Whether caused by a simple misstep or a trauma such as a car crash, a fractured (broken) ankle is a painful and common injury.

Broken ankles can vary significantly in severity from a tiny crack in the bone to a large crack to multiple cracks. But even minor ones can immobilize you and require proper treatment to fully heal. This is important because a tiny misalignment now can lead to osteoarthritis down the road, making your joints stiff and limiting your range of motion.

The ankle joint is made up of three bones: the shin bone (tibia), outer ankle bone (fibula), and a bone in the foot between the leg and heel bones (talus). The ankle can fracture in more than one place, and the surrounding ligaments (which connect the bones to stabilize the joints) are also often damaged.

The appropriate treatment depends on the location or locations of your fracture. What is also critical, is whether the fracture is stable, meaning the ankle joint remains in appropriate alignment when forces are applied to it (such as when walking). 

Many fibula fractures may require wearing a walking boot or cast for a period of time, whereas most tibia fractures need surgery. When both the tibia and fibula are fractured, or the joint is shifted or dislocated, surgery is usually the best option. At Yale Medicine, orthopedic surgeons from our Foot & Ankle Surgery Program are experienced in treating all types of ankle fractures.

“At Yale Medicine, we have a team of highly trained orthopaedic foot and ankle specialists and orthopaedic trauma specialists. Fractures that are complex and rare are routine because of the volume and variety of injuries we see on a daily basis,” says Sean Peden, MD, a Yale Medicine foot and ankle orthopaedic surgeon. Our operating room team of surgeons, nurses, and other support staff are committed to providing the best care utilizing cutting edge technology and research.”

If you fractured your ankle, you will likely experience immediate, sharp pain and possible swelling.

Additional symptoms include:

• Pain that spreads throughout the foot and up your leg, toward your knee
• Intensifying pain if you try to bear weight on your foot
• Bruising or discoloration
• Dislocation (the ankle appears bent, distorted, rotated, or out of place)

If you suspect you have fractured your ankle, your doctor will first ask you to describe what happened. Next, your doctor will perform a physical examination.

During the exam, your doctor will:

• Check for damage to blood vessels near the ankle (by taking your pulse at the top of the foot and examining skin temperature and color)
• Check for nerve damage (by assessing sensation) near the ankle
• Gently move the ankle to see where the pain is and check range of motion
• Examine the joints above and below the injured area

Often, a severe sprain and a fracture cannot be seen without an X-ray. An X-ray can show the precise fracture location and provide information that allows your doctor to identify the best treatment. For large fractures or ones that involve ligaments, your doctor may order more detailed image studies, including a CT (computed tomography) scan or MRI (magnetic resonance imaging).

Depending on the severity of your ankle fracture, your treatment may be nonsurgical or surgical.

Nonsurgical

For a simple break in one bone that is stable, your doctor may recommend using a walking boot or cast for about six weeks to protect the fracture as it heals. Depending on which bone is broken—and where the break is on the bone—you may be able to put some weight on the affected leg right away or you may need to use crutches for a few weeks.

Additional recommendations for mild fractures, especially in the first few days following injury, include:

• Resting the ankle
• Elevating the ankle (above the heart)
• Icing the area every one to two hours for 15 minutes at a time

Your doctor will have you come in regularly to have X-rays to check that the fracture fragments haven’t misaligned as they heal. Additionally, medications such as acetaminophen (Tylenol) and ibuprofen (Motrin) may help with pain and inflammation.

Surgical

For more serious fractures, including cases where the bones, and in particular the joints, are misaligned from the break, surgery may be necessary. 

In many cases, your surgeon will reposition any bone fragments into their normal alignment and hold them together with special screws and metal plates to keep the fragments together while you heal. Sometimes, bone grafting (transplanting bone tissue) may be done so that new bone has a place to grow.

After surgery, your ankle should be as strong as it was before the fracture. But if the bone fragments do not remain in place, you may fracture your ankle again or arthritis could develop.

The Yale Medicine Foot & Ankle Surgery Program offers a wide range of treatments for fractured ankles, from expert diagnosis to the most advanced surgical care. We work closely with specialists from radiology, anesthesiology, pediatrics, internal medicine, and vascular surgery.

Experts at Yale Medicine have particular interest in the care of pediatric, diabetic, and high-energy fractures of the ankle. These types of fractures are more complex and require particular experience. Yale Medicine has ongoing clinical research studies regarding the best treatment for sports-related ankle fractures and diabetic ankle fractures.