Recovery from an Ankle Fracture
A common injury in the young and active population, Ankle Fractures describe a break of any of the bones that make up the ankle joint. Physiotherapy guidance is crucial to help you regain maximum function in your ankle, so that you can get back to your active lifestyle in the safest, fastest way.
Here’s what you need to know about Ankle Fractures and what the recovery journey looks like.
COMMON ANKLE FRACTURE SITES
In the photo below, it clearly shows the bones that are susceptible to a fracture in the ankle. The most common that we see in the clinic, is the lateral malleolus (5).
SEVERITY OF ANKLE FRACTURES
The severity of the ankle fracture is determined by a few factors including
Number of bones affected. The more bones fractured the more severe!
Alignment. If the fracture resulted in the bones moving out of place, we call that a displaced fracture, and adds to the severity of the fracture.
Open vs Closed. This describes whether the fracture was severe enough to pierce through the skin (open), or whether it was contained within the skin (closed).
Associated Injuries. Other structures around the ankle can be involved, such as nerves, blood vessels and ligaments!
The more severe the fracture, the longer the recovery time. Working with a Physiotherapist experienced in the treatment and rehabilitation of Ankle Fractures will give you the highest chance of regaining maximum function and mobility in your ankle.
HOW LONG DO THE BONES TAKE TO HEAL?
In a healthy individual, it generally takes a minimum of 6 weeks before there starts to be some decent bony healing.
That’s why you will often be put in some sort of protective boot, cast, or weight bearing restrictions during that time.
The fracture site will undergo a constant process of remodelling and maturing over a period of up to 12-18 months where it will be considered ‘fully healed’, again, assuming the recovery process is straightforward.
If you’ve had a complicated injury, you should expect these timeframes to be pushed out even further. It is not uncommon for some to be in a protective boot or restricted weight bearing for up to 3 months.
STAGES OF RECOVERY
To keep things simple, we’ll categorise the recovery journey into 3 stages.
EARLY STAGE (1st 4-6 weeks)
MID STAGE (6 weeks +)
END STAGE (10-12 weeks +)
In reality, your Physiotherapist should use a combination of natural healing timeframes and objective physical assessment tests to determine your readiness to progress from one stage to the next.
What we mean by that, is you should not expect to be doing any dynamic exercises like running or jumping in the first 6 weeks, as it is unlikely that your fracture site is sufficiently healed yet, even if you don’t have any pain and seem to have progressed your mobility and strength exceptionally well.
Your Physiotherapist will be responsible for guiding you along your rehabilitation journey, progressing from stage to stage in the safest and fastest way.
EARLY STAGE (1st 4-6 weeks)
Here are some of the key components that we focus on during the ‘Early Stage’ of your recovery.
SWELLING
Swelling is a common side product of any injury, and is one of the major impairments Physiotherapists prioritise to address.
The consequences of not minimising swelling is that you are impeding blood circulation to the ankle. This means less waste is being removed from the injured area, and less ‘fresh blood’ with ‘recovery cells’ and nutrients are being transported to the fracture site.
Swelling management is as simple as regularly elevating the leg, getting regular movement into the ankle if appropriate, and gentle swelling massage that can be performed by an experienced Physiotherapist.
RANGE OF MOVEMENT (ROM)
When Physiotherapists talk about ROM, we are referring to the flexibility of your ankle.
Nowadays, many health professionals adopt an Early Active Mobility approach.
This means that we try to get your ankle moving ASAP, taking into account the weight bearing status your Orthopaedic Specialist has requested.
Some of the proposed benefits of encouraging safe, early movement is
Quicker recovery time
Reduced swelling (movement helps to pump fluid away from the ankle joint)
Maximising potential flexibility
Increased confidence in the ankles capabilities, making the later rehabilitation process more comfortable.
MUSCLE ACTIVATION
During the early stage, you may not be able to bear weight on your ankle, so it may rule out regular ankle strengthening exercises like heel raises.
However, there will likely be some modified exercises your Physiotherapist can prescribe for you to ensure you maintain the activity of the muscles around your foot and ankle.
Examples include isometric muscle activations and theraband exercises.
The major benefit of incorporating early Muscle Activation exercises is that you minimise muscular deterioration in the first 6 weeks.
This sets you up for a much more successful Mid Stage rehab journey!
GAIT RETRAINING
No matter what your weight bearing status is, or whether you are in a protective boot or not, your Physiotherapist should ensure that your gait (how you walk) is optimised.
Gait retraining will reinforce to your brain a more ‘proper’ walking pattern, ensuring you don’t pick up any bad walking habits.
This also prevents secondary injuries elsewhere due to overcompensation! It is not uncommon for people to complain of the opposite knee or lower back pain in the first 4-6 weeks due to a poor gait pattern.
MID STAGE (6 weeks +)
Building on the early stage, we progress to the mid stage when you’re allowed to put more weight on your leg, and hopefully, wean off your protective boot if applicable.
SWELLING
It is unlikely that the swelling would have completely resolved by this stage, so it is still important to continue with swelling management.
RANGE OF MOVEMENT (ROM)
You will most likely be able to perform more advanced mobility exercises in this stage, now that you’re able to bear more weight on your ankle.
The goal of this stage is to be able to achieve the same functional mobility as your uninjured ankle!
STRENGTHENING
You would have noticed that your muscles have atrophied (reduced muscle mass) not only in your calves, but also your thighs and hips!
A proper rehabilitation program will include direct foot and ankle strengthening, but also incorporate quadricep, hamstring, glute and core exercises.
A good rehabilitation program will incorporate whole lower limb training with your end goal in mind - whatever that is.
BALANCE AND PROPRIOCEPTION
Working on your balance and proprioception helps to stimulate specific nerves in the ligaments and joints of your lower limb that are responsible for control.
This is especially important if you plan to go back to hiking, running, or playing multi directional sports like football, tennis or basketball.
END STAGE (10-12 weeks +)
By this stage, we should expect you to have full (or reached your maximum) range of movement, minimal swelling, and strength that is at least 90% of your uninjured leg.
DYNAMIC EXERCISES
In this stage, we start to incorporate dynamic exercises, starting off with landing mechanics, then jumping mechanics and change of direction.
This also includes getting back into things like skipping and running, and they should be done with supervision and guidance from your Physiotherapist.
SPORTS SPECIFIC TRAINING
In preparation for you returning to sports, your Physiotherapist will prescribe exercises that mimic the demands of your sport.
We generally start off performing them in a gym setting, where we can control the environment and variables.
Gradually, we then progress to increasing the complexity of the task, or get you to do them under metabolic fatigue.
RETURN TO SPORT
Upon clearance from your Physiotherapist and Orthopaedic Specialist, you will be allowed to go back to training, and eventually, competition!
It is advised to continue with the rehabilitation exercises for a period of 12 months post injury, to ensure that you maintain a high level of strength and control of your ankle, preventing re-injury.
CONCLUSION
The recovery journey from an ankle fracture is different for everyone, and these are just general guidelines that we use in our clinical practice to structure their return to sport.
If you have a complex ankle injury, or have high level sporting goals that you want to return to, we recommend working with an experienced Physiotherapist who has a proven track record of guiding people back to full competition post ankle fracture.
Our team at Physiologic works closely with some of Hong Kong’s top Orthopaedic surgeons, having helped countless individuals coming back from ankle fractures get back to high level sports such as rugby, trail running, football and tennis to name a few.
Get in touch with us if you’re looking for an experienced team to guide you back to your competitive best.
ABOUT THE AUTHOR
Ryan Tan is our Clinical Director and Physiotherapist here at Physiologic Hong Kong. He’s had over 10 years of experience as a sports and musculoskeletal Physiotherapist, having looked after elite athletes such as the NZ Rugby 7’s team and more recently, some of Hong Kong’s top Trail Runners. He attributes his client’s successes to their commitment in being diligent with his individual rehabilitation programs. Excellent relationships with some of Hong Kong’s top Orthopaedic Surgeons also allows Ryan to provide a truly multidisciplinary team approach to his clients health care. Contact us to speak with Ryan if you are looking for an experienced Physiotherapist to guide you back to your competitive best!