An ankle fracture is a break in one or more of the bones that form the ankle joint, most commonly the tibia (shinbone), fibula (the smaller bone on the outer side of the leg), and sometimes the talus (the bone that sits above the heel bone). These injuries are among the most common lower limb fractures and can range in severity from a small crack in the bone to complex fractures involving multiple bone fragments and joint displacement.
Ankle fractures usually occur due to trauma such as twisting the ankle, falling from a height, or direct impact, such as during sports injuries, road traffic accidents, or slips on uneven ground. Depending on the direction and force of the injury, the fracture may affect the lateral malleolus (outer ankle), medial malleolus (inner ankle), posterior malleolus (back of the tibia), or a combination of these; often referred to as a bimalleolar or trimalleolar fracture when more than one area is involved.
Symptoms of a broken ankle include sudden, sharp pain at the time of injury, followed by swelling, bruising, and difficulty or inability to bear weight. In more severe fractures, there may be a visible deformity or misalignment of the joint. It is important to seek prompt medical attention, as untreated fractures can lead to long-term joint instability, arthritis, or chronic pain.
Diagnosis typically begins with a physical examination, where a clinician will assess swelling, bruising, tenderness, and joint stability.
Imaging is essential to confirm the diagnosis - X-rays are usually the first step, but CT or MRI scans may be used for complex fractures or to evaluate associated soft tissue injuries such as ligament tears. Early and accurate diagnosis is crucial for planning the appropriate course of treatment and achieving a successful recovery.
Treatment for ankle fractures depends on the type, location, and severity of the break, as well as the patient's overall health, activity level, and personal goals. For stable fractures, where the bones remain in proper alignment and the joint is unaffected, non-surgical management is often appropriate. This usually involves immobilisation with a boot or cast to protect the bone while it heals, combined with a period of reduced weight-bearing or crutches. After the initial healing phase, physiotherapy plays a key role in restoring strength, flexibility, and proprioception (balance awareness), helping to prevent future injuries.
However, unstable or displaced fractures, where the bones are misaligned or the joint surface is involved, usually require surgical intervention to ensure proper healing and preserve ankle function. Surgery is also considered when the fracture does not heal adequately with conservative treatment or if the ankle remains painful and unstable. Modern ankle fracture surgery is often minimally invasive (Keyhole), using small incisions and image-guided techniques to realign and stabilise the bones with screws, plates, or rods.
Minimally invasive surgery offers several benefits compared to traditional open techniques, including less soft tissue disruption, reduced pain, lower risk of infection, and faster recovery times. Most patients are able to start gentle movement exercises soon after surgery and progress to weight-bearing activities as guided by their specialist.
With appropriate post-operative care and rehabilitation, patients can expect excellent outcomes, often regaining full function and returning to sports or physically demanding activities within a few months.
