Fractures > Treatments
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.
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
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.