An ankle fracture is a break in one or more of the lower ends of the shinbone (tibia) and the thinner leg bone (fibula) that form the ankle joint, usually after a twist or a fall [1]. Stable fractures that have not shifted are treated in a cast or walking boot; displaced or unstable fractures usually need surgery with plates and screws [1]. Early bone healing takes at least 6 weeks and full healing 10-12 weeks, and complete recovery can take longer [1].
The ankle joint and types of fracture
The ankle joint is made of three bones: the shinbone (tibia), the thinner bone beside it (fibula) and the talus, which sits above the heel bone. The bump on the inner side is the medial malleolus, the one on the outer side the lateral malleolus, and the back of the tibia the posterior malleolus [1].
A fracture can involve one of these areas, or two or three at once. The ligaments holding the tibia and fibula together (the syndesmosis) can be injured as well. How many bones are broken and whether the joint stays stable decide the treatment [1].
How is it told apart from a sprain?
To tell them apart the doctor examines you and uses the Ottawa ankle rules to decide whether an X-ray is needed; the X-ray gives the definite answer [1][4].
An ankle fracture can feel like a sprain. The most common symptoms are [1][2]:
- Sudden, severe pain
- Marked swelling and bruising
- Tenderness when touched
- Being unable to put weight on the foot
- A deformed ankle if the joint is also dislocated
- Sometimes numbness or coldness in the foot
Causes
Most fractures happen when the foot twists or rolls while walking or running. Falls from a height and road accidents can also break the ankle [1].
Diabetes and the nerve damage it can cause (peripheral neuropathy) can affect healing and the choice of treatment, so the doctor asks about them when planning care [3].
How is it diagnosed?
The ankle and foot are examined first, checking the skin, blood supply and feeling [3]. Diagnosis is usually made with X-rays. Stress views may be taken to see whether the joint stays stable under load; a CT scan may be used to plan surgery and an MRI scan if a ligament injury is suspected [1].
If the ankle is visibly deformed it is put back into position and splinted without delay to protect the skin and circulation [3].
Treatment without surgery
Stable fractures that have not shifted can be treated in a cast or walking boot [1]. For stable fractures involving only one malleolus, guidelines recommend allowing full weight-bearing as comfort allows straight away, with an orthopaedic review within two weeks if stability is uncertain [4]. Most people can bear weight as tolerated in a splint or cast [3].
When is surgery needed?
If the bone fragments have shifted or the joint is unstable, surgery is usually needed. The fracture is fixed with plates, screws, rods or nails, chosen according to the type and location of the break [1].
For unstable fractures, guidelines recommend early surgery for most people under 60, on the day of injury or the next day [3][4].
Deciding in older age
In older people infection and wound-healing problems after surgery are an important concern, so the benefits and risks are weighed more carefully [5].
In a trial of 620 people over 60 with unstable ankle fractures, a carefully moulded close-contact cast applied in the operating theatre gave similar ankle function to surgery at 6 months. Infection and wound problems were more common after surgery, while the bone healing out of position was more common with casting, and some people in the cast group later needed surgery [5]. For older people and those with other health problems the decision is therefore made after discussing benefits and risks.
Recovery and weight-bearing
Early healing takes at least 6 weeks and full bone healing 10-12 weeks. Complete recovery can take longer, up to two years for some fractures [1]. Minor breaks often heal in 6-8 weeks [2].
After surgery, bearing weight early and using a removable ankle support may give slightly better results in the first months, but the difference is small and not always noticeable. It is unclear whether any particular physiotherapy method is better than another [6]. Regular exercise is still important for regaining movement and strength [1].
A clinic review within 6 weeks of surgery is recommended to check that the fracture is holding and there are no complications; the risk of blood clots is also assessed for each person [3].
Possible problems include stiffness, long-lasting swelling, the bone healing in the wrong position or not healing, infection, nerve damage and arthritis in later years [1]. People whose broken right ankle was treated with surgery can usually drive again after 9-12 weeks [1]. After a cast or boot, driving depends on being out of it and able to brake safely, so ask your doctor.
When not to wait: urgent care
Go to an emergency department straight away if you notice [2]:
- An obvious deformity or odd angle of the ankle
- Bone showing through the skin or a deep wound
- Very severe pain
- Toes that look blue or white or feel numb
- In a cast or splint: pain that keeps getting worse, numbness or burning in the foot or toes, or a cast that feels too tight with swollen, blue or white toes
- Until you reach hospital: keep the leg raised, apply ice wrapped in a cloth for 15-20 minutes, wrap the ankle loosely, remove jewellery, and do not eat or drink in case surgery is needed
Frequently asked questions
- How can I tell a broken ankle from a sprain?
- The symptoms can be similar. A doctor uses the Ottawa ankle rules to decide whether an X-ray is needed, and the X-ray gives the definite answer [1][4].
- When can I put weight on a broken ankle?
- With stable fractures, early weight-bearing as comfort allows is usually permitted [3][4]. Early weight-bearing after surgery is also generally safe, but the decision depends on the fracture and the fixation and is made by your doctor [6].
- Does a broken ankle in an older person always need surgery?
- No. In people over 60 a carefully applied close-contact cast gave similar function to surgery at 6 months, although the risk of the bone healing out of position was higher [5].
At our clinic we decide with you after looking at how many bones are broken, whether the ankle is stable, the state of the skin and your other health conditions.
Sources
- Ankle Fractures (Broken Ankle). American Academy of Orthopaedic Surgeons (OrthoInfo). orthoinfo.org
- Broken ankle. NHS (nhs.uk), 2025. nhs.uk
- BOAST – The Management of Ankle Fractures. British Orthopaedic Association, 2016. boa.ac.uk
- Fractures (non-complex): assessment and management (NG38). National Institute for Health and Care Excellence (NICE), 2016. nice.org.uk
- Close Contact Casting vs Surgery for Initial Treatment of Unstable Ankle Fractures in Older Adults: A Randomized Clinical Trial. JAMA (Willett K, et al.), 2016. pubmed.ncbi.nlm.nih.gov
- Rehabilitation for ankle fractures in adults (Cochrane Review). Cochrane Database of Systematic Reviews (Lewis SR, et al.), 2024. pubmed.ncbi.nlm.nih.gov
This article is general information and does not replace an examination or imaging. If you have symptoms, see a doctor.
More in this area
- Broken bone healing time: when does the cast come off, what eases the itch?
- Plates and screws after a fracture: do they have to be removed?
- Muscle strains and tears: how to recognise one and how long it takes to heal
- Osteoporosis (bone thinning): how is it detected and how are fractures prevented?
- Stress fracture: what are the symptoms and how does it heal?