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Ankle Fracture Physiotherapy

An ankle fracture happens when a bone on one or both sides of the patient's ankle is partially or completely broken (fracture).

Most ankle fractures are happens due to

• ankle-twisting injuries and falls or
  
• injuries experienced during sports or play

Under the age of 50, most ankle fractures happens in men. On the other hand, over the age of 50, it is women who experience more ankle fractures.

The type of fracture can vary from

• simple to complex ankle fractures and
  
• can involve 1 or all 3 bones that make up the ankle joint

It is very important to get medical attention and treatment after an ankle injury to determine if you have a fracture or not. Our senior physiotherapists are always on standby and plays an equally important part in your ankle treatment and full recovery from an ankle fracture, for a return to normal activity, life and play.

first of all, What is an Ankle Fracture?

An ankle fracture is a completely or partially broken bone on 1 or both sides of the ankle joint.

There are several types of ankle fractures, and 1, 2, or 3 bones may be fractured. The classifications based on the number of bones broken are:

• Lateral malleolus fracture. Only the bone on the outside of the ankle, the fibula, is broken.
• Medial malleolus fracture. Only the bone on the inside of the ankle, the tibia, is broken.
• Bi-malleolar fracture. Two bones are broken, the fibula and the tibia.
• Trimalleolar fracture. Three bones are broken, the fibula, tibia, and the posterior malleolus (the tibia at the back of the foot).

The severity of the fracture is classified as:

• Nondisplaced. The pieces of the fractured bone remain lined up.
• Displaced. The 2 parts of the fractured bone do not line up.
• Comminuted. Splinters or multiple small pieces of bone are found at the fracture site.
• Complex Fracture. The soft tissue surrounding the broken bone is severely damaged.
• Compound Fracture. Fracture fragments can pierce the skin.

When a fracture involves several broken bones or the bones do not remain aligned/lined up, then the ankle fracture is considered to be an unstable fracture and will require immediate treatment, even surgical intervention and correction. A compound fracture also involves a risk of infection.

Signs and Symptoms of ankle fractures

People who fracture their ankles may experience:

• Immediate, severe pain after a twisting injury or fall
• A “pop” or “snap” felt or heard at the time of the injury
• Swelling in the ankle
• Tenderness or pain in the ankle area
• Difficulty bearing weight on the ankle when standing, walking
• Not being able to bear weight on the ankle at all
• Bruising
• Pain that increases with activity and improves with rest
• Throbbing ankle pain that is always present
  
• Inability to put a shoe on due to swelling and pain
• A bump or deformity that may be seen or felt at the ankle

How Is ankle sprain Diagnosed?

When you see our senior physiotherapist after an ankle injury, they will ask about your medical history, and how the injury occurred.

They will also observe your ability to walk and bear weight on the injured side, and gently examine the area to observe presence of any

• swelling
• deformity
• and tenderness

Our senior physiotherapist also will examine your foot and lower leg to check and ensure if you may have any other undiagnosed injuries in other areas. If we suspect that you may have an ankle fracture, we will refer you to an orthopedic specialist, and refer to them to consult and they may order an x-ray to confirm or rule out an ankle fracture.

How Can our senior physiotherapists help

Before Surgery

If you see our senior physiotherapist after your injury and an ankle fracture is suspected, they will:

• Instruct you in acute injury care using the RICER formula: rest, ice, compression, and elevation.
• Immobilize your ankle by wrapping it with an wrap, or applying a stirrup brace to limit motion and control swelling or even a customized ankle splint.
• Apply cold therapy to reduce pain and swelling.
• Instruct you to keep the involved ankle elevated to control swelling.
• Instruct you to walk without putting weight on the injured ankle, using crutches or a walker.
• Make recommendations/referrals for additional care with an orthopedic physician

If you have an ankle fracture, treatment will depend on how many bones are broken, and if it is a simple, complex, or compound fracture. Initial treatment involves the realigning and stabilizing of the bones by your orthopedic specialist, and is performed in the hospital emergency room or, if needed, with surgery.

After Surgery

If your ankle requires corrective surgery, your affected ankle will be placed in a cast or fracture boot to stabilize it after ankle surgery. You will likely be hospitalized for at least one night (usually 2-3 or more), and you will be visited by your orthopedic surgeon to check on your ankle healing and ensure things are going well.

Then you will be discharged and referred for post-surgery ankle physiotherapy.

In the beginning, you may consider to request for our house call/home visit physiotherapy, where we send our senior physiotherapist to you to provide ankle physiotherapy in the comfort of your home as you may be tired post-surgery. We recommend a few sessions of home visit physiotherapy, and then we "upgrade" to physiotherapy in our clinics.

The reason for this is a few reasons:

• more equipment to help you heal faster
• we find that patients who come to the clinic has higher motivation (perhaps it also includes a sense of outing/normalization/socialization)

Ankle fracture physiotherapy ranges from 12 - 24 weeks, depending on

• severity of the ankle fracture
• healing rate of the ankle (including if there was any wound infections)
• how the ankle responds to ankle physiotherapy
• how fit/well the patient is before the injury/ankle surgery
  

We may teach you how to walk with the use of an assistive device, such as crutches or a walker. You will also learn how to go up and down steps and curbs using your assistive device.

When an x-ray confirms that the fracture has healed, your orthopedic surgeon will remove your cast. Our senior physiotherapist will work with you to safely put weight on your ankle, and begin treatment to help you return to your normal activity.

If You Do Not Require Surgery

Our senior physiotherapist can help treat a broken ankle after it has been treated by a physician and immobilized. After the bone is healed, we can help you gain back your ankle

• strength
• motion
• balance
• walking/gait pattern
  
• sport skills

After your injured leg is placed in a cast or a cast boot, we will teach you how to walk without bearing weight on the injured ankle, using crutches or a walker. Your physical therapist will teach you how to get in and out of bed, and your car.

When healing of the fracture is seen on an x-ray, your physician will remove your cast, and you will begin bearing weight on that leg again, and continue your physiotherapy treatment.

Physical therapy treatment will include:

• Gait/Walking Instruction. We will help you begin to put some of your weight on the injured leg, gradually progressing to full weight as your physician recommends.
• Gait Training. We will offer specific instruction and exercises to restore a normal walking pattern. The focus will be on how your foot and ankle move, and the timing of your steps. You may practice on a treadmill at low speed, on level ground, and on steps.
• Reducing Swelling. Swelling is very common after an ankle fracture. Treatment may include gentle massage, the use of a compression wrap, cold therapy, or heat therapy, and elevating the affected ankle when at rest.
• Exercise. We will design an exercise plan to begin when the cast is removed to help you strengthen and regain motion in your injured ankle. It is very important to regain the ability to bend/move your ankle to restore your full walking ability.
• Restoring Ankle Mobility. Our senior physiotherapists may use manual (hands-on) therapy to gently move your foot and ankle joints and surrounding tissues to reduce stiffness, and increase the ankle's bending range of motion.
• Return to Work/Play Activity. As you regain strength and flexibility, we will provide activity training specific to your job, leisure activity, or sport.

Return to full participation in sports and work activities generally occurs 12 to 24 weeks after an ankle fracture.

Note: Physiotherapy treatments and number of sessions is different for every patient and depends on your type of injury, how you are healing, and whether you had surgery, as well as your age and physical health.