Healthy Eating for Ankle Fracture Recovery
Your ankle is rebuilding. Send supplies.
FROM THE TRENCHES
One of the unexpected worries that comes with an ankle fracture is food. When you go from active to spending most of the day with your leg elevated, it’s easy to think, I’m barely moving. I’m going to look like a hog in a couple of weeks. I’d better barely eat.
That concern is a familiar topic with my fracture friends. Well, and with me, too.
“I worried that I was going to get fat while using crutches,” one woman admitted. Instead, she lost five pounds over three months.
Another, who had worked hard to lose weight before her injury, had the same fear. She focused on nutritious foods and protein while recovering — and when she was finally able to weigh herself, discovered she had lost seven pounds.
For some, the losses were much greater. “I lost 20 pounds because of the pain and stress,” one person wrote, adding that much of it was probably muscle. Another said her appetite disappeared initially and returned gradually as recovery progressed.
Protein was a recurring theme. One person recovering from ORIF spent 17 days in the hospital and said her surgeon specifically ordered extra protein with every meal to support healing. Others made a point of eating more protein at home, even while their activity levels were dramatically reduced.
Not everyone lost weight. Some people did gain while sidelined, particularly when they continued eating as they had before the injury. One man said to “Just remember when to stop eating” and that he’d gained 28 pounds.
Nevertheless, the stories are a good reminder that recovery isn’t necessarily the time for an aggressive diet simply because you’re sitting still.
As one very active man put it: “Don’t be afraid to eat while healing and recovering from surgery.”
Your activity level may have plummeted. Your body’s workload hasn’t.
Don't Diet While Your Body Is Trying to Heal
A common theme after an ankle fracture is how little you may move. If you're used to being active, weeks on the couch can make you painfully aware that you aren't burning calories the way you normally do.
The temptation may be to dramatically cut back on food to avoid gaining weight, but it’s not a great time for aggressive dieting.
Healing requires energy. Your body needs calories to produce new tissue, support immune function and repair bone. At the same time, eating too little protein and being inactive can accelerate the loss of muscle—the very muscle you'll need when it's time to stand, walk and rebuild strength.
That doesn't mean recovery is an excuse for an unlimited supply of cookies and ice cream. (Though maybe a little cookie or two when you’re sad.) It means this probably isn’t the time for crash diets, fasting or severe calorie restriction.
Think nourish, not diet.
Protein: The Heavy Lifter
If there's one nutrient worth paying particular attention to during recovery, it's protein.
Protein supplies amino acids your body uses to repair muscle, skin and other tissues. It's also especially important when you're inactive because immobilization and reduced weight-bearing can cause muscle to disappear surprisingly quickly.
Rather than trying to cram all your protein into one giant dinner, include some throughout the day.
Good sources include:
Eggs
Chicken, turkey and lean meats
Fish
Greek yogurt and cottage cheese
Milk and other dairy products
Beans and lentils
Tofu and other soy foods
Nuts and nut butters
Protein shakes can also be extremely useful during ankle recovery. They're not inherently better than food, but they're easy—and easy matters when standing long enough to cook scrambled eggs feels like an Olympic event.
If you're eating poorly because of nausea, medications or lack of appetite, a shake or smoothie may be much more realistic than a full meal.
Building Bone: Calcium, Vitamin D and the Supporting Cast
Bone isn't simply a hard structure that glues itself back together. Fracture healing is a complicated biological process, and several nutrients are involved.
Calcium is a major structural component of bone. Dairy products such as milk, yogurt and cheese are obvious sources, but calcium is also found in fortified foods, some leafy greens, tofu and other foods.
Vitamin D helps your body absorb and use calcium. Fatty fish, egg yolks and fortified foods provide some vitamin D, and your body also produces it in response to sunlight. Vitamin D deficiency is common enough that your doctor may recommend testing or supplementation if there's reason to suspect you're low.
Other nutrients play supporting roles. Vitamin C is needed for collagen formation and is plentiful in citrus fruits, berries, peppers, tomatoes and broccoli. Zinc contributes to wound healing and tissue repair, while magnesium is involved in bone metabolism and numerous other processes.
You don't need to micromanage every vitamin and mineral at every meal. A varied diet with adequate protein, fruits, vegetables, whole grains and calcium-rich foods will cover a lot of territory.
Eat the Rainbow—Without Making Yourself Crazy
You've probably heard the advice to "eat the rainbow." During recovery, it's actually a pretty useful shorthand.
Fruits and vegetables provide vitamins, minerals, fiber and a huge variety of plant compounds. Fatty fish, nuts, seeds and olive oil provide healthy fats. Whole grains and other carbohydrate-rich foods provide energy your body can use for healing.
Foods such as salmon, berries, leafy greens, nuts and olive oil are often labeled "anti-inflammatory." That's fine as far as it goes, but inflammation isn't the enemy.
Inflammation is a normal and necessary part of healing. Your goal isn't to somehow eat it out of existence. It's simply to build most of your diet around nutritious foods rather than expecting a particular berry, spice or supplement to make your ankle heal faster.
No superfood is going to knit your fibula together by Thursday.
WORTH KNOWING
Hydration matters more than you think, and it's surprisingly easy to become mildly dehydrated during ankle recovery.
You aren't moving around normally. Getting up to refill a glass may be a production. And if every trip to the bathroom requires crutches, a walker or a scooter, drinking less can start to seem strangely appealing.
Don't fall into that trap.
Fluids support circulation, digestion and normal body function. Adequate fluid intake is also particularly important if you're taking opioid pain medications, which commonly cause constipation.
Water is the obvious choice, but milk, soups, broths and other beverages contribute to fluid intake too. Coffee and tea count as fluids as well.
One practical solution is simple: keep a large water bottle within reach of wherever you've established recovery headquarters.
Your intestines will thank you.
When You Have No Appetite—or No Desire to Cook
This is where healthy-eating advice collides with ankle-fracture reality.
"Prepare a nutritious meal" sounds perfectly reasonable until you're non-weight-bearing and cooking is nearly impossible.
Even if you can stand, cooking may be exhausting. Pain medications can cause nausea. Anesthesia can temporarily affect appetite. Pain itself can make food unappealing.
Keep easy foods around:
Greek yogurt or cottage cheese
Hard-boiled eggs
Cheese
Rotisserie chicken
Tuna packets
Soup
Frozen meals with a decent amount of protein
Fresh or frozen fruit
Precut vegetables
Nuts and nut butter
Protein shakes
Smoothies
Whole-grain crackers or toast
If someone asks what they can do to help, asking them to bring dinner is a perfectly legitimate answer.
So is grocery delivery.
What About Supplements?
Supplements can be useful—but "good for bones" doesn't automatically mean "more is better."
Large doses of calcium, vitamin D, zinc and other nutrients can cause problems, and supplements can interact with medications. Taking a fistful of bone-healing supplements also doesn't compensate for not eating enough protein or calories.
For a closer look at calcium, vitamin D and other supplements commonly considered during ankle recovery, see the chapter on supplements.
Alcohol, Caffeine and Recovery
Alcohol can interfere with the biological processes involved in bone formation and fracture healing, with the clearest evidence of harm associated with heavy or chronic alcohol use. Because there isn't a well-established "safe" amount specifically for fracture healing, avoiding or limiting alcohol while your bone heals is the cautious choice.
Alcohol can also interact dangerously with opioids, sedatives and other medications, as well as impair balance and judgment at a time when one bad step could send you straight back to the orthopedic surgeon.
If you're taking opioid pain medication or another drug that shouldn't be combined with alcohol, don't combine them.
Coffee is a different story.
Moderate caffeine consumption isn't generally something you need to panic about because you've broken an ankle. The bigger practical issue is sleep. Too much caffeine—particularly later in the day—can interfere with sleep at a time when good sleep is already difficult and important to recovery.
Coffee and tea also contribute to fluid intake; ordinary amounts don't automatically dehydrate you.
The sensible approach is moderation rather than treating your morning coffee as another casualty of the fracture.
MY TAKE ON IT
One of the useful things that came out of my ankle fracture and subsequent surgery was that I quit drinking alcohol, almost entirely. I really wanted to heal, to get my life back, to speed it up as much as possible.
I used to love my gin martinis, swimming with extra olives, and a nice glass of vino. But my injury forced me to look at what was helping my recovery and what was possibly hurting it.
For me, cutting out booze ended up being a good thing. I feel better. I sleep better. I’m healthier. I’m shocked at how little I miss it. And I’m shocked that I don’t really enjoy it when I have a drink.
Not saying it’s for everyone—but it worked for me. Did it speed up my recovery? Who knows?
NOBODY TOLD ME...
You may be less active, but there's a construction project underway.
Feed the crew.
ASK YOUR SURGEON OR DOCTOR
Most people don't need an elaborate nutrition plan after an ankle fracture, but a few questions may be worth asking:
Should I be taking vitamin D or calcium during fracture healing?
Is there any reason to check my vitamin D level?
Am I getting enough protein for recovery?
Are there supplements I should avoid because of my medications or medical conditions?
If I'm struggling to eat or losing significant weight, should I speak with a dietitian?
If you have kidney disease, diabetes, digestive disease or another condition that affects what you should eat or how your body handles nutrients, your own medical team's advice takes precedence over general recovery nutrition recommendations.