A fractured ankle can range from a simple break in one bone, which may not stop you from walking, to several fractures, which forces your ankle out of place and may require that you not put weight on it for a few months.
Simply put, the more bones that are broken, the more unstable the ankle becomes. There may be ligaments damaged as well. The ligaments of the ankle hold the ankle bones and joint in position.
Broken ankles affect people of all ages. During the past 30 to 40 years, doctors have noted an increase in the number and severity of broken ankles, due in part to an active, older population of “baby boomers.”
Three bones make up the ankle joint:
- Tibia – shinbone
- Fibula – smaller bone of the lower leg
- Talus – a small bone that sits between the heel bone (calcaneus) and the tibia and fibula
The tibia and fibula have specific parts that make up the ankle:
- Medial malleolus – inside part of the tibia
- Posterior malleolus – back part of the tibia
- Lateral malleolus – end of the fibula
Doctors classify ankle fractures according to the area of bone that is broken. For example, a fracture at the end of the fibula is called a lateral malleolus fracture, or if both the tibia and fibula are broken, it is called a bimalleolar fracture.
Two joints are involved in ankle fractures:
- Ankle joint – where the tibia, fibula, and talus meet
- Syndesmosis joint – the joint between the tibia and fibula, which is held together by ligaments
Multiple ligaments help make the ankle joint stable.
- Twisting or rotating your ankle
- Rolling your ankle
- Tripping or falling
- Impact during a car accident
Because a severe ankle sprain can feel the same as a broken ankle, every ankle injury should be evaluated by a doctor.
Common symptoms for a broken ankle include:
- Immediate and severe pain
- Tender to touch
- Cannot put any weight on the injured foot
- Deformity (“out of place”), particularly if the ankle joint is dislocated as well
Chronic ankle instability is a condition characterized by a recurring giving way of the outer (lateral) side of the ankle. This condition often develops after repeated ankle sprains. Usually, the giving way occurs while walking or doing other activities, but it can also happen when you’re just standing. Many athletes, as well as others, suffer from chronic ankle instability.
People with chronic ankle instability often complain of:
- A repeated turning of the ankle, especially on uneven surfaces or when participating in sports
- Persistent (chronic) discomfort and swelling
- Pain or tenderness
- The ankle feeling wobbly or unstable
- Chronic ankle instability usually develops following an ankle sprain that has not adequately healed or was not rehabilitated completely. When you sprain your ankle, the connective tissues (ligaments) are stretched or torn. The ability to balance is often affected. Proper rehabilitation is needed to strengthen the muscles around the ankle and retrain the tissues within the ankle that affect balance. Failure to do so may result in repeated ankle sprains.
- Repeated ankle sprains often cause—and perpetuate—chronic ankle instability. Each subsequent sprain leads to further weakening (or stretching) of the ligaments, resulting in greater instability and the likelihood of developing additional problems in the ankle.
The ankle joint is affected by arthritis much less often than other joints. When patients have ankle arthritis, they have worn out the tibiotalar joint, which is the joint between the shin bone (tibia) and ankle bone (talus).
- Previous ankle injury is the most common cause of ankle arthritis. In people who have sustained an injury such as an ankle fracture, the cartilage may be damaged and this could lead to accelerated arthritis. When the ankle is injured, it is also susceptible to an injury called osteonecrosis. When osteonecrosis occurs as the result of an ankle injury, there is damage to the blood flow to a portion of the bone. Osteonecrosis can also lead to ankle arthritis.
- Another cause of ankle arthritis is rheumatoid arthritis. Rheumatoid disease causes joint inflammation and damage to the cartilage. Over time, this can lead to significant problems, necessitating treatment.
- Infections of a joint, which lead to damage of the cartilage cells, is another cause. Because cartilage cells cannot regrow, the damage from an infection can last permanently.
- Although the effect of genetics on the development of arthritis is not well understood, some people have been observed to have a genetic tendency to wear out joints faster than others.
- Body weight is another common factor for ankle arthritis. People who are overweight place a larger burden on their weight-bearing joints-hips, knees, ankles, as well as their feet. They have more of a tendency to develop arthritis, and often have more accelerated damage to the joint cartilage.
Ankle arthritis typically causes pain around the ankle joint, and the most frequent reason for patients to seek treatment is the pain associated with this condition. Other common symptoms of ankle arthritis include:
- Stiffness of the ankle
- Swelling around the joint
- Bone spurs causing a lumpy-looking joint
- Deformity of the joint
- Instability, or a feeling the joint may “give out”
Less commonly, ankle arthritis can lead to irritation of the nerves around the joint, causing tingling and numbness in the feet and toes.
Peroneal Tendon Pathology
A tendon is a band of tissue that connects a muscle to a bone. The two peroneal tendons in the foot run side by side behind the outer ankle bone. One peroneal tendon attaches to the outer part of the midfoot, while the other tendon runs under the foot and attaches near the inside of the arch. The main function of the peroneal tendons is to stabilize the foot and ankle and protect them from sprains.
Peroneal tendon injuries may be acute (occurring suddenly) or chronic (developing over a period of time). They most commonly occur in individuals who participate in sports that involve repetitive ankle motion. In addition, people with higher arches are at risk for developing peroneal tendon injuries. Basic types of peroneal tendon injuries are tendonitis, tears and subluxation.
Tendonitis is an inflammation of one or both tendons. The inflammation is caused by activities involving repetitive use of the tendon, overuse of the tendon or trauma (such as an ankle sprain).
- Warm to the touch
Acute tears are caused by repetitive activity or trauma. Immediate symptoms of acute tears include:
- Weakness or instability of the foot and ankle
As time goes on, these tears may lead to a change in the shape of the foot in which the arch may become higher.
Degenerative tears (tendonosis) are usually due to overuse and occur over long periods of time, often years. In degenerative tears, the tendon has been overstretched until it becomes thin and eventually frays. Having high arches also puts you at risk for developing a degenerative tear. The symptoms of degenerative tears may include:
- Sporadic pain (occurring from time to time) on the outside of the ankle
- Weakness or instability in the ankle
- An increase in the height of the arch
Subluxation means one or both tendons have slipped out of their normal position. In some cases, subluxation is due to a condition in which a person is born with a variation in the shape of the bone or muscle. In other cases, subluxation occurs following trauma, such as an ankle sprain. Damage or injury to the tissues that stabilize the tendons (retinaculum) can lead to chronic tendon subluxation. The symptoms of subluxation may include:
- A snapping feeling of the tendon around the ankle bone
- Sporadic pain behind the outside ankle bone
- Ankle instability or weakness
Early treatment of a subluxation is critical since a tendon that continues to sublux (move out of position) is more likely to tear or rupture. Therefore, if you feel the characteristic snapping, see a foot and ankle surgeon immediately.