Broken Ankle

Overview

A broken ankle means one or more of the bones in your ankle joint has cracked or split. The ankle is the area where the lower leg meets the foot, and it includes the tibia (the larger shinbone), the fibula (the smaller bone beside it), and the talus (a bone in the foot). A break can be as slight as a thin crack or as serious as a wound that opens up to the surface of the skin.

Yes. A broken ankle is one of the most common injuries treated in urgent care and emergency settings.

Anyone can break an ankle, but it is especially common in active people who play high-impact sports, and in older adults whose bones may be weaker. Conditions that weaken bone strength, such as osteoporosis, can also raise the risk.

Symptoms

Common symptoms

• Pain in the ankle, usually worse when you try to stand or put weight on it
• Swelling and bruising around the joint, sometimes severe
• Tenderness when you touch the area
• Difficulty moving your foot and ankle normally
• A loud snap or crack at the moment of injury

Symptoms in children

• Children may not be able to say exactly what hurts. They might cry, refuse to walk, or limp if they try to walk.
• In children, the growth plates (the areas of developing bone near the joint) can be injured, so a doctor should always check a child's ankle after a fall or twist.

Symptoms in older adults

• Swelling and pain can be less obvious in older adults, but they may still have a break after a minor fall.
• If you are older and your ankle is swollen or painful after a stumble, it is important to have it checked, even if you can put some weight on it.

Causes

Main causes

• Twisting your ankle, such as when you step awkwardly off a curb or land from a jump
• Falling directly onto your ankle or landing hard on your foot
• A sudden, forceful blow to the ankle, like from a car accident or a sports tackle

Risk factors

• Playing high-impact sports like football, basketball, or soccer
• Having weak or brittle bones (for example, from osteoporosis)
• Carrying extra body weight, which puts more stress on the ankle joint
• Wearing shoes with poor grip, or walking on uneven surfaces
• Having a problem with balance or stability, such as after a previous ankle injury

When to see a doctor

See a doctor urgently if:

• If you have any of the emergency symptoms listed above, call your local emergency number immediately.
• You cannot put any weight on the foot after the injury
• You heard a snap or cracking sound at the time of the injury
• The pain gets worse, or you have new bruising, swelling, or changes in the colour of your foot

Book a routine appointment if:

• The pain is mild and you can walk, but the ankle still hurts after a few days
• You are not sure whether it is a break or just a sprain

Diagnosis

To diagnose a broken ankle, a healthcare professional will ask how the injury happened, examine your ankle for swelling, bruising, tenderness, and any change in shape, and gently feel the area for signs of a break. They will also check the circulation and nerve supply in your foot by feeling for a pulse and asking you to move your toes.

Tests that may be done

• X-rays are the most common test. They can show most fractures and how out of line the bones are.
• A CT scan (computerised tomography) may be used if the break is complex, or if there is concern about how well the joint surfaces have come together.
• An MRI (magnetic resonance imaging) can show damage to ligaments and tendons, and is sometimes used if ligament injury is suspected.

What to expect at your appointment

You may have the X-ray taken in an emergency or urgent care setting. The scan takes only a few minutes. If a break is found, the doctor will tell you whether it needs a simple cast or splint, or whether it is a more serious break that may need surgery. You may be asked to raise the leg and put a cold pack on the ankle while you wait for the results.

Treatment

Treatment for a broken ankle aims to hold the broken bone in a good position so it can heal steadily. This may be done either with a cast or splint (called non-surgical treatment) or, if the break is severe or unstable, with surgery to fix the bones. You will also get advice on pain relief, how to keep the swelling down, and when you can start putting weight on your foot again.

Self-care at home

• Rest the ankle and do what your doctor or physiotherapist tells you about how much weight you can put on it.
• Apply ice wrapped in a cloth to the area for about 15–20 minutes every few hours to help reduce swelling. Never place ice directly on the skin.
• Keep your foot raised on a pillow or stool when you are resting, so it is above the level of your heart.
• Follow your clinic's advice on when to change the cast or dressing, and check for any skin soreness or signs of irritation.

Medical treatments

Medical treatment may include a plaster cast or a splint to keep the bones aligned while they heal. Some patients are given a functional brace (a special walking boot) that lets them move the ankle earlier. Your doctor or pharmacist can suggest a suitable over-the-counter or prescription pain reliever, and will tell you the right dose and how often to take it. In more severe breaks, you may be offered a surgical operation to place pins, plates, or screws to hold the bones in place.

When is surgery considered?

Surgery is usually recommended if the bones are shifted out of line, if the break goes into the joint and makes it unstable, or if the bone has broken through the skin (an open fracture).

Living with this condition

For the first few weeks, you will need to keep weight off your ankle. You may need crutches, a boot, or a cast. Your doctor will give you a plan for when you can start moving the ankle and putting weight on it. Expect the ankle to feel sore and stiff, and continue to use ice and elevation, especially in the first week. Your physiotherapist or doctor will give you gentle movements to do at home.

Lifestyle tips

• Do not smoke, as smoking slows down bone healing and can increase the risk of complications.
• Avoid putting weight on the ankle until your doctor tells you it is safe, and use your crutches or boot correctly.
• Keep your home well lit and clear of loose mats or wires to avoid another fall while you are recovering.
• Stay in contact with friends and family to help with practical things like shopping and cooking while you are less mobile.

Diet and exercise

While your ankle heals, try to eat a healthy balanced diet. Calcium and vitamin D are especially important for bone strength – think of dairy products, leafy green vegetables, and fortified foods such as certain plant milks. Once your doctor or physiotherapist says it is okay, gradually start with simple ankle exercises and later add strengthening and balance exercises. If you are able, do upper-body exercise like swimming or seated weights to keep the rest of your body active.

Mental health and emotional wellbeing

It is completely normal to feel frustrated, low, or a little anxious when you are less mobile and cannot do your usual activities. Recovery takes time and cannot be rushed. Be kind to yourself, set small goals, and let your family or friends help. If you feel your mood is low for more than a couple of weeks, talk to your healthcare team – there is help available.

Prevention

You cannot always prevent a broken ankle, but you can lower your chances by keeping your leg muscles strong, practising good balance, wearing shoes that provide good grip and support, and using handrails on stairs. Being at a healthy weight and doing regular weight-bearing activity (like walking or jogging) also helps build bone strength.

Screening programmes

If you are over 50, or you have risk factors for weak bones, such as certain long-term conditions or a family history of fractures, ask your doctor about a bone density scan. This can spot early signs of bone thinning so you can make changes to protect your health.

Complications

If left untreated

• The bone may heal in a crooked position, causing pain and a limp that may be long-lasting.
• The joint may become stiff or unstable, and you may be more likely to develop arthritis in the ankle later in life.
• If an open break is not treated promptly, the risk of serious infection in the bone (osteomyelitis) is high, and this is a medical emergency.

Long-term outlook

With the right treatment and rehabilitation, most people recover fully or return close to their normal level of activity. It takes patience – a broken ankle can take several weeks to months to heal completely, and full recovery from stiffness and swelling may take even longer. The most important step is to follow your healthcare provider’s advice and to do your rehabilitation exercises once they say it is safe to start. The outlook is good if you look after yourself while you heal.

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