I have occasionally written articles about ankle fracture before and I’m still going to highlight it today due to the increased prevalence of this injury both locally and across the borders. Sometimes last year I highlighted about this injury after one of my players in the team unfortunately sustained it.
In this article I just want to focus on the risk factors to this injury and how it can be minimized. This injury mostly occurs during certain activities such as landing from a jump, or when rolling an ankle, stress is placed on these bones. When this stress is traumatic, and beyond what the bone can withstand, a break may occur. Because of the large forces required, this fracture often occurs in combination with other injuries such as a sprained ankle or other fractures of the foot, ankle or lower leg.
Those with this fracture typically experience a sudden onset of sharp, intense ankle or lower leg pain at the time of injury. An audible sound, such as a “crack”, may also have been heard. The pain associated with this condition usually causes the person to limp so as to protect the injury. In severe cases, particularly involving a displaced fracture weight bearing may be impossible. Depending on the location of the fracture (or fractures), pain may be felt at the front, back, inner or outer aspect of the ankle or lower leg. Occasionally the intense initial pain may settle quickly with rest, leaving one with an ache at the site of injury that may be particularly prominent at night or first thing in the morning. Occasionally one may experience symptoms in the Achilles or calf region.
Those with this fracture usually experience swelling, bruising and pain on firmly touching the affected region of bone. Pain may also increase during certain movements of the foot or ankle or when attempting to stand or walk (particularly up hills or on uneven surfaces). In severe cases an obvious deformity may be noticeable. Occasionally one may also experience pins and needles or numbness in the lower leg, foot or ankle.
A thorough subjective and objective examination from a physiotherapist is essential to assist with diagnosis of this fracture. An X-ray is required to confirm the diagnosis and assess the severity. Further investigations such as an MRI, CT scan or bone scan may be required, in some cases, to assist with diagnosis and assess the severity of the injury.
For those fractures that are displaced or where the normal body relationship of the bones of the ankle has been disrupted, treatment typically involves re-alignment of the fracture by careful manipulation under anesthesia followed by surgical internal fixation (using plates and screws) to stabilize the fracture and restore the normal alignment of the ankle. This may be followed by the use of a protective boot, brace, or, more commonly, a plaster cast, and/or crutches for a number of weeks.
One of the most important components of rehabilitation following a fracture is that the person rests sufficiently from any activity that increases their pain (crutches and / or a protective boot are often required). Activities which place large amounts of stress through the ankle should also be avoided, particularly excessive weight bearing activity such as running, jumping, standing or walking excessively. Rest from aggravating activities allows the healing process to take place in the absence of further damage. Once the person can perform these activities pain free, a gradual return to these activities and weight bearing forces is indicated provided there is no increase in symptoms.
The writer is a physiotherapist with Kenya Premier League side Mathare Untied