following an individual starting a new physical activity that involves a considerable impact on their foot, like running or hiking. Moreover, it can happen in an individual who increases their duration and frequency of exercise.
- Being in a space that is poorly lit or cluttered
- Using improper sports equipment or technique — Faulty equipment like shoes that do not fit properly can lead to falls and stress fractures. Inappropriate training techniques like not stretching or warming up could lead to an ankle injury.
- Participating in high-impact sports — The direct blows, stresses, and twisting injuries in sports could contribute to ankle fractures.
While complications of ankle fractures are not common, they can include:
- Ankle fracture extending into your joint can result in arthritis later in life. If the ankle begins hurting following a break, you should seek a medical evaluation immediately.
- If you have an open fracture (an end of your bone protrudes through your skin), the injury might expose the bone to bacteria that cause osteomyelitis (bone infection).
- Trauma to your ankle might injure your blood vessels and nerves and sometimes tear them. You should seek immediate medical care if you discover circulation challenges or numbness since lack of blood flow could cause your bones to die and collapse.
- Compartment syndrome is a rare condition with fractured ankles. It leads to swelling, pain, and sometimes incapacity in affected leg muscles.
Can Ankle Fracture be Prevented?
While you cannot prevent every ankle fracture, you can take some precautions. You can reduce the risk of the injury by:
- Putting on appropriate protective gear when engaging in sports
- Training to reach your top fitness and strength levels
- Wearing proper shoes and replacing your athletic shoes often.
- Removing all clusters and obstacles from rooms and hallways in your house
- Working and living in well-lit spaces
- Installing grab bars to shower/tub areas
- Adding railing to all sides of stairways
- Maintaining fitness and strength throughout your life
Different Types of Ankle Fracture
Since your ankle joint has three bones, there are various types of a broken ankle, namely:
- Lateral malleolus fracture — It is the most common form of a broken ankle. It involves the break of your lateral malleolus (the knobby bump on your ankle's outside).
- Bimalleolar ankle fracture — It is the second most popular form. It involves a break of your lateral malleolus and medial malleolus, the knobby bump on your ankle's inside.
- Trimalleolar ankle fracture involves breaks in the medial malleolus of your tibia, posterior malleolus, and lateral malleolus.
- Plafond fracture (pilon fracture) — Generally, this is a high-energy traumatic injury stemming from falling from a height. It's a fracture through a weight-bearing roof of your ankle.
The higher the number of injured lines, the greater the likelihood of enduring joint damage. Pilon fracture and trimalleolar ankle fracture have the most cartilage injuries hence a higher probability of suffering from arthritis later.
Symptoms of Ankle Fracture
Generally, the initial symptom of a broken ankle is severe and immediate pain. Other symptoms might manifest later.
The most common symptoms of an ankle fracture include:
- Severe pain at the fracture site
- Swelling along the leg or at the ankle
- Bruising along the leg or at the ankle
- Radiating pain
- Blisters at the fracture site
- Challenges putting weight on the foot/ankle or walking
- In serious cases, bones protruding through the skin
How Ankle Fracture is Diagnosed
Your physician will examine the ankle to look for a tender area. The exact location of the pain could help determine the root cause of the fracture.
The doctor might move the foot in various positions to check the range of motion. They might also ask you to walk for short distances so the expert can examine the gait.
Additionally, if your symptoms suggest a fracture, the medical professional might suggest either of the imaging tests below:
- X-rays — Many fractures are seen on an x-ray. Your technician might be required to conduct the imaging test from many angles, so your bone images do not overlap a lot. Typically, stress fractures do not show on x-rays until your break begins healing.
- Computerized tomography — A CT scan captures images from various angles and combines them to form cross-sectional images of your body's internal structures. It can disclose a lot of details about your injured bone and the soft tissues surrounding it. It helps the doctor determine your best treatment plan.
- Magnetic resonance imaging — MRI uses powerful magnetic fields and radio waves to produce comprehensive images of the ligament holding the ankle together. The diagnostic test shows bones and ligaments and could identify ankle fractures not seen on x-rays.
- Bone scan — A skilled technician injects a small amount of radioactive material into your vein. The radioactive material is attracted to the bones, particularly to the damaged areas. Damaged parts such as stress fractures show as bright spots on the resulting images. The imaging test can help your doctor diagnose fractures not visible on x-rays.
If the imaging test shows that you have a fractured ankle, you should seek immediate medical attention. Early diagnosis and proper intervention are essential to preserving your ankle joint for long.
Ankle Fracture Treatment: Physical Therapy
While at a healthcare facility after the injury, the physician might try to reduce your fracture. Fracture reduction means how the bone is set or fixed after it is broken.
The healthcare provider puts all pieces of your bone close to each other so that recovery can happen. Fracture reduction ensures that your bone recovers properly and that permanent deformity or functional loss is prevented.
Next, the doctor will place the ankle in a cast. It immobilizes your ankle, allowing your bones to recover appropriately. You will also require an assistive device to walk.
How Your Physical Therapist Can Help You Before the Surgical Procedure
If you consult with an experienced physical therapist following the injury and they suspect your ankle has broken, the expert will:
- Instruct you in acute injury care using the RICE (rest, ice, compression, and evaluation) formula
- Apply ice to reduce swelling and pain
- Immobilize the ankle by applying a stirrup brace to regulate swelling and restrict motion
- Require you to keep your involved ankle raised to regulate swelling
- Making recommendations for further care with an emergency department or orthopedic physician
- Require you to walk without placing any weight on your ankle using an assistive device such as a walker or crutches
If you have a broken fracture, your treatment depends on the number of the broken bones and whether it's a complex, compound, or simple fracture. The initial treatment encompasses your physician realigning and stabilizing your bones. It is executed in a healthcare emergency room or with a surgical procedure.
Following Surgical Procedure
If a surgical procedure is needed, your broken ankle will be put in a fracture boot or cast to stabilize it after surgery. Your physical therapist can visit you in the hospital and assist you in getting out and up from your bed. They can also aid you in standing up and sitting on your bed.
You won't be permitted to put weight on your ankle for approximately six to ten weeks. The PT will guide you on how to use assistive devices. On top of that, you will learn how to go down and up steps and curbs with the assistive device.
When your imaging test confirms that your ankle has recovered, the doctor will remove the cast. The PT will help you place weight on the ankle and start treatment to assist you in going back to your daily routine.
At Your Home
When a patient returns home from the hospital following a broken ankle, their physician might order PT at home. Typically, home care PT is tailored for individuals who cannot leave home due to their injury.
The physical therapist could assist you in learning using your assistive device in the home environment. Additionally, you can exercise to strengthen your muscles around the injured site and improve your overall endurance.
If you break the ankle, the healthcare provider might have weight-bearing limitations that you should comply with. The therapist can aid you in maintaining the restrictions and ensure that you don't put a lot of stress on your healing bone.
If a surgical procedure is needed, your seasoned therapist could assess the surgical scar to make sure your bone is healing correctly.
Moreover, the physical therapist could assess your house. They could make recommendations about making adjustments to permit you to move securely in the home.
In the Clinic
After you have healed enough to leave your home, the doctor might refer you to a PT clinic to restore your everyday functions. Generally, it happens after removing the cast, and you have started mobilizing the region around your fracture. You can also adhere to lifting restrictions or weight-bearing safety measures. However, you should first check with the doctor to ensure that you understand your limitations.
The initial visit with the physical therapist involves an assessment and evaluation. The therapist will take measurements of different body parts surrounding your broken ankle. It could be measurements of:
- Range of motion
- Swelling or girth
- Overall mobility and function
Following your initial evaluation, the physical therapist could develop the best treatment strategy. Physical therapy is designed to overcome the adverse impact of being immobilized by the cast. Immobilization might result in decreased functional mobility and loss of strength and motion.
Also, PT could improve functional mobility. The physical therapist could assist the patient in improving walking and deciding if they should use an assistive device.
Physical modalities or agents could be used to aid with swelling and pain. Electrical stimulation can be used to improve your muscle recruitment. While your physical therapist could use passive treatments such as ultrasound or electrical stimulation, you should also participate in PT activities.
If you underwent a surgical procedure to reduce the broken ankle, you might have surgical scar tissue. Your trained physical therapist could use mobilization and scar massage to improve mobility and lower scar adhesions around your scar.
You can also start exercises to boost strength and range of motion. You should pay attention to the broken ankle and joints around your injury.
How Long Will Your Physical Therapy Last?
Generally, physical therapy for a broken ankle lasts between six and eight weeks. The experience might be longer or shorter depending on your injury. Also, different people heal differently. Your therapist should discuss with you the prognosis with the ankle fracture rehab. The prognosis depends on how well the ankle is moving when you first begin rehabilitation.
Continuing with the home exercise program plays a significant role in the rehabilitation. Being consistent with it could assist you in recovering function and returning to your everyday activities as soon as possible.
Best Exercises Following Your Ankle Fracture
When you are recovering from a broken ankle, you cannot get back to the weekly tennis match immediately after your bone has healed. Instead, you should gradually return to your everyday activities but under your physical therapist's care.
The therapist will create a plan for the injury and your healing goals. They might also recommend elevating and icing the ankle following performing the prescribed exercise program.
Range of Motion
Your competent physical therapist will prescribe a range of motion exercises once you get out of the cast following your ankle fracture. The PT might passively move the ankle joint through different motions and have you actively move the ankle to improve motion around the joint.
A simple exercise to engage in might include:
- Moving the ankle by pointing the toes up and down
- Moving the foot in and out
You might feel pain. If you feel lasting, intense pain, stop your exercise and consult with the physical therapist.
Balance and Proprioception Exercises
Following the fracture, you might realize that the balance is off. The therapist might recommend a single-leg standing exercise to improve the balance. You can also attempt the T-stance exercise to boost confidence in the ankle's ability to assist you to remain upright.
After mastering the simple leg standing exercise, you can benefit from sophisticated balance exercises like using a BOSU and a wobble board to challenge the proprioception and balance.
If a patient engages in intensive sport, they might want to do plyometric exercises like hopping and jumping to prepare to return to the sport following the broken ankle.
Learning to jump appropriately ensures that the ankle can tolerate forces placed on it when cutting, hopping, and running during sports. A skilled physical therapist can develop a training strategy that includes plyometrics.
Find a Skilled Physical Therapist Near Me
A fractured ankle can bring life to a stop. It is because it can stop you from engaging in basic tasks like walking. After your fracture heals, you might think that you're good to go. Well, that isn't true. The ankle is not as robust and stable as before the fracture, and you might require physical therapy. Suarez Physical Therapy is a seasoned physical therapy clinic in Las Vegas that pays attention to individualized care to assist patients in achieving health goals. All sessions include manual treatment, patient education, therapeutic modification strategies, and patient education. We are dedicated to offering world-class services so you can return to your daily function and sports as soon as possible.
If you want to get your questions answered or book a session with us, contact us at 702-368-6778. We look forward to offering you the care you require.