Broken ankles and the different types

When we roll an ankle, often we feel a significant amount of pain in the short term, and then after 10 minutes or maybe an hour, it starts to feel better again. We find that we can walk on it again or at the very least, put weight through the ankle again. But sometimes the pain and swelling lingers and just won’t go away. In this case, the injury can be more than torn ligaments alone, it can be a fracture (just to be clear, a fracture is a medical term for a break, not just a grading system for how badly a bone is broken). We are going to “break” down some of the different types of ankle fractures and some of the common management strategies for these.

Anatomically, as you can see in figure 1 – the ankle is made up of a mortise style joint. This means one bone slots into the groove of another bone(s). In the ankle, this is the talus bone of the foot slotting into the groove that is formed between the tibia and fibular bones. The first type of fractures we will discuss identifies injury are the Weber classifications. This refers to the specific level of the fracture in relation to the ligament that holds the tibia and fibular bones in place.

Weber A – this type of fracture involves the distal (or furthest part) of the fibula bone. It can often be seen in conjunction with a rolled ankle, as the ligaments can pull a section of the bone with them as they stretch and elongate. This is least unstable of the Weber fractures as it does not affect the integrity of the ankle joint. These can typically be managed in the same way as an ankle sprain and immobilised in a brace or boot for a short period, and then physio exercises can commence to regain strength. These can vary in return to activity timelines but anywhere from 2-6 weeks is typical.

Weber B – this fracture occurs at the level of the syndesmosis and is seen in conjunction with a syndesmosis ligament tear. The syndesmosis can either partially or completely tear and this type of fracture is more instable. Immobilisation in a boot or brace is essential for these injuries and in some circumstances, surgery may be indicated to repair the damage. A period of non-weight bearing is also required for this type of injury. 6-8 weeks is a common return to sport timeline for this injury, but potentially more depending on the intervention required.

Weber C – these are the most unstable of the fractures described because they occur further up the leg and above the syndesmosis. The fracture occurs above the syndesmosis, hence in classification. These almost always need a period of non-weightbearing and can take 6 weeks or more to completely heal or resolve.

In any ankle injury, physio exercises to strengthen around the ankle are vital. Regaining strength in the calf muscles, tibialis posterior, peroneal muscles, plus the muscles around the foot and the knee are all essential in ensuring a successful and high performing return to sport, activity or life!

Other types of broken ankles can include tibial fractures (the shin bone) usually caused by trauma or a Jones fracture of the foot. This is a chip off the outer most bone in the foot (the 5th metatarsal) and needs close examination of an x-ray to identify. While this is a summary of ankle fractures, it is by no means a complete list. If you’ve hurt your ankle and aren’t sure on how to best manage it, reach out to one of our physios today at Instinct Health and we can help guide you and get you back on track!

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The Anatomy of the Shoulder

Broken ankles and the different types