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Foot and Ankle

Ankle Fracture


There are three distinct bones that join together to make up the ankle joint:  The tibia (the main bone in the lower leg), the fibula (the bone that makes up the outside of the lower leg) and the talus (the ankle bone).

Ankle fractures occur when one of these three bones break, fracture, or split. They occur when the ankle is severely twisted or rotate beyond the normal degree of motion. Severe trauma caused by force (such as a hard landing) can also fracture this joint.

The difference between an ankle sprain and an ankle fracture:

  • When the ankle joint sustains massive stress, if only the ligaments are stretched or torn, then the result is a sprain.
  • If one of the bones in the joint breaks, it is a fracture. 


The symptoms of an ankle fracture are pain and swelling almost immediately after the traumatic incident. Intense swelling, pain, and bruising often occurs swiftly after the injury has occurred.  The pain, depending on the degree of the fracture, will usually prevent a patient from walking or putting pressure of any kind on the joint. In more severe cases, a break or bone deformity can be visibly seen though the skin. The surrounding nerves may be affected which may result in numbness and the inability to move your foot or toes.  If any or all of these symptoms are present, it’s important to see medical care so that treatment can be applied quickly.

Diagnostic Testing

In almost all cases, an X-ray will be the initial method used to diagnose an ankle fracture. X-rays allow the bone to be viewed from various angles so that the severity of the break can be examined. In some cases an MRI is used to evaluate the ligaments of the ankle or a CT is needed to evaluate the boney structures in more detail.

Broken Ankle Treatment

Non-Surgical Treatment for an Ankle Fracture

Ankle fractures occur along a continuum of injury.  Some are avulsions of bone which can be treated like a sprain and some require surgical intervention to realign the bones.  Our orthopaedic surgeons carefully evaluate each patient to determine fracture stability and optimal treatment.  If the fracture is minimally displaced and stable, non-operative treatment is often recommended.  Non-operative treatement varies from CAM boot treatment to casting.  Physical therapy may be necessary after a period of immobilization and fracture healing.

Surgical Treatment for an Ankle Fracture

In complex cases involving displaced/unstable ankle fractures, surgery will be necessary to correct the injury. Surgical intervention involves making incisions on the ankle medially, laterally, or both to directly visualize the bone fragments and reduce them into anatomical alignment.  The bone fragments are then held in place using metallic plates and screws.  An arthroscopic examination of the ankle cartilage may be recommended.  If arthroscopy is preformed, our surgeons can typically treat concomitant cartilage injury at the time of the initial surgery.

Post-Operative Care

Surgery for ankle fractures can be done as an outpatient procedure or involve a one-night stay depending on the severity of the injury.  We typically employ nerve blocks which can help control post-operative pain.  Weight bearing after surgery depends on the severity of the injury.  In severe fractures weight bearing my not be allowed for up to eight weeks. Patients are treated with a splint or cast and transitioned to a CAM boot prior to weight bearing.

At a Glance

Dr. Brian Waterman, MD

  • Chief & Fellowship Director, Sports Medicine, Wake Forest
  • Team Physician, Wake Forest University, Chicago White Sox
  • Military affiliation/Decorated military officer and surgeon
  • Learn more

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