How can my physio help me with my broken ankle?
August 28, 2019
So you’ve been told you’ve got a broken ankle, and you need to know how to manage it! Let’s take it right back to the start and discuss what a broken ankle actually is.
In medical terms, a broken ankle is same as a fracture. It means that there has been a separation of two sides of any particular bone. There are a variety of different fracture types and these usually reflect the pattern that the break of the bone has taken. Some of these fracture type vary throughout the lifecycle – for example a greenstick fracture is likely to only occur with adolescents or children whose bones have not yet finished hardening. Arthritic fractures by comparison are not likely to occur in a child.
Specifically to the ankle, there are a few more common fracture types. A Weber type fracture explains where the break has happened relative to the ankle joint itself.
Weber A fractures occurs below the level of the syndesmosis (a thick ligament that joins the tibia and fibular bones)
Weber B fractures occur at the same level as the syndesmosis (and higher up in the leg)
Weber C fractures occur above the syndesmosis (and higher again up the leg).
Because of their positioning, Weber C fractures are the most unstable and common treatment for these includes a period of non-weight bearing and a moon boot. There may also be a need for surgery depending on the severity of these.
Another common fracture type is one that occurs to a bone on the outside of the foot. These are often missed, but will be picked up in a thorough examination by a physiotherapist. These are most commonly occurring when an ankle is sprained and the ligaments on the outside of the ankle are stretched and/or torn. The “Pseudo-Jones” fracture occurs when the peroneal muscle pulls a portion of bone away from the rest of the fifth metatarsal bone. This is termed an avulsion fracture. There is a distinction between these and true Jones fractures, which tend to happen slightly further along the fifth metatarsal bone.
From there, there can also be a break to the tibia or the fibular bones. The tibia is again the more unstable option of the two, and will usually require a period of non-weight bearing again. There can again be a need for surgery if a tibial fracture is severe enough. Fibular fractures are generally more stable and less severe, owing to the fact that the fibula bone carries far less of our overall bodyweight than the tibia. These can be often managed in the same way as a sprain of the ankle.
Now that you know you’ve had a broken ankle, where to from here?
Our physiotherapists in Camberwell will be able to give you a diagnosis as to the specific type of fracture or break you have sustained. Sometimes, this may only be possible with a referral for an x-ray or MRI scans. Your physiotherapist will be able to complete this referral for you if necessary.
From there, your physiotherapist will guide you through the process of getting back to normal life and your usual activities.
The first stage in fracture management is to settle down the inflammatory phase and immobilise. If a broken bone is going to move, it will move in the first 2 weeks and therefore this first phase is vital. During this phase, your physio will also help to maintain your range of movement and strength of the muscles surrounding the break. This may mean a period of time in a moonboot or an ankle brace to ensure the bones are not going to shift and the early stages of bone healing can occur.
The second stage of your rehabilitation from a broken ankle is to gradually increase your range of movement of the ankle. One of the biggest limitations after a broken ankle is stiffness into dorsiflexion (or the movement of the knee forward over the toes) and this will be an early goal for you and your physiotherapist. At this stage, you may be able to begin walking again, but usually with crutches or a stick to protect the still-healing broken bone. There will be a host of exercises you may start at this stage including using theraband (or resistance bands) to help in the increasing of range of movement. In the sessions with your physiotherapist, you can expect, amongst other treatment techniques, massage, dry needling and joint mobilisation during this phase to assist in the increase of range of movement. You can expect phase two to last for between 4-6 weeks, or longer in severe breaks.
The third stage is a gradual return to strengthening. If you aren’t already full weight bearing, this is when you can expect to be free of crutches, free of a moon-boot or other immobilisation device. You will begin full weight bearing strengthening exercises like a single leg heel raise or squats, and return to walking, skipping or even jogging if approved. You may well be referred to a gym for some specific exercises for a period of time, or using other household items to increase the resistance and challenge for the broken ankle.
The final stage of your broken ankle rehabilitation is a return to sport or a specific activity. This is likely to be occurring anywhere from 6-8 weeks after the initial break and will be dependent on how well your bones have healed, and how well you have progressed through the previous three stages. Your physio is likely to put you through a return to sport test, and testing the specific movements that initially caused the injury. This will also often result in a few weeks of full and unrestricted training to improve fitness, as well as giving you the confidence to know that you can return to your chosen sport at your pre-injury level.
Be mindful that the timelines listed in this post should be used as a guide only, and you should always consult your healthcare professional after any injury and be guided by them as to your return to play.
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