Ankle Fracture

An ankle fracture is a break in one or more of the bones that form the ankle joint. It is one of the most common fractures, often caused by a fall, a twist, or a sporting injury — sometimes by the same mechanism that causes a sprain.

Ankle fractures range from a simple crack in one bone through to injuries involving several bones and the ligaments that hold the joint together. What matters most is whether the ankle joint itself remains stable and correctly aligned.

Symptoms

1. Immediate pain: Usually severe at the time of injury.

2. Inability to weight-bear: Difficulty taking more than a few steps is a significant sign.

3. Swelling and bruising: Often develops rapidly.

4. Tenderness over bone: Directly over the bony prominences rather than the soft tissue beside them.

5. Deformity: In more severe injuries the ankle may look visibly out of shape.

A fracture and a bad sprain can feel very similar, which is why imaging matters — an X-ray is the only reliable way to tell them apart.

Diagnosis

• X-ray: The first investigation, showing the fracture pattern and the alignment of the joint.

• CT: Used where the fracture involves the joint surface or the pattern is complex, giving detail that guides surgical planning.

• MRI: Occasionally used to assess ligaments or cartilage where injury is suspected alongside the fracture.

Treatment without surgery

Many ankle fractures do not need an operation. Where the bones are well aligned and the joint is stable, treatment in a cast or boot allows the fracture to heal in position. This typically means around six weeks of protection, with weight-bearing introduced as advised, followed by rehabilitation to restore movement and strength.

When is surgery recommended?

Surgery is generally recommended where:

• The bones are displaced and cannot be held in acceptable position

• The ankle joint is unstable

• The fracture extends into the joint surface, where alignment matters for long-term function

• More than one bone is broken, or the ligaments holding the joint together are disrupted

• The bone has broken through the skin — an open fracture, which requires urgent treatment

The aim of surgery is to restore the alignment of the joint and hold it stable while it heals, usually with plates and screws. Restoring the joint surface accurately matters because a joint that heals out of position is more likely to develop arthritis over the following years.

Recovery

1. First six weeks: Protection in a cast or boot. Weight-bearing depends on the fracture and whether surgery was performed. Elevation is important throughout.

2. Six to twelve weeks: Increasing weight through the foot, moving out of the boot into supportive footwear.

3. Three to six months: Physiotherapy to restore movement, strength and walking pattern. Return to most daily activities.

4. Six to twelve months: Return to sport and heavier physical work for most people. Swelling and occasional aching commonly persist well into this period.

Dr Janan's approach

Dr Janan Chandrananth is an Australian-trained orthopaedic surgeon who treats the full spectrum of orthopaedic trauma, with fellowship training in the foot and ankle in Bristol and in Tokyo under Professor Satoru Ozeki, past president of the Japanese Society for Surgery of the Foot.

That subspecialty background is particularly relevant when a fracture involves the ankle joint surface, where the accuracy of the reconstruction affects long-term function.