Ankle Fractures

An ankle fracture breaks one or more of the bones that form the ankle joint. The two bony knobs on either side grip the talus, the block of bone the leg pivots on, forming a ring that keeps the joint lined up under body weight. The key question is not whether a bone is broken but whether that ring stays stable. A single break with the talus still centered is often stable and heals in a boot. A break that disrupts the ring in two places lets the talus shift, and if it heals out of alignment, arthritis can follow. Ankle fractures cannot be reversed, but they heal, and most people return to their normal activities.

Common symptoms include:

• Sudden pain after a twist, often with a snap or pop
• An ankle that can no longer support weight
• Swelling and bruising that spread toward the toes within an hour or two
• Point tenderness directly over the bony knob on the inside or outside of the ankle

Your provider presses along each side of the ankle to find where it is tender, checks the skin, circulation, and sensation, and assesses weight-bearing, then uses X-rays to show the fracture pattern and whether the talus stays centered. A CT scan is added for complex fractures, and a stress X-ray can reveal whether the ring opens under load.

A stable fracture can heal without surgery:

• A walking boot or short-leg cast to protect the joint while the bone knits
• Protected weight-bearing, with early walking when the fracture allows
• Repeat X-rays to confirm the talus has not drifted

Surgery is offered when the ankle cannot hold its alignment under body weight, such as a break on two sides of the ring, a talus that shifts on weight-bearing X-rays, or an open fracture. Fixation uses plates and screws to rebuild the ring so the joint surface heals aligned.

For a fuller explanation, including anatomy, diagnosis, and the full range of treatment:

• Ankle Fractures (Broken Ankle) — AAOS OrthoInfo