Ankle fracture - aftercare

Some ankle fractures may require surgery when:

• The ends of the bone are out of line with each other (displaced).
• The fracture extends into the ankle joint (intra-articular fracture).
• Tendons or ligaments (tissues that hold muscles and bones together) are torn.
• Your health care provider thinks your bones may not heal properly without surgery.
• Your provider thinks that surgery can allow faster and more reliable healing.
• In children, the fracture involves the part of the ankle bone where bone is growing.

When surgery is needed, it may require metal pins, screws, or plates to hold the bones in place as the fracture heals. The hardware may be temporary or permanent.

You may be referred to an orthopedic (bone) doctor. Until that visit:

• You will need to keep your cast or splint on at all times and keep your foot raised as much as possible.
• Do not put any weight on your injured ankle or try to walk on it.

Without surgery, your ankle will be placed in a cast or splint for 4 to 8 weeks. The length of time you must wear a cast or splint depends on the type of fracture you have.

Your cast or splint may be changed more than once, as your swelling goes down. In most cases, you will not be allowed to bear weight on your injured ankle at first. You may also wear a boot, which will allow you to put some weight on your ankle for walking.

At some point, you will use a special walking boot as the healing progresses.

You will need to learn:

• How to use crutches
• How to take care of your cast or splint

To reduce pain and swelling:

• Sit with your foot elevated higher than your knee at least 4 times a day
• Apply an ice pack 20 minutes of every hour, you are awake, for the first 2 days
• After 2 days, use the ice pack for 10 to 20 minutes, 3 times a day as needed

For pain, you can use ibuprofen (Advil, Motrin, and others) or naproxen (Aleve, Naprosyn, and others). You can buy these medicines without a prescription.

Remember to:

• Talk with your provider before using these medicines if you have heart disease, high blood pressure, kidney disease, or have had stomach ulcers or internal bleeding in the past.
• Not take more than the amount recommended on the bottle or more than your provider advises you to take.
• Not give aspirin to children.
• Check with your provider about taking anti-inflammatory medicines like ibuprofen or naproxen after a fracture. Sometimes, they will not want you to take the medicines as it can affect healing.

Acetaminophen (Tylenol and others) is a pain medicine that is safe for most people. If you have liver disease, ask your provider if this medicine is safe for you.

You may need prescription pain medicines (opioids or narcotics) to keep your pain under control at first.

Your provider will tell you when it is OK to place any weight on your injured ankle. Most of the time, this will be at least 6 to 10 weeks. Putting weight on your ankle too soon may mean the bones do not heal properly.

You may need to have your duties at work changed if your job requires walking, standing, or climbing stairs.

At a certain point, you will be switched to a weight-bearing cast or splint. This will allow you to start walking. When you start walking again:

• Your muscles will likely be weaker and smaller, and your foot will feel stiff.
• You will begin learning exercises to help you rebuild your strength.
• You may be referred to a physical therapist to help with this process.

You will need to have full strength in your calf muscle and full range of motion back in your ankle before returning to sports or work activities.

Your provider will do x-rays periodically after your injury to see how your ankle is healing.

Your provider will let you know when you can return to regular activities and sports. Most people need at least 6 to 10 weeks to fully heal.

Contact your provider if:

• Your cast or splint is damaged.
• Your cast or splint is too loose or too tight.
• You have severe pain.
• Your foot or leg is swollen above or below your cast or splint.
• You have numbness, tingling, or coldness in your foot, or your toes look dark.
• You cannot move your toes.
• You have increased swelling in your calf and foot.
• You have shortness of breath or difficulty breathing.

Also contact your provider if you have questions about your injury or your recovery.

Malleolar fracture; Tri-malleolar; Bi-malleolar; Distal tibia fracture; Distal fibula fracture; Malleolus fracture; Pilon fracture

McGarvey WC, Greaser MC. Ankle and midfoot fractures and dislocations. In: Porter DA, Schon LC, eds. Baxter's The Foot and Ankle in Sport. 3rd ed. Philadelphia, PA: Elsevier; 2021:chap 6.

Rose NGW, Green TJ. Ankle and foot. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 49.

Rudloff MI. Fractures of the lower extremity. In: Azar FM, Beaty JH, eds. Campbell's Operative Orthopaedics. 14th ed. Philadelphia, PA: Elsevier; 2021:chap 54.

Updated by: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.