A Guide to Physical Therapy for an Ankle Fracture
If you have recently suffered an ankle fracture, you may be wondering what the next steps are. From surgery to physical therapy, how long will it take to recover? Ankle fractures can affect anyone at any age and lead to severe pain, swelling, instability, and limited mobility.
Recovering from an ankle fracture will definitely impact your ability to complete daily activities. It will most likely require time off of work or sport as you allow the bone(s) to heal. Plus, you'll be limited in weight-bearing activities, such as walking, climbing stairs, or standing at the counter, for a minimum of 4 weeks — but usually 6 weeks or more.
Physical therapy plays an important role in the recovery of an ankle fracture. Keep reading to learn more.
- Understanding Ankle Fractures
- Symptoms of an Ankle Fracture
- What are the Most Common Causes of Ankle Fractures?
- Diagnosing an Ankle Fracture
- What to Expect from Physical Therapy
- The Phases of Ankle Fracture Recovery
- Preventing Ankle Fractures
- Is It Time to Seek Treatment?
The ankle is made of three bones: the tibia (medial malleolus), fibula (lateral malleolus), and talus. An ankle fracture is a break in one or more of these bones which can occur after a fall, twist, or direct blow to the area.
The majority of ankle fractures (70%) occur in just one bone (uni-malleolar).1 Breaking two or more areas of the ankle (bi-malleolar) is less common and comes with more tissue damage and a higher risk of instability.
The stability of the ankle is achieved via a combination of bones, ligaments, and tendons. During an ankle fracture, some of these connective tissue structures may be damaged or torn as well.
While there are several different ways to classify an ankle fracture, basic fracture classification includes:
- Nondisplaced: The broken bone remained aligned and relatively stable.
- Displaced: The broken bone moved into a different position and is unstable.
- Comminuted: The bone is broken into multiple pieces.
- Compound or open: The fractured bone breaks through the skin.
- Complex: The fracture involves damage to the joint and other structures surrounding the ankle.
Symptoms of an ankle fracture can include one or more of the following:2
- Severe pain
- An audible crack or pop with immediate onset of pain
- Swelling, bruising, and/or discoloration
- Inability to bear weight through the foot and ankle
- Deformity of the foot or ankle
- Stiffness and limited mobility of the ankle joint
Most ankle fractures are caused by a high-impact fall, twist, or direct blow to the ankle. This can happen while playing sports such as basketball, soccer, and volleyball, participating in extreme physical activities like skiing or mountain biking, or walking on uneven terrain.
Other potential causes include:2
- An abrupt change in direction while running, landing from a jump, or missing a step
- A motor vehicle accident
- Complications with lower impact activities, such as walking or a misstep, due to underlying medical conditions, such as osteoporosis or diabetes
Most ankle fractures will result in a visit to the emergency room or walk-in care. When an ankle fracture is suspected, the first step is typically to take an x-ray to confirm the diagnosis. A CT scan or MRI may also be ordered to get a more detailed look at the bone, joint, and soft tissue structures in the area to assess other potential foot or ankle injuries.
Additionally, your doctor may use special tests to assess the severity of the fracture and degree of joint instability, such as range of motion tests, stress x-rays, and stability testing.
They will also look at the integrity of other important surrounding tissues, such as blood vessels and nerves. This will help them determine if surgical fixation (internal or external screws and plates) or casting is best for optimizing bone and tissue healing.
Initially, a bone fracture requires complete immobilization. How long the ankle will need to be immobilized will depend on the fracture severity, your health status, and whether surgery was needed or not. This period of rest is crucial for allowing the bone to fully heal in an optimal position.
Once the bone is healed (or almost healed), physical therapy is an important next step for restoring ankle function. Traditionally, weight-bearing activities and physical therapy are initiated around 6 weeks.
More recent research demonstrates the benefits of initiating gentle mobility with a physical therapist as early as 4 weeks.3 This helps combat common ankle dysfunction following casting, such as gait (walking) disturbances and excessive ankle stiffness.
Physical therapy for an ankle fracture typically progresses through the following phases:3
- Initial pain management and mobility: Your CityPT physical therapist can help you learn how to get around with the use of crutches, and other daily activities you may be struggling with. Plus, you'll learn tips for early pain management and keeping other areas of the body conditioned and strong.
- Early mobility: During this stage, the focus is on reducing pain and gently maintaining lower body strength and range of motion to prevent excessive loss of muscle strength and joint mobility.
- Progression to weight bearing: Once cleared by your physician, you will gradually progress to weight bearing and gait (walking) activities, as tolerated.
- Return to daily activities/sport: A focus on functional activities to promote optimal safety and balance with return to daily movement. This phase will focus on your specific activity goals and help you get back to activity pain and limp-free.
These phases of recovery are crucial regardless of whether surgery was needed or not. The phases and progression will likely be slower following surgery.
Since most ankle fractures are traumatic in nature, prevention is not typically possible. However, here are some general tips for optimizing ankle and lower body tissue health:
- Stay active! Weight-bearing exercise helps to maintain adequate bone density and muscle strength that offers protection from injury.
- Wear appropriate and well-fitting footwear with sports and other daily activities.
- Strengthen the ankle and foot. In particular, perform balance exercises regularly.
- Eat a high-quality diet rich in Vitamin D and calcium (for bone health), supplementing when necessary.
- Keep your home picked up and free of tripping hazards.
- Keep areas you are walking around well-lit.
- Manage chronic health conditions, such as diabetes.
- Promote overall good health with adequate sleep, hydration, and stress management.
If you or someone you know has experienced an ankle fracture, seek medical treatment immediately. A doctor can help determine the severity of the injury and what type of treatment is best for achieving a healthy, full recovery.
Seeing a CityPT physical therapist as soon as possible can help you with learning to get around efficiently and managing your pain. Then, they can be your guide throughout the recovery process to fully return to your normal life.
This guide is intended for informational purposes only. We are not providing legal or medical advice and this guide does not create a provider-patient relationship. Do not rely upon this guide (or any guide) for medical information. Always seek the help of a qualified medical professional who has assessed you and understands your condition.
Seewoonarain S, Prempeh M, Shakokani M, Magan A. Ankle fractures. Journal of Arthritis. 2016:1-4. https://www.iomcworld.org/open-access/ankle-fractures-review-article-46484.html ↩ ↩2
Albin SR, Koppenhaver SL, Marcus R, Dibble L, Cornwall M, Fritz JM. Short-term Effects of Manual Therapy in Patients After Surgical Fixation of Ankle and/or Hindfoot Fracture: A Randomized Clinical Trial. J Orthop Sports Phys Ther. 2019 May;49(5):310-319 https://www.jospt.org/doi/10.2519/jospt.2019.8864 ↩ ↩2