Ankle > Ankle Fractures > Treatments

   Casting

Treatment Introduction

Minor fractures in your ankle may be treated in a cast or a removable brace called a cam walker. A cast typically is used when the broken bone has not moved out of position. The type of ankle fracture most commonly treated in this manner is a fracture of the fibula, your smaller lower leg bone that forms the bony knob on the outside of your ankle. Typically, you wear a short leg cast for at least two to four weeks, followed by a period of four to six weeks in a cam walker or other removable ankle brace. While in the cast, you usually can bear some weight on your ankle as tolerated.

SHORT LEG CAST

A short leg cast wraps around your foot, ankle, and lower leg, starting below your knee. It is open around your toes to allow toe movement and is usually made of layers of plaster or fiberglass. Your physician usually rolls a thin, elastic stocking, called a stockinette, over your skin, and then pads your leg with soft-roll bandages. A dry layer of fiberglass is wrapped around your leg and foot. Extra fiberglass strips are wrapped around the sole of your foot. Additional fiberglass layers are applied wet over the first layer. When the short leg cast dries, it should immobilize your ankle but still allow you to move your toes. It should be snug but not tight. You should report any loss of sensation within your foot to your physician.

CAM WALKER

A cam walker is a removable hard plastic boot, made with nylon straps that fasten around your calf and foot. Most cam walkers have an adjustable hinge at the ankle that can be set to allow the range of motion your physician prescribes. The sturdy bottom of the cam walker is rocker shaped, which enables you to walk. More severe fractures may be treated in a cast for two to four weeks and then in a cam walker for an additional six to eight weeks.

Crutches may be prescribed for two to four weeks after an ankle fracture. Depending on the severity of the fracture, you may be able to bear weight on your ankle while wearing a cast. It can take six to eight weeks for the damaged bone to heal. Physicians generally play it safe and recommend you take it easy on your injured ankle until they are sure your bones have healed. Household tasks that require you to be on your feet may be difficult during this time. It can be helpful to have someone around the house who can help with any physical chores. In general, you should continue using your crutches as instructed by your doctor until symptoms lessen. Your physician usually schedules regular follow-up visits to check your progress every couple of weeks. During the follow-up visits, your physician may decide to remove your cast and prescribe a cam walker. You may begin weight bearing in a brace or cam walker before going back to normal shoe wear. Your physician typically prescribes range-of-motion exercises for you to perform at home after your cast is removed. The goal is to avoid pain and stimulate blood flow and circulation. Patients generally are instructed to remove their brace or cam walker for a brief period and prop their lower leg on a stool or pillow so your ankle is off the floor. Physicians usually recommend moving your ankle up, down, and side-to-side - start with slow movements and do not move your ankle too far in any direction. Your physician may suggest physical therapy that can be done at home, or refer you to a physical therapist after about six weeks. However, many patients can strengthen their ankles without formal physical therapy. Your physician generally evaluates your ankle after four weeks and determines whether regular cardiovascular exercise and everyday weight bearing can sufficiently strengthen your ankle. Massage and heat therapy also may be used to soothe muscle pain.

Rehabilitation

When your cast comes off two to four weeks after fracturing an ankle, most patients can perform daily range-of-motion exercises to stretch their ankles. You should usually stretch for about two to four weeks prior to using weights to strengthen your ankles. Your ankle may feel stiff when it first comes out of the cast, but the pain should go away as you rebuild your strength. Once your bones have healed and your strength is equal in both ankles, you will likely be able to return to any sports and activities that you participated in before the fracture. Everyone heals at a different rate, and you should begin exercises slowly until your pain has decreased. Your ankle bones should be stable before you put stress on your ankle with walking, running, and other exercise. Physical therapy usually involves learning an ankle stretching routine and performing ankle strengthening exercises. As you improve muscular strength, the final phase is proprioceptive training, in which you stand on balancing boards to assist training your leg muscles to stabilize the foot and ankle. Rehabilitating an ankle fracture can take up to three months, depending on the severity.

Once your anklebones have healed, the bone should be just as strong as it was before the fracture. To prevent re-injury, you should strengthen the muscles and tendons around your ankle. Appropriate strength training, which focuses on the peroneal muscles of the lower leg, and conditioning for the sports you play are important preventive measures. Athletes should use up-to-date equipment. To prevent ankle fractures, you should try to play on good, level fields, courts, or tracks. If your ankles are already weak, avoid playing on uneven surfaces. Another preventive technique is choosing the right footwear. Proper fit, support, and design for specific sports should be taken into consideration. Some shoes have built-in medial and lateral supports, which may assist in preventing injury. Soccer shin-guards with circular pads on the bony sides of the ankles may prevent direct bruise or trauma to the bone. Hockey players should wear extra ankle padding to help avoid injury from sticks and skate blades. Adding calcium supplements to the diet may help women with osteoporosis strengthen their ankle bones.