Ankle injuries are one of the most common bone and joint injuries. A fractured (broken) ankle can range from a simple break in one bone to several fractures. The degree of injury determines if you can treat with conservative care or if surgical repair of the broken bones is needed.
Symptoms that occur with an ankle fracture include pain, swelling and bruising. The pain may be moderate to severe, and it’s not always localized at the fracture. You may also experience pain throughout the foot area or even in your knee. The pain is generally too severe to allow walking without support. The joint may swell because of excess fluid caused by tissue damage. Eventually, the area will probably bruise. Bruising may spread down to the toes or upwards into the leg. Only severe fractures are actually seen by the naked eye with a noticeable deformity
An ankle fracture is generally caused by twisting, rolling or rotating your ankle. Direct impact such as during a car accident or fall can also lead to a break in one of the bones that make up your ankle.
Diagnosing ankle fracture starts with physically examining the ankle and obtaining X-rays to evaluate the bones. The goal of evaluation is to determine the stability of the joint. Joint instability often suggests multiple fractures, a fracture with a ligament injury, or sometimes ligament injury alone. Occasionally advanced imaging such as a MRI or CT scan is needed.
Treatment of an ankle fracture is determined by the stability of the joint. When the ankle joint is stable, ankle fractures usually heal with nonsurgical treatment. This includes wearing a cast or brace and using crutches for 4-6 weeks and then slowly transitioning to putting weight on the affected foot. Occasionally physical therapy is needed to improve strength and flexibility of the ankle joint.
If the fracture is out of place or your ankle is unstable, your fracture may be treated with surgery. During this type of procedure, the bone fragments are first repositioned (reduced) into their normal alignment. They are held together with special screws and metal plates attached to the outer surface of the bone. The procedure itself is determined by which bones are fractured. The healing process for those who have surgery can take several months.
Total ankle arthroplasty (TAA), also known as total ankle replacement, is a surgical procedure that is used to treat ankle arthritis. The procedure replaces the damaged arthritic ankle cartilage with an artificial ankle joint.
The goal of TAA is to provide pain relief while preserving some ankle motion to allow the patient to have less pain and improved function during activity.
TAA is considered for patients who continue to experience ankle pain and decreased function from arthritis despite trying conservative management. TAA is done to restore flexibility and function, in contrast to a fusion-type procedure that would eliminate the motion at the ankle joint.
TAA is not suited for patients with severe deformity or dead bone in the talus (the bottom bone of the ankle joint). Patients with a history of deep infections of the ankle, significantly abnormal nerve function or sensation (also known as peripheral neuropathy), inadequate or absent leg muscle function, and poor blood flow of the leg are not considered good candidates for a TAA.
Recovery from a total ankle replacement requires a period of non-weightbearing and immobilization. The patient usually will spend one to several nights in the hospital. After the surgical wounds are healed, the patient is allowed to start working on gentle range-of-motion activities. Weightbearing then usually begins a few weeks after surgery if X-rays show good healing.