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Ankle Fractures: Causes, Treatment and Common Exercises

February 13, 2020 by Kam Hoonjan

ankle fracture - physiotherapy and chiropractic treatment in TorontoA surgical consult for an ankle can occur for different reasons. The most common and urgent cause being an ankle fracture (break in a bony integrity). Other reasons you may consult with an ankle surgeon include but are not limited to; chronic instability, chronic tendon dysfunction and arthritis.

What Can Cause an Ankle Fracture?

Ankle fractures can be caused by excessive force that the anatomical structures including soft tissues and bone are not able to absorb. This can occur from a forceful twisting, turning, rolling or impact to the ankle. Stress fractures can also happen over time due to repetitive force or an underlying bone health issue.

What Type of Ankle Fractures Are There?

The most common type of ankle fracture is a unimalleolar fracture which occurs at the lateral malleolus, the bony bump on the outside of the ankle. A bimalleolar fracture is the second most common and occurs at both the lateral malleolus and the medial malleolus, the bony bump on the inside of the ankle. A trimalleolar fracture involves all three sides of the ankle: the outside and inside structures mentioned and the posterior rim of the tibia at the back of the ankle.

How Can Physiotherapy, Chiropractic and/or Massage Therapy Help Treat Ankle Fractures?

Patients with ankle fractures are usually given a non-weight bearing status by their doctor for 4-6 weeks, meaning they will need to use crutches with a cast as they are not permitted to put weight through that foot when standing or walking. During this time, the patient can see their physiotherapist to help them optimally adjust their gait aid and to learn exercises they can be doing to manage pain, swelling, and maintain strength to nearby joints while casted. Around the 6-week mark, if imaging demonstrates the bone(s) are healing well, your doctor will give you clearance to begin hands on treatment in the form of physiotherapy, chiropractic and/or massage therapy. It is important to start treatment right away for optimal recovery. As a result of immobilization in a cast, the ankle will become stiff, weak and the muscles around the joint will be tight. The goal of therapy is to improve pain, range of motion, strength, and return to desired activities.

What Should be Avoided with an Ankle Injury?

Patients should follow the instructions from their doctor regarding their weight bearing status and any other special instructions they may have been given. This may include avoiding to put all or some of their weight through their affected ankle early in the rehabilitation process. Your Physiotherapist and or Chiropractor will make sure to fully explain your doctor’s instructions before commencing treatment. When you first start to use your ankle again after the cast you may experience pain, swelling and some uncomfortable sensations. This is most likely normal but it is always important to bring them to the attention of your health care professional.

How Long Does It Take to Recover from Ankle Injuries?

Some ankle fractures can heal without surgery using a cast or a splint, however, more serious fractures will require surgical intervention with the insertion of hardware (pins, screws or plates) to ensure optimal alignment of the ankle bones. Generally, bones heal by 6 weeks and you can start introducing stress, but other injured soft tissues, such as ligament damage, may prolong the healing process.

It usually takes another 2-3 months to restore full range-of-motion, strength and function in the ankle. In some severe cases it can take up to six months to a year to maximize range of motion, strength and function. In these cases, full range and function may not be achieved due to uncontrollable factors and you may be at higher risk to develop arthritis.

The prognosis for the injury is better if the patient receives rehabilitation early and does not have hardware inserted into the joint space.

What Are Some Safe Home Exercises for a Post-Immobilized Ankle?

Most importantly, it is always best to follow your sports doctors, physiotherapist and or chiropractors’ instructions post operatively as every ankle fracture and or surgery is different.

First, you can begin range-of-motion and mobility exercises. These can include things such as ankle circles and movement of the ankle in specific directions. Another exercise you can typically start right away is calf stretching. You can perform a calf stretch by using the belt to pull the ball of your foot towards your shin, holding to a point that a comfortable pulling sensation is felt on the back of the calf.  This is held for 30 seconds and repeated three times 2-3 x/day.

Next it is important you get comfortable with weight bearing through that leg and ankle. This can start by standing near a counter for support while shifting weight slowly from the unaffected side to the affected side to a point before there is discomfort and repeating daily.

When it comes time to remove the cast and you are cleared for weight bearing, exercises and hands on therapy should start right away. It is important to consult with your health care professional so they can develop an individualized exercise program which will include strengthening and balance training. Finally, as range of motion and strength have been maximized, speed and agility exercises such as running, jumping and cutting will be introduced.

If you are suffering from an ankle fracture and are seeking treatment, please contact us today.

Kam Hoonjan

Kam Hoonjan is a registered physiotherapist practicing at Rebalance Sports Medicine in downtown Toronto.

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