Important Tips on Ankle Fracture Physiotherapy Treatment

From a simple misstep to high-impact sports injuries, anything can quickly lead to a broken ankle. This common injury, an ankle fracture, occurs when one or more of the three bones in your ankle joint break. In most cases, you can treat ankle fractures with conservative approaches like physical therapy. This article explores this type of ankle fracture rehabilitation and what to expect during treatment.

How Do Ankle Fractures Happen?

You can be one step away from a broken ankle. The bones comprising the ankle (talus, tibia, fibula) might seem sturdy, but they are susceptible to everyday mishaps. In fact, ankle injury is a primary cause of orthopaedic conditions in Singapore and a common lower extremity fracture worldwide. Fractured ankles account for 10% of all traumatic fractures among young men (mostly athletes) and older women.

Below are common reasons why ankle fractures occur:

• Rolling your ankle outward (lateral ankle sprain) and sudden twists
• Landing awkwardly from a jump
• Tripping or falling from a height
• A direct blow to the ankle
• Twisting your ankle with a planted foot
• Repeated stress over time (running or jumping)

Understanding these common causes can help you be more mindful of your movements and avoid an ankle fracture.

Who Gets Ankle Fractures?

Ankle fractures are an equal opportunity injury, but some groups are more susceptible due to various factors.

Athletes

High-impact sports like basketball, football, soccer, and gymnastics put a lot of stress on the ankles. Sudden changes in direction, jumps, and landings can all lead to ankle sprains that, if left untreated, can progress to fractures.

Older Adults

As we age, our bones naturally lose density, making them more susceptible to fractures. This, combined with a decline in balance and muscle strength, increases the risk of falls and ankle fractures in older adults. Osteoporosis, a condition that weakens bones, is a particular concern.

People Who Wear High Heels

While stylish, high heels can significantly alter your balance and gait. The elevated heel shifts your weight forward, putting extra strain on your ankle joint and making it more prone to rolling or twisting, especially on uneven surfaces.

People with Existing Ankle Instability

Prior ankle sprains or injuries such as a broken bone that hasn't healed properly can leave your ankle joint less stable. This increases the risk of future sprains and fractures with even minor twists or falls.

People with Certain Medical Conditions

Certain medical conditions like rheumatoid arthritis can weaken bones and joints, making them more susceptible to fractures. Additionally, some medications, such as corticosteroids, can contribute to bone loss.

Kinds of Ankle Fractures

Ankle fractures come in various forms, each with its own characteristics. The type of fracture you experience depends on the force and direction of the impact that caused the injury. Let's explore the most common types based on the location and severity of the break below.

Lateral Malleolus Fracture

This is the most frequent ankle fracture, accounting for roughly 70% of all cases. It involves a break in the fibula, the thinner bone on the outer side of your ankle. This fracture often occurs when the ankle rolls outward, stretching or tearing the ligaments on the inner side of the joint.

Medial Malleolus Fracture

Less common than lateral malleolar fractures, this involves a break in the bony bump on the inner ankle joint (medial malleolus). This typically happens due to a forceful inward rolling motion of the ankle, impacting the strong ligaments on the outer side. Medial malleolar fractures can also indicate ligament damage on both sides of the ankle joint.

Posterior Malleolus Fracture

The least common ankle fracture, this type affects the back of the fibula. This fracture usually occurs from a forceful backward bending motion of the ankle joint, often in combination with other injuries.

Complex Fracture

This more severe fracture involves multiple breaks in one or more bones, often accompanied by ligament damage. The force required to cause a complex fracture can also damage the cartilage that cushions the ankle joint (talar cartilage). Additionally, complex fractures may involve breaks that extend into the joint itself, requiring a more intricate surgical approach for proper healing and restoration of joint stability.

Symptoms of an Ankle Fracture

Ankle fractures can announce themselves with various symptoms, although the severity and exact presentation can vary depending on the type and location of the break. Watch out for these common signs.

Ankle Pain

This is a surefire sign of an ankle fracture, typically manifesting as a sharp, throbbing pain that intensifies when you put weight on the injured leg. The pain might also radiate from the ankle joint up your calf or down to your foot. Physiotherapy for ankle pain helps you manage this symptom.

Swelling and Bruising

Shortly after the injury, swelling and bruising will often set in around the ankle joint. The degree of swelling can vary depending on the severity of the fracture, but it's a telltale sign that something's amiss.

Difficulty Walking or Bearing Weight

You may not be able to bear weight on the injured ankle since it will likely be extremely painful. In some cases, it might be impossible altogether. This is due to the instability caused by the broken bone and the surrounding soft tissue damage.

Tenderness to the Touch

The area around the fracture will likely be very sensitive to the touch. Even gentle pressure can cause significant pain, further indicating a potential break.

Deformity of the Ankle Joint

In some cases, a broken ankle can cause a visible deformity of the joint. This might involve an unnatural angulation, bulging, or obvious misalignment of the bones. However, not all fractures will cause a noticeable deformity.

These symptoms can come with a severe ankle sprain. If you experience any of these signs following an ankle injury, seek immediate medical attention.

Diagnosing an Ankle Fracture

If you suspect a fracture after a painful ankle twist or fall, don't hesitate to consult with a doctor. The general diagnostic process for ankle fractures includes a thorough physical examination of your ankle. This will involve:

• Visual inspection: Looking for any visible signs of swelling, bruising, deformity, or discolouration around the ankle joint.
• Palpation: Gently feeling the ankle to identify areas of tenderness and pinpoint the location of potential pain.
• Range of motion assessment: Moving your ankle gently through its range of motion to assess for pain or limitations caused by the injury.
• Stress tests: Applying gentle pressure in specific directions to test for ligament stability and identify any abnormal movement.

Imaging techniques such as X-rays are the gold standard for further ankle fracture diagnosis. These images allow the doctor to visualise the bones in your ankle and confirm the presence, location, and type of fracture.

Your doctor may employ additional imaging techniques for a more comprehensive evaluation, such as:

• Multiple X-ray views for different angles (anterior-posterior, lateral, and oblique) to get a complete picture of the bones and surrounding structures
• Weight-bearing X-rays where you stand on the injured ankle to identify certain types of fractures and reveal possible misalignments
• CT scan in complex fractures or when X-rays are inconclusive for detailed cross-sectional images of the bones and soft tissues
• MRI scan in specific, less common situations for detailed images of soft tissues like ligaments and cartilage, which can be helpful in identifying ligament tears

Treating an Ankle Fracture

There are two main categories in treating an ankle fracture: Conservative management and surgery.

Surgical Intervention (Ankle Fracture Fixation)

For complex fractures where the bones are significantly displaced, surgical intervention may be necessary. The goal of surgery is to realign the broken bones and stabilise the joint to ensure proper healing and prevent long-term complications.

Ankle surgery approaches involve an incision near the fracture site to access the broken bones. Depending on the type of fracture, this may employ different techniques to realign the bones, such as:

• Open Reduction Internal Fixation (ORIF): The surgeon physically manipulates the bones back into their correct anatomical position. Once aligned, they secure the bones using plates, screws, or wires to ensure proper healing and stability.
• Arthroscopy: This minimally invasive arthroscopic procedure utilises a small camera and specialised surgical tools inserted through tiny incisions to visualise and repair the fracture and any associated cartilage damage.

Conservative Treatment (Non-surgical)

For less severe fractures where the bones haven't shifted significantly and the ligaments remain relatively intact, a non-surgical approach should suffice. This involves immobilising the ankle joint to allow the bone to heal properly.

Non-surgical methods for ankle fractures include using a cast or walking boot. A cast made of plaster or fibreglass applied to your ankle and lower leg will hold the bones in the correct position while they heal. Depending on the fracture, you might wear the cast for 4-8 weeks.

Meanwhile, you can use a walking boot instead of a cast if you opt for a bit more flexibility while still providing support.

Finally, physical therapy presents itself as the best non-surgical treatment and management for ankle fractures. Even after surgery, this becomes a crucial rehabilitation method. Similar to tenosynovitis ankle physiotherapy or ankle sprain physiotherapy, this involves a program focused on regaining range of motion. Additionally, it helps strengthen the surrounding muscles, improve balance and proprioception, and ultimately restore functional mobility.

We'll break them down below.

Why Ankle Fracture Physical Therapy Treatment Is Important

Physical therapy (PT) is the initial treatment for the ankle fracture recovery process. Research says that PT not only jumpstarts healing but also yields significant benefits compared to passive approaches like immobilisation alone.

Here's why PT is so important:

1. Pain Management and Reduced Swelling

PT offers tools to combat pain and swelling from an ankle fracture. Skilled therapists in Singapore like Phoenix Rehab can utilise manual therapy techniques like massage and joint mobilisations to reduce pain and swelling. This allows for earlier movement and participation in exercises, accelerating the healing process. Additionally, modalities like ultrasound or electrical stimulation might be incorporated to further manage pain and promote healing.

2. Improved Range of Motion

After some time immobilised in a cast or boot, your ankle joint can become stiff and lose its natural range of motion. A tailored physical therapy program helps restore full flexibility and mobility in the joint. This not only allows for pain-free movement but also helps prevent future stiffness, ensuring long-term comfort and function.

3. Strengthening Muscles

Ankle fractures can significantly weaken the muscles surrounding the joint. PT incorporates targeted strengthening exercises to rebuild this strong support system. Stronger muscles improve stability in the joint, allowing for confident movement and reducing the risk of future re-injury.

4. Restored Balance and Proprioception

An ankle fracture can disrupt your sense of balance and body awareness (proprioception) in the injured joint. This can lead to instability and an increased risk of falls. PT helps retrain your body through balance exercises that utilise wobble boards or uneven surfaces. By regaining balance and proprioception, you'll feel more confident during daily activities and less prone to falls.

5. Promoted Healing

Specific exercises within the PT program can promote blood flow to the injured area. This accelerated blood flow can significantly speed up the healing process of the fractured bone and surrounding tissues. Additionally, PT helps manage scar tissue formation, preventing long-term limitations in movement and ensuring a smooth recovery.

Tips for Doing Exercises

Below are some general tips to keep in mind when performing your ankle fracture physical therapy exercises.

Start Slowly

Begin with gentle exercises and gradually increase intensity as your pain improves and strength returns.

Listen to Your Body

Stop any exercise that causes pain and consult your physical therapist.

Maintain Proper Form

Ensure you perform exercises with good technique to avoid further injury.

Exercises You Can Do

Your physical therapist will design a personalised exercise program based on your specific needs. Here are some common exercises used in ankle fracture rehab.

Range-of-motion exercises

Gentle movements to improve ankle flexion, extension, inversion, and eversion.

Strengthening exercises

Exercises using resistance bands, weights, or your body weight to strengthen the muscles around the ankle joint.

Balance exercises

Activities like single-leg stance or wobble boards to improve balance and proprioception.

How Long Does Ankle Fracture Physical Therapy Treatment Last?

The duration of ankle fracture physical therapy treatment varies depending on the severity of the injury and your progress. Generally, it can last anywhere from 6 to 12 weeks.

Tips for When the Cast Comes Off

Once your walking cast comes off, here are some tips to aid your recovery:

Gradual Weight Bearing

Your physical therapist will guide you on gradually increasing weight bearing on the injured ankle, starting with crutches or an assistive device.

Continue Exercises

Consistent adherence to your prescribed exercises is crucial for regaining full strength, range of motion, and walking ability.

Wear Supportive Shoes

Opt for shoes with good arch support and a stable sole to promote proper alignment and prevent future complications.

Conclusion

Ankle fracture physical therapy treatment ensures a full recovery and gets you back to your normal activities, even with or without surgical intervention. Follow your doctor's instructions and diligently perform your physical therapy exercises to regain strength, flexibility, and confidence in your injured ankle. Proper treatment promotes healing, reduces the risk of complications, and helps prevent future ankle injuries.