Ankle fracture - aftercare

More about Your Injury

Severe ankle fractures may require surgery. Fractures that may need surgery if:

• The ends of the bone are out of line with each other (displaced)
• The fracture involves the ankle joint
• There are fractures in 2 (bimalleolar) or 3 (trimalleolar) parts of the ankle bones
• Tendons or ligaments (tissues that hold muscles and bones together) are torn
• Your doctor thinks your bones may not heal properly without surgery
• In children, the fracture involves the part of the ankle bone where bone is growing

When surgery is needed, it will likely involve using metal pins, screws, or plates to hold the bones in place as the fracture heals. The hardware may be temporary or permanent.

What to Expect

You may be referred to an orthopedic (bone) doctor. Until that visit:

• You will need to keep your cast or splint on at all times and keep your foot raised as much as possible.
• Do not put any weight on your injured ankle or try to walk on it.

Without surgery, your ankle will be placed in a cast or splint for 4 - 8 weeks.

• The length of time you must wear a cast or splint depends on the type of fracture you have.
• Your cast or splint may be changed more than once, as your swelling goes down.
• Almost always, you will not be allowed to bear weight on your injured ankle at first.
• At some point, you will use a special walking boot as the healing progresses.

You will need to learn:

• How to use crutches
• How to take care of your cast or splint

Symptom Relief

To reduce pain and swelling:

• Sit with your foot elevated higher than your knee at least 4 times a day.
• Apply an ice pack 20 minutes of every hour you are awake for the first 2 days.
• After 2 days, use the ice pack for 10 - 20 minutes 3 times a day, as needed.

For pain, you can use ibuprofen (Advil, Motrin, and others) or naproxen (Aleve, Naprosyn, and others). You can buy these medications without a prescription.

• Do not use these medications for the first 24 hours after your injury. They may increase the risk of bleeding.
• Talk with your health care provider before using these medicines if you have heart disease, high blood pressure, kidney disease, or have had stomach ulcers or internal bleeding in the past.
• Do not take more than the amount recommended on the bottle or more than your health care provider advises you to take.
• Do not given aspirin to children.

Acetaminophen (Tylenol and others) is a pain medicine that is safe for most people. If you have liver disease, ask your provider if this medication is safe for you.

You may need prescription pain medicines (opioids or narcotics)) to keep your pain under control at first.

Activity

Your health care provider will tell you when it is okay to place any weight on your injured ankle.

• Most of the time, this will be at least 6 weeks.
• Putting weight on your ankle too soon may mean the bones do not heal properly.

You may need to have your duties at work changed if your job requires walking, standing, or climbing stairs.

At a certain point, you will be switched to a weight-bearing cast or splint. This will allow you to start walking. When you start walking again:

• Your muscles will likely be weaker and smaller, and your foot will feel stiff.
• You will begin learning exercises to help you rebuild your strength.
• You may be referred to a physical therapist to help with this process.
• Returning to sports or work activities requires that you have full strength in your calf muscle and that you have almost full range of motion back in your ankle.

Follow-up

Your health care provider may do x-rays 7 - 10 days and 1 month after your injury to see how your ankle is healing.

Your health care provider will let you know when you can return to regular activities and sports. Most people need at least 6 - 10 weeks to fully heal.

When to Call the Doctor

Call your health care provider if:

• Your cast or splint is damaged.
• Your cast or splint is too loose or too tight.
• You have severe pain.
• Your foot or leg is swollen above or below your cast or splint.
• You have numbness, tingling, or coldness in your foot, or your toes look dark.
• You cannot move your toes.

Also call your health care provider if you have questions about your injury or your recovery.

References

Ankle fractures. In: Eiff MP, Hatch RL, eds. Fracture Management for Primary Care. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 13.

Update Date: 6/27/2012

Updated by: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.