A broken ankle is a fracture of one or more of the bones that form the ankle joint: the lower ends of the two lower leg bones, the tibia and the fibula. It most often happens when the ankle twists sharply, in a fall or from a blow. Sometimes a broken ankle looks like a severe sprained ankle, so if the pain is severe and the ankle swells quickly, you need an X-ray. A fracture is treated with a cast, a walking boot (orthosis) or surgery, and rehabilitation is then needed so that you can walk steadily again. Kaloyan Zarkov works with patients after a broken ankle at the practice in the Lozenets district and at home.
Symptoms
- Severe pain in the ankle straight after the injury.
- Quick swelling and bruising that may spread down to the foot.
- You can’t put weight on the foot or take a few steps.
- Pain when you press on the bone at the side of the ankle.
- The ankle looks deformed if the bones have shifted.
- Numbness or a cold foot.
After the cast or boot comes off, the ankle is usually stiff and swells in the evening. The hardest things are stairs, uneven ground and walking without a limp.
Why it happens
- A sharp twist of the ankle in sport, on a kerb, a step or an uneven surface.
- A fall, including from a low height or on stairs.
- A direct blow or a road accident.
- Bones that weaken with age (osteoporosis).
The fracture is confirmed by X-ray. The orthopaedic doctor decides how to treat it: with a cast or a walking boot if the bones are in place, or with surgery using a plate and screws if they have shifted or the joint is unstable. Sometimes displaced bones can be put back in place without surgery. The orthopaedic doctor also decides when you can put weight on the foot, and how much. The bone usually heals within a few weeks, but a normal walk takes longer to come back.
How we treat it
Rehabilitation starts right after the cast comes off. Until then, it’s important to move the toes, knee and hip, which aren’t in the cast. Bring the discharge summary from the hospital, your X-rays and the orthopaedic doctor’s instructions. Kaloyan asks what you’re allowed to do, then checks how far the ankle moves, your muscle strength, the swelling and how you walk. The doctor’s timelines are always followed, and when needed Kaloyan contacts the orthopaedic doctor.
The foundation is kinesitherapy for injuries (exercise and manual therapy), and the work goes in stages. First come device-based physiotherapy and manual therapy, that is, Kaloyan loosening the ankle with his hands. With Combined physiotherapy, Kaloyan picks the devices at the practice that suit you, for example to bring down the swelling. Then come passive-active movements: you move the ankle yourself, and Kaloyan takes the movement further than you can on your own. Last are the active exercises for lower leg strength, balance, walking without crutches and climbing stairs.
If the fracture was operated on, the work is post-operative rehabilitation within the surgeon’s timelines. If you’re older and getting around is hard, Kaloyan can come to you with home visits. You leave with a few exercises for home, shown and explained. Usually 5–10 sessions are needed, depending on the fracture and how long the ankle was immobilised.
What you can do yourself
- While you’re in the cast, move your toes, knee and hip several times a day.
- When you rest, raise the leg above the level of your heart to reduce the swelling.
- Put weight on the foot exactly as much as the orthopaedic doctor has allowed, no more and no less.
- Use the crutches until the doctor says you can manage without them. Kaloyan will show you the exercises that suit you.
When to see a doctor first
See a doctor first, or call your orthopaedic doctor, if:
- your calf is swollen, painful and warm: this may be a blood clot (thrombosis) and needs an urgent examination;
- you have chest pain or sudden shortness of breath: call 112;
- your toes are numb, cold, pale or blue, especially under the cast;
- the pain gets worse instead of easing, or the wound is red and warm and you have a temperature;
- you’ve fallen again or twisted the same ankle sharply.
