Ankle fracture

A “fracture” or “break” of the ankle usually involves the bones that form an arch around the ankle joint (tibia or fibula).

Your doctor will decide how best to manage your bone fracture. This may be in a plaster cast, a boot, with surgery or a combination of these to help the bone to heal.

Your doctor or physiotherapist will be able to guide you on how much weight to put through your ankle as it is healing. It is likely you will be given elbow crutches or a Zimmer Frame to make sure you are safe when moving around.

How long it takes you to recover will depend on the type of ankle fracture you have sustained and other factors such as age, underlying health conditions and general fitness.  If you are a smoker, this can considerably delay the healing process (ask your healthcare professional for further advice).

How much weight can I put through my foot?

Following your injury or surgery it is important to keep moving, but to do so in a safe way. You will be told how much weight you can put through the ankle.

 

Non weight bearing (NWB) 

No weight should go through the affected leg when walking – you will need crutches or a Zimmer Frame to help you to move about safely.


Touch weight bearing (TWB)

This is where a very small amount of weight is put through the toes of your affected limb as you place your foot to the ground. Pressure should be very light (10%), and most of your weight should be taken through your arms (using crutches or a Zimmer Frame) and your non-affected leg.


Partial weight bearing (PWB)

Partial weight bearing means putting some weight through your affected limb with help of crutches or Zimmer Frame, but not all your weight. You can try to walk normally but, when you have the affected foot on the ground, you need to have both crutches in contact with the floor; putting only 50% of your weight through your leg.


Full weight bearing (FWB)

You can put full weight through your affected leg. This means the fracture has healed well enough now to bear your full body weight as you walk, enough so you can stand fully on one leg while holding on. You may still be experiencing some pain or discomfort. You can discuss this with your healthcare professional, as this may be due to other factors such as muscle weakness.

How do I get up and down the stairs using my crutches?


Downstairs with elbow crutches

  1. Put your crutches onto the step below. 
  2. Lower your injured leg first onto the step.
  3. Take some weight through your arms and step down with your good leg so it is on the same step as your injured leg.
  4. Repeat, stepping down one at a time.
  5. If a handrail is available, use the rail and one crutch and follow the same instructions.


Upstairs with elbow crutches

  1. Keep the crutches on the same step as you are standing on.
  2. Step up with your good leg first (if not weight bearing then hop up with the good leg).
  3. Keep your crutches on the step below you while you bring your injured leg up so it is on the same step as your good leg.
  4. Finish by bringing your crutches up to the same step.
  5. If handrail is available, use the rail and one crutch and follow the same instructions.

Rehabilitation: What can I expect?

Following an ankle fracture you may be referred to Physiotherapy to help you return to the activities that are important to you. You may also receive input from Occupational Therapy if you require help or advice about returning to work.

The early stages of rehabilitation will focus on:

  • regaining movement
  • reducing swelling
  • controlling pain
  • weaning out of your walker boot (if appropriate)
  • progressing your walking

How can I manage the swelling?

If you have swelling at the ankle or lower leg, make sure you try these steps below:

  • Ice – use a bag of frozen peas or ice cubes wrapped in a damp towel (to avoid ice burn) and apply it to the swollen area. You can do this for 10 minutes at a time, several times a day. Check skin regularly for signs of ice burn.

  • Elevation – resting with your foot propped up on pillows helps to reduce swelling. It is advisable you do this for 10 minutes every hour in the early stages.

  • Movement – keeping moving is important.

  • Massage – gentle massage to the area promotes blood flow, which can help with swelling. Use moisturiser or oil to massage the area – this will also help hydrate your scar if you have had surgery. Start this when your wounds have fully healed.

What exercises should I be doing?

After you have had your plaster cast removed, or have been told to wean out of your boot by your physiotherapist or doctor, you can start these gentle exercises below.

Make sure you are allowed to put your full weight through your leg before attempting the exercises whilst standing.
 


 

These exercises get progressively more challenging so you can gradually work through them and do more or less depending on your symptoms. Try and complete these exercises two or three times a day and complete 10-15 repetitions.

You will be guided through more advanced exercises by your physiotherapist, working towards aims and goals tailored to you.

At a later stage, exercises can be designed for higher level activities such as running and sports, depending on what you want to get back to. This can take several months due to bone and tissue healing – ask your doctor or therapist for further advice.