Types of Ankle Fractures & Injuries
This is my ankle— the first time out of a cast— two weeks post op after an ORIF surgery for a bimalleolar fracture and ruptured tendon.
The ankle is a complex joint that bears your full body weight and allows for movement, balance, and flexibility. Because of this, it’s especially vulnerable to injuries — from sprains and tendon tears to fractures that may require surgery. Understanding the different types of ankle injuries can help you recognize symptoms, seek proper treatment, and plan for recovery.
Disclaimer: This article is for informational purposes only and is not medical advice. Always consult a doctor or orthopedic specialist for an accurate diagnosis and treatment plan.
Ankle Sprains
What they are:
An ankle sprain occurs when the ligaments that support the joint are stretched or torn, usually from twisting, rolling, or overstretching the ankle.
Common symptoms:
Pain, swelling, and bruising.
Difficulty bearing weight.
Instability when walking.
Benefits of early care:
With proper rest, ice, compression, and elevation (RICE), many sprains heal without surgery.
Physical therapy can restore stability and strength.
Cautions:
Severe sprains may mimic fractures and need imaging to confirm.
Inadequate healing can lead to chronic ankle instability.
Stable Ankle Fractures
What they are:
A stable fracture means the bone is broken but remains in proper alignment. Often caused by falls, twists, or sports injuries.
Common symptoms:
Localized pain and swelling.
Ability to bear some weight, though painful.
Treatment:
Usually managed with a cast, walking boot, or brace.
Recovery often takes 6–8 weeks.
Cautions:
Skipping immobilization or rehab may lead to long-term weakness.
Unstable Ankle Fractures
What they are:
An unstable fracture means the bone fragments have shifted, or the ankle joint itself is misaligned.
Common symptoms:
Severe pain, swelling, and inability to bear weight.
Visible deformity in some cases.
Treatment:
Surgery (open reduction and internal fixation, or ORIF) is often required.
Recovery includes immobilization, then gradual physical therapy.
Cautions:
Higher risk of complications such as arthritis or chronic pain.
Malleolus Fractures
What they are:
The ankle is supported by three bony structures called malleoli:
Medial malleolus (inside of the tibia)
Lateral malleolus (end of the fibula)
Posterior malleolus (back of the tibia)
Fractures can occur in one or more of these areas, depending on the type of injury.
Common symptoms:
Sudden pain and swelling around the ankle.
Bruising and tenderness directly over the malleolus.
Difficulty or inability to bear weight.
Treatment:
Isolated medial or lateral malleolus fractures may be treated with a cast or boot.
Bimalleolar or trimalleolar fractures usually require surgery with plates and screws.
Cautions:
Higher risk of instability and post-traumatic arthritis with multiple malleoli fractures.
Early and proper treatment is critical for joint alignment.
Bimalleolar and Trimalleolar Fractures
What they are:
Bimalleolar fractures involve two of the three ankle bones (the tibia and fibula).
Trimalleolar fractures involve all three ankle bones (medial, lateral, and posterior malleolus).
Common symptoms:
Severe swelling and bruising.
Significant pain and loss of function.
Usually unable to bear weight at all.
Treatment:
Almost always require surgical repair with plates and screws.
Longer recovery times, often several months.
Cautions:
High risk of stiffness and post-traumatic arthritis.
Extensive rehab is essential to restore mobility.
Stress Fractures
What they are:
Tiny cracks in the bone from repetitive stress, often seen in athletes, dancers, or people who increase activity levels too quickly.
Common symptoms:
Gradual onset of pain with activity.
Tenderness to the touch.
Less swelling compared to acute fractures.
Treatment:
Rest, protective footwear, or walking boot.
Activity modification until healing is complete.
Cautions:
Continuing to push through the pain may worsen the fracture.
Underlying issues (like weak bones from osteoporosis) should be checked.
High Ankle Sprains (Syndesmotic Injuries)
What they are:
A high ankle sprain injures the ligaments that connect the tibia and fibula above the ankle joint. These occur from twisting injuries, often in sports.
Common symptoms:
Pain above the ankle joint.
Pain worsens with walking or rotating the foot outward.
Less bruising compared to common sprains.
Treatment:
Mild cases managed with rest, ice, and bracing.
Severe injuries may require surgery to stabilize the joint.
Cautions:
Longer healing times than typical sprains.
If untreated, can lead to chronic instability.
Achilles Tendon Injuries
What they are:
The Achilles tendon connects the calf muscles to the heel. Ruptures or tears often occur during sudden, explosive movements like jumping or sprinting.
Common symptoms:
Sudden sharp pain, often described as feeling like being kicked in the back of the leg.
Swelling and difficulty pointing the toes or pushing off the foot.
Treatment:
Partial tears may heal with immobilization and therapy.
Complete ruptures often require surgical repair.
Cautions:
Delayed treatment can lead to chronic weakness or reduced mobility.
Peroneal Tendon Injuries
What they are:
The peroneal tendons run along the outside of the ankle and stabilize the joint during walking and running. Injuries can include inflammation (tendonitis), tearing, or dislocation, often caused by repetitive stress or sudden ankle rolling.
Common symptoms:
Pain and swelling on the outer ankle.
A snapping sensation when moving the ankle.
Weakness or instability during activity.
Treatment:
Mild cases managed with rest, ice, physical therapy, and supportive footwear.
Severe tears or dislocations may require surgical repair.
Cautions:
Chronic peroneal tendon issues can mimic or occur alongside ankle sprains.
Ignoring symptoms can lead to long-term instability or arthritis.
Final Thoughts on Ankle Injuries
Ankle injuries range from sprains and tendon damage to complex fractures involving multiple malleoli. Early medical evaluation is the key to proper treatment and a successful recovery. Whether it’s a peroneal tendon tear, a stress fracture, or a trimalleolar break, following your doctor’s advice and committing to rehabilitation gives you the best chance of regaining full mobility.