The ankle joint cannot withstand a sudden twist. Beyond a certain limit, the bone can break, in particular at the level of the malleolus. Rehabilitation usually starts after six weeks of immobilization.
The particular structure of the ankle makes it a fragile joint.
How do you break your ankle?
Theankle joint is designed, primarily, to allow flexion and extension of the foot when walking and running. It is very limited in the lateral direction and in rotation.
Both malleoli, which represent the end of the tibia and fibula, enclose a bone in the foot called astragalus. The whole form “A very tight clamp, in which there is not much play”, explains Prof. Didier Mainard, president of the French Association for Foot Surgery. In these conditions, we understand better why the fracture most often occurs as a result of a sudden twist or tilt of the ankle.
Typical situation: you miss a step or curb and fall on a badly positioned foot.
Likewise, fractures are not uncommon in sports which impose significant mechanical stress on the ankles, with sudden changes in direction as in the soccer where the rugby, all the more so when the cleats block the foot to the ground.
What are the signs?
The pain is the most obvious symptom. Some people hear a crackle and the ankle begins to swell.
“In the majority of cases, the person cannot press on it, unlike a sprain. This functional impotence should alert ”, specifies Pr Mainard.
How is the diagnosis made?
By gently palpating the ankle, the doctor will identify a sharp pain next to the fracture and a possible deformity. In all cases, the x-ray remains necessary. At least two images must be taken, face and profile, to visualize the divide.
We do not appeal to to scan only for complex cases. For example, when the fracture is accompanied by a dislocation, the talus is dislocated.
Should an ankle fracture be operated on?
When the bone is not moved, surgical intervention is not systematic. “We can consider simple orthopedic treatment. But we make a kind of contract with the patient: no support! “, underlines Professor Mainard.
Concretely, the ankle is immobilized for six weeks in a resin boot. The support being prohibited, the person can move only with crutches.
An x-ray is done in the following days to check that the bone is in place. At the slightest pain or if the foot seems to swell, you should consult your doctor without delay.
For a displaced fracture, surgery is required. “There is no escape. If we do not reduce this fracture and if the ankle is not properly stabilized, osteoarthritis will inevitably appear, in a few years ”, estimates Professor Mainard.
The type of intervention varies depending on the case:
For fix the malleolus external, the surgeon will lay a plate. For an internal (or medial) malleolus, screwing or strapping is put in place.
When the interosseous membrane that connects the tibia to the fibula is ruptured, “The open space is reduced using one of the screws on the plate, so that healing takes place under the best conditions”, specifies the surgeon.
After surgery, the patient is immobilized in a resin boot for six weeks. In some cases, a simple splint replaces this cast, and support is allowed after three weeks. “In this way, we save time on rehabilitation”, observes the surgeon. But this accelerated procedure only concerns simple fractures.
In all cases, the equipmentosteosynthesis (screws and plates) placed during the operation is left in place in an elderly person, unless it is too inconvenient. “In a young subject, the rule is to remove this material, even if there is no imperative in the matter”, specifies the surgeon. In this case, a second intervention takes place at least six months after the first.
Anticoagulants essential when the ankle is immobilized
As long as the ankle is immobilized and the patient limits his movements, the anticoagulant treatment “Is an absolute rule”, considers Prof. Mainard. These drugs, which are taken by mouth or as a daily injection, help to prevent the risk of phlebitis (formation of a blood clot in a vein).
How long does it take for the bone to consolidate?
After six weeks of immobilization, the bone is strong enough for the patient to be allowed to lean on his ankle. For a few days, crutches can be useful, the time to find your bearings.
What stoppage of work?
The sick leave for an ankle fracture is a minimum of six weeks, the time of immobilization. But this period can be extended depending on the severity of the fracture (one or two malleoli affected, displacement, ligaments damaged or not…) and the patient’s profession. The duration of the work stoppage will not be the same for office activity, a job that requires standing or carrying heavy loads.
What rehabilitation after an ankle fracture?
Once the displaced ankle, “Rehabilitation is carried out fairly quickly in the following month”, estimates the surgeon. Under the control of a physiotherapist, the patient will work on flexion/extension movements and proprioception, that is to say, this ability to stabilize his body in space. Some exercises can be continued at home.
After an ankle fracture, the joint sometimes retains a certain stiffness.
Pain or tingling may persist (algodystrophy) in some people.
Osteoarthritis can develop quickly when the cartilage in the joint has been damaged, or if the fracture has not been reduced properly.
When to resume sport?
A physical activity that does not put too much strain on the ankles can be resumed, gradually, in the month following the removal of plaster :
“I often recommend cycling,” says Prof. Mainard. The ankle only makes flexion / extension movements without any risk. It’s a very good rehabilitation ”.
For the practice of a sport which engages more the ankles, the wearing an ankle brace is advised when resuming. The goal is not to hold the joint, but rather to remind the patient to remain cautious and resume sport, gently.