Your foot is a complex structure that consists of 26 bones, 33 joints, and over 100 muscles, tendons, and ligaments. Its unique design allows your foot and ankle to handle heavy forces every day. But how much force can your ankle take before you fracture your ankle?

The unique design of your ankle makes it a very stable and strong joint. It needs to withstand 1.5 times your body weight when you walk, and up to eight times when you run.

The average adult takes 4,000 to 6,000 steps per day. That’s enough steps to walk around the earth four times during your life. When you consider the weight and stress we place on our feet and ankles each day, it’s easy to see how approximately 80% of people will experience a foot or ankle related problem at some point.

Luckily our physiotherapists are fully equipped to deal with all ankle injuries, including your broken ankle.

What is the structure of your ankle joint?

Your ankle is made up of 3 bones that come together. These 3 bones are the tibia, fibula and talus bones.

  1. The tibia or the shin bone is the main bone of your lower leg. The tibia makes up the inside part of your ankle.
  2. The fibula is the smaller bone that runs parallel to the tibia in your lower leg. The fibula makes up the outside part of your ankle. The furthest ends of the tibia and fibula are known as the malleoli. Together they form an arch that sits on top of a bone called the talus.
  3. The talus is a small cube like bone in your foot and carries all the weight of your body when standing on 1 leg.

How does your ankle joint actually function?


The tibia is the bigger bone and also carries most of the body weight. Whereas the fibula is a much thinner bone and it serves as an anchor for muscles to attach onto. Lastly the talus is a small cube shaped bone forming part of the foot. The ends of the tibia and fibula glide on top of the talus to form your ankle joint.

There is a cushion or lining between these bones, called cartilage. The main purpose of cartilage is to provide shock absorption and but more importantly a even surface for these bones to glide on one another allowing smooth movement of your ankle. These 3 bones form the movement surfaces, while stability is provided by surrounding connective tissues: Interosseous membrane, joint capsule, and various ligaments. It’s important to understand that with an ankle fracture not only the bone breaks, but various other structures get injured around the bone that help to keep it sturdy.


Ligaments connect bone to bone to provide stability to the joint. Ligaments always tear to varying degrees with an ankle fracture. When ligaments are torn it leaves your ankle unstable.

I have a broken ankle… How did it happen?

Pressure over the shin or foot, fractures your ankle. When you stress your ankle beyond its boundaries you injure the joint. If only your ligaments give way and tear, you’ve sprained your ankle. If the force exceeds the strength that the bone can handle the bone cracks and you end up with an ankle joint fracture. Torn ligaments always accompanies a broken ankle, and sometimes the ankle joint even dislocates.

Ankle breaks can occur in several ways such as:

  • Rolling your ankle in or out.
  • Twisting your ankle side to side.
  • Flexing or extending your ankle joint beyond its normal range.
  • Landing on your turned in ankle.
  • With high force impact like a kick to the shin.

Risk factors that increases your chances of getting an ankle fracture

  • Smoking – Nicotine and increased levels of corbon-monoxide lowers the body’s immune response to repair injured tissue.
  • Diabetes – Bone healing is slow due to uncontrolled bloodglucose levels.
  • Obesity – A Couch potato’s poor circulation and not to mention the added weight and forces your ankle must hold.
  • Previous falls or fractures – Poor stability from the supporting structures around your ankle can put you at high risk of re-injuring your ankle.
  • Very high or low levels of physical activity – Poor circulation and nutrition can alter bone structure and strength, than makes it easier to break.
  • Low bone mineral density – underlying conditions can absorb more Calcium from your bones making them brittle.
  • Individuals older than 50 years of age – Bone density peaks in your 30s, and gradually declines throughout your life, in some patient this process is accelerated triggered by hormonal changes, especially in females. Even a greater risk after menopause without hormone replacement therapy.
  • Post menopausal bone loss – hormonal changes triggers faster absorption of Calcium due to lack of estrogen that is an essential ingredient to create osteoclasts (bone forming cells)

Causes of your broken ankle.

Ankle breaks that occur suddenly, during a specific incident or injury, are known as traumatic ankle fractures. But bone in the ankle can also break/crack due to repetitive stress over time, or a sudden increase in the load required of the ankle. This leads to mechanical fatigue of the bone and as a result a fracture, called a stress fracture. Lastly, a fracture of the bone can also occur as a result of a disease such as cancer and is then known as a pathological fracture.

Ankle fractures are mostly caused by traumatic incidents such as falls, high speed motor vehicle accidents, twisting injuries, and sports-related injuries. Therefore ankle fractures do not only occur in the older, but also the young and active population.

Ankle sprains and even fractures are commonly seen in sports.

Mainly those that involve a lot of jumping, for example: netball, basketball and tennis. With these jumping sports, the players usually injure the ankle when landing on an inward turned ankle, or landing on another player’s foot, or even as simple as a quick direction change/pivoting action to reach that ball in time.

Ankle breaks are also found in contact sports or high velocity sports such as rugby, soccer and motocross. With contact sports for example rugby, the player’s ankle might be stuck in a ruck with numerous players lying on his foot. The player then gets tackled and his foot is anchored by the ruck only to be forced in a direction that the ankle is not normally suppose to move in, leading to a broken ankle. Motocross on the other hand can lead to different ankle fracture types, depending on what position the ankle is in and at what speed and position the ankle hits the ground when falling off the motorbike.

Symptoms of a broken ankle

Your body will respond with an inflammatory reaction when you fracture or even just sprain your ankle. This inflammatory response is the body’s natural way of dealing with an injury. Common symptoms of inflammation after a broken ankle would be swelling, redness, decreased movement of the ankle joint, increased pain and an increase in temperature localized to the fracture site.

When you fracture your ankle you will most probably also have some bruising to the surrounding muscles. Muscles that are commonly bruised and that go into spasm with an ankle fracture are the Tibialis posterior muscle, Peroneal muscles, Achilles tendon, Gastrocnemius muscle and the Soleus muscle.

When these muscles are inflamed and in spasm, you will have difficulty in moving your ankle and you might also be burdened by muscle cramps, a tingling sensation in the foot, and throbbing pain when the leg is hanging.

Tests that you can do to see if you have a broken ankle

Here’s a few test for your painful ankle and see if you might have a broken ankle. These test should guide you to distinguish whether your ankle is broken or just badly sprained.

  • Stand barefoot without any walking aid. But be close to a stable object to hold onto if you do need some additional support.
  • Slowly shift your weight onto the painful leg.
  • Attempt to lift your unaffected foot off the floor, taking all the weight through the painful leg.
  • If you experience severe pain that prevents you from taking full weight or the leg gives way under you, you most probably have a broken ankle.
  • Sit on a bed and bring both legs up onto the bed.
  • Place the two ankles next to one another.
  • Compare the shape and symmetry of the two ankle joints.
  • It is to be expected that the injured ankle will be swollen.
  • If there is a drastic difference in the shape of the injured ankle, with a prominent bump or dip on the bone you might have fractured the ankle.
  • Stand barefoot with no walking aid, but be close to a firm object to hold onto if you do loose your balance.
  • Shift all your weight onto the painful ankle.
  • Now attempt to give 3 small hops on one leg, taking all the weight on the injured leg.
  • Also attempt to land on the same spot after each hop.
  • If you have too much pain to even do 1 hop or if your co-ordination is severely compromised you might have a broken ankle.
  • Bring both feet up onto a bed.
  • Try to localize the most painful area by rubbing over the injured ankle joint.
  • If your ankle is tender or hurts specifically over your ankle bone and not the soft tissue part of the ankle, you most probably broke your ankle.
  • Try to recall what sound you heard when you injured your ankle.
  • If you heard a loud popping sound, you most probably sprained your ankle.
  • Whereas if you heard a loud cracking sound, the chances are good that you might have fractured your ankle.

How severe is my ankle fracture?

Seeing as your ankle joint is comprised of 3 bones, there are numerous ankle fracture types. In the medical field your ankle is seen as having 3 sides and a “roof”. Fractures can occur in each of these areas or in combination, depending on how you injured your ankle. The lower portion of your shin bone forms the roof and inside of your ankle. While the lower portion of the Fibula forms the outside and back of your ankle joint.

The most common ankle fractures are:

Lateral malleolus fracture: This is the most common ankle fracture type. It is a break of your lateral malleolus, the knobby bump on the outside of your ankle and the lower portion of your fibula.

Bimalleolar ankle fracture: This is the second-most common ankle fracture. This type of fracture involves the break of both your lateral- and medial malleolus, the knobby bump on the inside of your ankle and lower portion of your tibia.

Trimalleolar ankle fracture: This type of ankle fracture involves breaks in all 3 sides of your ankle. Namely the medial- and lateral malleolus as well as the lower portion of your posterior malleolus of the tibia.

Pilon ankle fracture: Also known as a Plafond fracture, this is a fracture through the weight bearing “roof” of your ankle (the central portion of the lower tibia). This fracture is usually a result of a higher energy traumatic injury, for example falling from a height and landing on one foot.

As the number of fracture lines increase, so does the complexity of your injury and your risk of long-term joint damage. Trimalleolar ankle fractures and pilon fractures have the most cartilage injury and therefore, have a higher risk of developing arthritis and degenerative changes in the future. Within each of the above fracture types, the fracture will be further classified as a displaced or nondisplaced fracture.

Displaced: Broken portions of bones shifted and are not well aligned.

Nondisplaced: Bones are broken but didn’t shift and are still well aligned.

The treatment of your fractured ankle will be based on your fracture alignment and the stability of your ankle joint. Generally a nondisplaced ankle fracture doesn’t require any surgery or lead to many secondary complications. Whereas a displaced ankle fracture mostly requires surgery and has greater risk of developing postoperative infection, malalignment and quicker degeneration of your ankle joint.

Things to consider when determining how severe your ankle fracture is… If you feel you have many of the following symptoms your ankle fracture is more serious.

  • Frequency – Constant pain that does not resolve with pain medication.
  • Size – Very focused area of pain on the bone that radiates up the shin to the knee or down to the foot.
  • Color – Severe discoloration and bruising of the area.
  • Loading – Not able to take any weight on the injured leg due to too much pain or your ankle joint giving way.
  • Amount of movement – Limited or no movement of your ankle, limited by pain and grinding of the broken bones.
  • Intensity – Severe pain with a localized sharp stabbing pain, that radiates up and down your leg.
  • Movement or static positions – Severe pain when moving your ankle and only slight decrease in pain when keeping ankle still.
  • Symmetry – Drastic difference in shape and alignment of your ankle compared to the uninjured side.
  • Open or closed fracture – If the displaced bone fragments pierce through the skin.
  • Amount of bone involved – If all 3 bones of your ankle is fractured.
  • Numbness – Complete sensation loss and severe pins and needles felt in your toes.


Physiotherapy diagnosis

Our physiotherapists are experts when it comes to the structure of your ankle and experienced in the type of injuries that can lead to a fractured ankle. We have years of experience to test, diagnose and treat a fractured bone. If you have a broken ankle, we will accurately diagnose it and refer you to get a X-ray and confirm the size, shape and stability of the fracture. If you perhaps don’t have a broken ankle we will be able to confidently identify the root cause of your ankle pain by testing other structures like joints, muscles, ligaments and nerves in the area and provide you with an accurate diagnosis. That’s why our physiotherapists are the best equipped to manage your ankle injury.


Therefore x-rays are the best to diagnose an ankle fracture. We can determine the site, size depth and number of bones that’s broken, even larger cracks can be picked up by a skilled radiologist.

X-rays shows the integrity and alignment of the 3 bones that make up your ankle joint. Our physios can refer you to get x-rays.

Diagnostic ultrasound

A Sonar is not the first choice of imaging when want to confirm a broken ankle bone. However, bone gapping, callus formation and sever bone oedema can be signs that we look for to assume there might be a fracture. Sometimes avulsion fractures are first picked up on sonar, that’s usually followed by an X-ray Furthermore ultrasound identifies bleeding, ruptured ligaments and tendons around your injured ankle.

If you need an ultrasound, your physio will refer you.


An MRI scan can image all of the structures in your ankle, including soft tissue, ligaments, nerves and bones. However, for a simple broken ankle an image like this is unnecessary and very expensive.

A MRI scan would also be requested if you sustained a very complex ankle fracture where multiple bones are involved leaving you with many displaced bone fragments (comminuted fracture). The scan will then assist the surgeon as to which technique to use to reduce or realign and fixate the many pieces of broken bone in your ankle.

If your physiotherapist suspects that you sustained a very complex ankle fracture, you will be referred to the right specialist whom is authorized to request an MRI scan.

Why is the pain not going away?

When you fracture your ankle, the initial pain that you feel in and around your ankle joint is considered to be normal. This is your body’s way of warning you that you are loading your injured ankle too early. It reminds you that your broken ankle still needs to heal and thus you can see the pain as a protective mechanism. There is a risk of more critical and possibly irreversible damage if you don’t take the warning signs seriously.

If you follow the correct treatment protocol, your pain should gradually decrease with time. However, if you neglect to work through your rehabilitation process and don’t get the right treatment from the start, you’ll continue to feel pain. With time, it will bother you more and more, it will prevent you from using your leg properly and your ankle and knee will get painful, weak and stiff. You become stuck in a cycle of pain, not knowing if it is better to respect pain or push through pain.

It is crucial to ensure that you are getting the right treatment for your ankle fracture from the start.

This includes getting an accurate diagnosis, the right medical treatment and working through a proper rehabilitation program. This includes surgery to realign and fixate your broken bone, ensuring optimal healing for the bone. This optimal healing gives you confidence that your ankle is now stable and ready for strengthening and loading. Rehabilitation is the only way to ensure that you regain optimal function of your leg and ankle. This program ensures that you can return to walking, running, jumping and even taking your better half for a spin on the dance floor.

What NOT to do

  • Continuous use of anti-inflammatory medication

  • Not keeping to the treatment guidelines, and taking weight on the injured ankle too soon or removing the moon boot.

  • Not respecting your ankle pain and pushing through the pain

  • Not doing your prescribed exercises because it is uncomfortable

  • Do not ignore your ankle pain that gets worse

  • Leave it untreated

What you SHOULD do

  • Rest, elevate and offload the ankle as instructed

  • Take your pain medication as prescribed so that your pain is well controlled.

  • Make an appointment with our physiotherapists to confirm the diagnosis and determine how severe the tissue damage is

  • Finish your treatment and rehabilitation program for better long-term results and to prevent re-injuring your ankle

  • If you are uncertain of the diagnosis, rather call us and be safe.

Making it worse

  • Sitting with the foot hanging for prolonged periods

  • Returning to strenuous sports like rugby, soccer and netball too soon

  • Walking without your brace or moonboot while your ankle is still healing

  • Not using your crutches

  • Trail running

  • Wearing high heels

  • Rope skipping

  • Walking long distances on the beach while your ankle is still weak

  • Continuous wearing your moonboot/ankle brace after the physiotherapist instructed you to stop using a brace

Problems we see when patients come to us with an injured ankle…

Patients wait too long to consult a physiotherapist, because they think the pain will get resolved on its own. Many people easily mistake a badly injured ankle with a minor sprain. What makes things even more difficult is that the symptoms of a badly sprained ankle and a broken ankle overlap and are very similar. The problem with leaving a broken ankle without treatment for too long is that many secondary complications and protective mechanisms start to kick in; like severe muscle stiffness, blood clots that can form in the calf and abnormal walking patterns leading to other painful joints

Not getting a proper diagnosis can delay your healing time and might cause more damage to the already injured ankle as well. Trying out, but not completing different forms of treatment is a very common problem that we see in our practice. You might tend to think that your ankle is healed when you don’t experience any pain and when you realise that you can return to your normal daily activities. Unfortunately, this is not the case. You can reinjure your ankle very easily when you’re doing an odd activity. For example playing volleyball on the beach during your long awaited holiday. The reason for this reinjury is that even though your ankle is now pain free, it is not yet optimally strong and is specifically lacking balance and stability. Balance and stability needs to be retrained and is usually done at the end stage of your treatment process.

Medication use has a fine balance that needs to be maintained. You need to ensure that you take enough medication to control your pain and enable you to exercise effectively, but remain cautious of taking too much pain medication. You need to be weary of masking your pain and pushing your injured ankle too hard which can cause more harm than good.

Wearing a brace and the use of crutches greatly assist your ankle by decreasing the load on the joint. But, these aids should only be for a specific time frame, while your ankle joint is still healing. A few functional goals need to be achieved first before your physiotherapist will start guiding you away from using a brace and crutches. Using these walking aids for too long can actually weaken your ankle joint and delay your healing.

Physiotherapy treatment

We are confident that we can provide you with the best possible treatment for your broken ankle. Patients are often scared that they will never be able to participate in their favorite sport again, or won’t perform at the same level as before their injury took place. That is why we are here to provide guidance and answers throughout your healing journey to address your fears. We understand the various treatment protocols to follow for your specific ankle fracture and will be able to provide you with guidance and advice. A personalized treatment program will be formulated for your specific injury and get you back to full function.

We’ll develop and implement a tailor made treatment program for you, that treats all the aspects of your injury. This way your ankle pain, weakness and poor joint stability will improve and you’ll be able to hop, skip and jump with confidence again. However, it’s important that you complete your treatment plan, as this improves your chances of a full recovery and decreases the risk of reinjury.

Our physiotherapists will use these techniques during your treatment:

We use Ultrasound and Laser machines to decrease your pain and speed up the healing process. Strapping and Taping is used to support and protect your weak ankle joint from further injury. Dry Needling of the surrounding compensating muscles, is used to ensure smooth pain free movement of your joint. We Massage and use Soft tissue mobilization of all the affected muscles to improve blood flow and speed up your healing. Joint mobilization techniques move all the surrounding joints and Myofascial release of the lower limb muscles limit excessive scar tissue formation and compensatory patterns from forming. Eccentric loading, followed by plyometric exercises condition the muscle fibers. Compression bandaging can promote blood flow through the site of injury and prevent blood clots from forming in the calf area. Gradual loading of the fractured bone conditions your ankle to handle weight once more. Crutches and an ankle brace immobilize/offload the ankle joint for the first few weeks which enables your ankle to rest. We will gradually progress your rehabilitation exercises to regain full function of the lower limb.

Phases of rehabilitation

1st Phase: Pain management, protection and initial healing of your ankle.

Period: (0-1 week)

The first phase of rehabilitation will run from your initial incident where you broke your ankle up until a week after your ankle fracture.

Aim of this phase:

Hematoma Formation (days 1 to 5 after fracture). This stage begins immediately following the fracture and starts the healing process of your broken bone. Fibrocartilaginous callus formation (days 5 to 11 after fracture). This stage involves the forming of new bone cells to mend your fracture site. It is crucial to ensure good immobilization of your ankle joint by means of a cast, brace or moon boot to limit the excessive movement of your broken bones. Adequate immobilization will allow for optimal bone healing to take place through surface contact of the 2 broken bones. Not taking any weight on your broken ankle, is important to ensure no displacement of your fractured bones.
To decrease your inflammatory response that was triggered by your ankle fracture. This would include decreasing the swelling, pain, and stiffness of your ankle.

Another aim of this phase would be to keep your blood flow optimal in your leg to avoid blood clots from forming. Lastly, maintain your optimal level of functionality by learning how to safely mobilize (non-weight bearing on your injured leg) with crutches. This would ensure that your overall body strength doesn’t decrease by lying in bed the whole day or by being pushed around in a wheelchair.

Physiotherapy treatment techniques used in the first phase are:

Laser and ultrasound are applied to the injured area to decrease swelling and increase the rate of healing. Cryotherapy, correct elevation techniques, light massage (of the surrounding muscles and soft tissues), circulatory and strengthening exercises helps to decrease pain. Compression bandaging, Kinesio taping (to improve circulation), and the teaching of correct walking patterns with crutches, are used to support the hands-on therapy received at the practice. We will educate you on the correct use of medication relevant to your ankle condition (precautions and contraindications for this specific phase).

Functional goals you should achieve in this phase:

At the end of this phase you will be able to walk and climb stairs with crutches independently with non-weight bearing on the affected leg.

2nd Phase: Establishing pain free range of motion and strengthening

Period: (2-6 weeks)

This period will run from 2 weeks up to 6 weeks after your ankle fracture. At 6 weeks you will generally be allowed to start taking weight on your affected leg.

Aim of this phase:

Achieve good bone healing and union through your normal physiological processes. These processes include bony callus formation (days 11 to 28 after fracture). Callus formation/new bone-cell formation can be seen on an X-ray as a cloudy white formation at your fracture site. Take control x-rays at 6 weeks after your fracture to ensure optimal bone healing takes place. Achieve pain-free range of movement on your broken ankle.

Maintain full range of motion on your surrounding joints (knee and foot). Strengthen your affected leg in preparation for walking. Improve balance and coordination of your affected limb in preparation for walking. Desensitize your broken ankle to avoid hypersensitivity from developing.

Physiotherapy treatment techniques you can expect in the 2nd phase are:

We will use Soft tissue release, TENS, laser therapy, and Joint mobilization techniques to decrease the swelling and pain. Neural interface release, Strengthening exercises for your surrounding muscles, and Isometric exercises are used to build the necessary support for your fractured ankle. Balance and coordination retraining is used to help get your ankle in working condition once more.

Functional goals you should achieve in this phase:

At the end of this phase, you will be able to walk with crutches and take partial weight on your affected leg. When you walk with crutches you will feel minimal pain, adequate strength, and good balance on your affected leg.

3rd Phase: Soft tissue, bone and joint stress

Period: (6-8 weeks)

This period will run from 6 weeks up to 8 weeks after your fracture.

Aim of this phase:

Bone remodeling (day 18 after fracture onwards, lasting months to years). 6 Weeks after your ankle fracture, no fracture line should be seen on a x-ray. A white bump like formation can be seen at your fracture site uniting your 2 broken bones. This “bump of bone” will gradually remodel and become smaller, after a few months no bump will be seen and your bone would look the same as before your fracture took place.

Evaluate to see if your ankle joint and lower limb muscles are able to handle tensile, elastic and compression forces. Gradually increase the load required on your ankle to condition the joint and surrounding muscles. Ensure that you regain confidence in your ankle’s functional ability.

Physiotherapy treatment techniques:

Gradually we will increase the loading of your affected joint, and ensure independent walking with full weight-bearing. Soft tissue release of your surrounding muscles and ligaments as well as Joint mobilization techniques are used to help you make the most of this phase. Corrective taping and bracing of your joint and muscles as support and Dry needling of your muscles. Finally, there will be Concentric strengthening exercises and Proprioceptive and balance retraining.

Functional goals you should achieve in this phase:

You will be able to walk independently, pain-free, without crutches or a limp. At the end of this phase, your ankle will have full range of movement and you will be able to balance on your affected leg for 10 seconds without losing balance and without pain.

4th Phase: Muscle strength and endurance

Period: (8-10 weeks)

This period will run from 8 weeks up to 10 weeks after your fracture.

Aim of this phase:

To Optimally strengthen your ankle to your specific daily functional demands. Ensure that your ankle can handle an increased load for an extended time period, without failing.

Physiotherapy treatment techniques:

After gradually increasing the load of your affected joint we will start to increase the amount/repetitions of the prescribed exercises. We will continue with Soft tissue release of your surrounding muscles and ligaments, Joint mobilization techniques, and might use Electrotherapy (laser, EMG, Russian stimulations) to support the hands-on treatments. Corrective taping and bracing of your joints and muscles can be used to support your ankle and Dry needling manages the muscle pain you are feeling. Concentric and eccentric strengthening exercises go along with Proprioceptive and balance retraining.

Functional goals you should achieve in this phase:

At the end of this phase, you will be able to walk 1 kilometer, climb an entire flight of stairs (with alternating legs) and balance on your affected leg alone for 60 seconds, without losing your balance, feeling pain, or limping.

5th Phase: Joint stability, proprioception and plyometrics

Period: (10-12 weeks)

This period will run from 10 up to 12 weeks after your fracture.

Aim of this phase:

Optimize your ankle’s stability and balance to avoid future injuries. Restore your ankle’s strength when coming to jumping activities.

Physiotherapy treatment techniques:

We will provide a specific exercise prescription to improve your ankle’s stability and balance as well as use Kinesio taping to facilitate ankle coordination. Rigid strapping can be used to brace or offload your ankle and laser therapy is used to increase the rate of healing. Soft tissue release of your surrounding muscles and ligaments encourages free movement and gets paired with Joint mobilization techniques.

Functional goals you should achieve in this phase:

At the end of this phase, you will be able to balance for 1 minute on your injured ankle, while standing on a trampoline with your eyes closed. You will also be able to run 1 km at an easy pace, and jump & land on your injured ankle with no pain or limping. Every jump on your injured ankle should be as easy as it is to jump on your uninjured ankle.

6th Phase return to sporting activities

Period: (3 months-5 months)

This period will run from 3 up 5 months after your fracture.

Aim of this phase:

Gradually condition your ankle to meet all the requirements of your specific sporting discipline. Ensure that you are ready to return to sport training and matches. Minimize the chances of you reinjuring your ankle.

Physiotherapy treatment techniques:

We will provide endurance and fitness drills (for example Bleep tests) as well as sport-specific exercises (for example dribbling a soccer ball through cones.) depending on the sport you partake in. We make use of corrective and assisted taping techniques to support your ankle and use muscle activation techniques to encourage your muscle movement. Laser therapy is used to support hands-on therapy and Psychotherapy ensures your confidence, in your newly healed ankle. Yes! You can return to your sport.

Functional goals you should achieve in this phase

At the end of the final phase, you will be able to balance for 5 minutes on your injured ankle while standing on a trampoline and throwing a ball against a wall. You can now jump forwards, backward and sideways over a hurdle on your previously injured ankle. When you run on grass you will be able to pivot and change direction quickly to catch a ball without incident, injury or pain.

How long will my ankle fracture take to heal?

The treatment protocol is specifically tailored to your unique condition and might therefor differ slightly depending on your specific injury. In general, a broken ankle that did not require surgery will be handled as follows:

You will need physiotherapy treatment twice a week for the first 2 weeks post fracture, to decrease your pain and ensure safe mobility. After these initial 2 weeks, your treatment sessions can be spaced out to 1 session a week for the next 4 weeks.

At 6 weeks after your ankle fracture, a control x-ray will be requested to ensure adequate bone healing took place. You will have to continue physiotherapy treatment after your fracture has healed. Your last phase in the treatment process will run from 6-10 weeks post-injury. In this phase you will have to see the physiotherapist twice a week. This phase will focus on regaining strength and stability in your injured leg, to ensure you can return to all your daily activities – pain free and confident.

How fast you recover will greatly be up to you. If you commit to and complete the prescribed treatment program, we will ensure that you are pain free and fully functional.

Other forms of treatment

If you start your treatment process at your doctor (GP), then refers you for an x-ray to confirm whether your ankle is broken or not. Afterwards, you will be referred to an orthopedic surgeon by either your GP or physiotherapist. Your physiotherapist or GP will recommend pain meds or injections to decrease pain and inflammation. A biokineticist will be able to help you in the final stages of your rehabilitation and get you back to training for your specific sport. Unfortunately, wearing an ankle brace for a prolonged time won’t be the solution to your problem, but your physiotherapist will ensure that you wear it correctly. Ozone therapy and calcium supplements will only assist your healing process, but your broken ankle will still take 6 weeks to heal and need physiotherapy to return to normal.

When will your broken ankle need to be operated?

Ankle fracture surgery is necessary when:

You sustained a very complex ankle fracture with many broken bones (comminuted fracture). If your fractured ankle’s bones shifted (displaced fracture) and are not well aligned then it will need to be surgically repaired. If you severely fractured your ankle, which resulted in broken pieces of bone piercing through your skin (open fracture), then surgery might be necessary. No bone healing (non-union) or poor aligned bone healing (mal-union) took place in your broken ankle, after 6 weeks of non-operative treatment then your ankle still needs surgery. If it is determined that your bone quality is poor because of an underlying disease.

Types of ankle surgeries that can be done:

There are numerous surgical procedures available to manage your broken ankle. The specific procedure chosen by the orthopedic surgeon will depend on a variety of aspects. For example: what type of fracture you sustained, how old you are and what level of function you want to return to after the surgery.

The aim of any surgical procedure will be to reduce and realign your fracture and then to fixate your broken bones to allow for optimal healing. This fixation is achieved with hardware, for example a plate and screws.

As mentioned before, there are various surgical procedures available to manage a broken ankle, the most common procedures are:

  • Open reduction and internal fixation.
  • Open reduction and external fixation.
  • Closed reduction and external fixation.

Why is rehab important after surgery?

It is important to understand that surgery is only the halfway mark on your road to recovery. Surgery ensures that your ankle fracture is now optimally aligned and fixated in order to heal adequately, this does not imply that your ankle is now as strong as before your fracture. Our expert team of physiotherapists will guide you through the various stages of healing after your ankle surgery. Many aspects of your treatment journey will be addressed post-operatively to ensure that you are fully functional, experience very little pain and also minimize your risk of reinjury.

What else could it be?

Seeing that your ankle is made up of many bones and ligaments, it is sometimes difficult to distinguish between a ankle fracture and a severely sprained ankle. Also, your ankle is very close to your foot and your foot’s structure is even more complex, compared to your ankle. Therefore an injury to the upper part of your foot can be mistaken for an ankle ankle fracture.

Here are some conditions that can be easily confused with a broken ankle, as well as how to distinguishing between the two.

Ankle dislocation

After your ankle has been reduced/put back into its normal position, you will have much less pain and great improvement in the amount of ankle movement. Also, when taking an x-ray of a dislocated ankle, no fractures will be found.

Severely sprained ankle with ligament tear

Your symptoms will present very similarly to a broken ankle. But, when taking an x-ray of a sprained ankle, no fractures will be found. A sonar is used to diagnose torn ankle ligaments.

Lisfranc fracture

This condition is also known as a forefoot dislocation. It can also be very painful, though your symptoms will be localized more on your forefoot area than your ankle. When taking an x-ray of a Lisfranc injury no ankle fractures will be found. An MRI scan is used to accurately diagnose a Lisfranc fracture.

Also known as…

  • Fracture dislocation of the ankle
  • Broken ankle
  • Bimalleolar fracture of the ankle
  • Trimalleolar ankle fracture
  • Avulsion fracture of the ankle
  • Lateral malleolus ankle fracture
  • Pilon ankle fracture
  • Maisonneuve ankle fracture