Ankle Fracture: From Break to Steady Steps
An ankle fracture usually occurs suddenly during a fall, twisting injury, sports mishap or direct blow. Many people feel a sharp, severe pain at the moment of injury, sometimes accompanied by a popping or cracking sound. Swelling and bruising develop quickly, and the ankle may appear deformed or out of place. It becomes tender to the touch and bearing weight on the foot becomes difficult or impossible. In some cases, there may be numbness or a cool sensation in the foot. Rarely, a hairline fracture allows limited weight‑bearing but still causes persistent pain. Without prompt treatment, symptoms can worsen over the next few hours as swelling and discoloration increase.
If you suspect you’ve broken your ankle, stop using the injured leg immediately and avoid putting any weight on it. Follow the RICE method: rest the joint, ice it for 15–20 minutes every hour during the first couple of days, wrap it gently with an elastic bandage for compression and elevate your foot above the level of your heart to reduce swelling. Over‑the‑counter pain relievers such as acetaminophen, ibuprofen or naproxen can help ease pain and inflammation when used as directed. Keep the ankle immobilized with a splint or supportive brace until you can see a healthcare professional. Do not attempt to realign the bones yourself, and avoid heat or massage in the acute phase.
Seek medical attention promptly if you have severe pain, significant swelling or bruising, difficulty or inability to bear weight on your injured foot, or if your ankle looks deformed. Numbness, tingling, cool or bluish skin, or a popping sensation at the time of injury are other red flags. Even if pain improves after initial first aid, you should consult a doctor within 24–48 hours to determine whether your ankle is fractured or sprained. During recovery, contact your provider if your cast or splint becomes too tight or too loose, if you develop severe pain, increased swelling or numbness in your foot or toes, or signs of infection such as fever or redness.
Many ankle fractures that are stable and non‑displaced can be treated without surgery. Your doctor will examine your ankle and order X‑rays to determine the fracture type. Nondisplaced fractures of the lateral or medial malleolus are typically immobilized in a short leg cast, boot or walking brace for four to eight weeks, with little or no weight‑bearing at first. As swelling decreases, your doctor may adjust or change the cast. After the initial immobilization period, weight‑bearing is gradually reintroduced, often using a walking boot. Pain is managed with NSAIDs or acetaminophen, and icing continues to control swelling. Once the bone shows signs of healing, physical therapy helps restore range of motion, strengthen the calf and foot muscles and improve balance to prevent stiffness and long‑term instability. Smoking cessation, calcium and vitamin D intake, and addressing underlying health conditions can also support healing.
Bone healing usually takes six to ten weeks. Stable fractures treated conservatively require immobilization for about four to eight weeks and progressive weight‑bearing for another two to four weeks. Most people notice improvement and begin rehabilitation within a few weeks, though swelling and stiffness may persist for months. Returning to routine activities like walking and driving generally takes three to four months. Complete recovery—including restoration of full strength, range of motion and resolution of swelling—may take six months to a year, and up to two years for more severe fractures or those requiring surgery.
Surgery is recommended when the broken bones are displaced, unstable or unable to be aligned with a cast; if multiple bones or both sides of the ankle (bimalleolar or trimalleolar) are fractured; when the fracture extends into the joint; or if the ankle is dislocated or the bone has pierced the skin. Fractures involving torn ligaments causing the talus to shift or injuries that fail to heal properly with conservative treatment are also surgical indications. Surgery may be necessary in children when the growth plate is affected, and in adults if there is neurovascular compromise or open fractures.
The most common procedure is open reduction and internal fixation (ORIF), where an orthopedic surgeon makes incisions, repositions the bone fragments and secures them with screws, plates, rods or wires to hold the bones in proper alignment. This procedure stabilizes the joint and allows the bones to heal correctly. In less severe cases, a closed reduction with percutaneous screws may suffice, while complex fractures or those with significant soft‑tissue injury may require external fixation or staged procedures. Surgery is usually performed under general or regional anesthesia, and may involve an overnight hospital stay. After surgery, the ankle is immobilized in a splint or cast, and weight‑bearing is avoided for several weeks. Physical therapy begins once the bones start to heal, and hardware is rarely removed unless it causes irritation.
With appropriate treatment, most ankle fractures heal well, and individuals regain good function. Stable fractures treated conservatively often heal without long‑term problems, and patients return to normal activities within a few months. Surgical fixation has a high success rate for restoring alignment and stability; however, recovery can be longer, and some people experience residual stiffness, swelling or aching for months. Factors like age, bone quality, smoking and diabetes can affect healing. In severe fractures or those with significant cartilage damage, post‑traumatic arthritis may develop later in life, but early rehabilitation and adherence to weight‑bearing restrictions improve overall outcomes.
Complications from nonsurgical treatment include malunion, nonunion or delayed union, where the bones heal in the wrong position or fail to unite, leading to chronic pain or deformity. Surgical complications are uncommon but can include infection, bleeding, nerve or blood vessel injury, hardware irritation and blood clots. Stiffness and swelling may persist for many months, and a small number of patients develop post‑traumatic arthritis or require revision surgery. Risk factors such as smoking, diabetes, poor circulation and severe open fractures increase the likelihood of complications.
Initial fracture healing and non‑weight‑bearing typically last six to eight weeks. Most patients transition from a cast or splint to a walking boot and begin weight‑bearing between six and ten weeks under their doctor’s guidance. You may return to driving at about 9–12 weeks if the right ankle is affected and you can safely operate pedals. People generally resume light activities and desk work by three months and regain most normal functions by four months. High‑impact sports and strenuous work may require six months or more, and residual swelling can take a year or longer to resolve. After surgery, recovery timelines are similar but may extend if multiple bones were repaired or complications arise. Adherence to rehabilitation exercises and gradual progression of activity are essential to maximize recovery.
A successful outcome is characterized by a healed fracture with stable alignment, minimal pain, and the ability to walk, climb stairs and return to daily activities without significant limitations. Most patients (over 80–90%) achieve good to excellent functional outcomes with appropriate treatment and rehabilitation. They regain near‑normal range of motion and strength and can return to low‑impact sports, although some may have lingering stiffness or swelling. Long‑term success depends on following the prescribed weight‑bearing restrictions, attending physical therapy, maintaining overall bone health and addressing modifiable risk factors such as smoking or poor nutrition. Early diagnosis and prompt treatment greatly increase the likelihood of a smooth recovery and a return to an active lifestyle.