INFORMATION FOR PATIENTS Ankle fractures

This leaflet intends to educate you on How is it treated? the immediate management of your ankle fracture. It also contains Most fractures will heal themselves but do exercises to prevent stiffening of your need a period of protected immobilisation ankle, whilst your fracture heals. to allow this healing to occur.

What has happened to my ankle? Occasionally your ankle may need to be manipulated prior to being immobilised to A fracture is a break, or divide, in a bone, ensure it heals in the correct position. which is most commonly caused by trauma. The ankle is made up of 2 long Your ankle may be immobilised in a shin bones (the tibia and fibula) along Plaster of Paris (POP) cast or a boot. with small bones inside the ankle, and the This usually lasts for up to six weeks but foot. The most common trauma is where may differ depending how well healing the foot has turned inwards, or from an occurs. While the plaster is on, it is impact injury. important to keep your toes and knees moving to prevent them becoming stiff. The broken bone often occurs in just the When your consultant thinks you are fibula (the thinner shin bone on the ready the plaster cast will be removed outside of your lower leg). The break may and you can then start to move your be below, at the same level or above your ankle. ankle joint. These fractures may be referred to as a Weber fracture and are In some circumstances, your ankle may classified as A, B or C dependent on the require surgery to stabilise the fracture site of the break (see below). with pins and plates (ORIF).

Occasionally the tibia (the thicker shin After removal of the plaster bone in your lower leg) may also be involved. Occasionally you will be told to reduce the amount of weight you put through your foot and ankle, or to avoid certain activities initially.

If you are not advised of any restrictions

you should use your ankle as pain allows. Your ankle may feel quite uncomfortable Swelling when the plaster is initially removed, It is normal for your ankle to swell after along with apprehension around moving breaking your ankle and this may remain it, but this is normal. It is normal for your for up to one year after the fracture. This ankle to feel vulnerable once the plaster is normal and does not mean there is has been removed because it hasn’t been anything wrong with your ankle. moved for a long time. Swelling can reduce your ability to move It is important that swelling, pain, strength your ankle and make it uncomfortable. and stiffness are addressed following the Try the following to minimise the swelling: removal of the plaster. You will be - When you are resting, sit with your referred to our physiotherapy department leg up to elevate your foot. for a graded exercise programme to help - At night rest your foot on some with this. pillows so that it is above the level of your heart. What should I expect after removal of - You may also wish to use ice to my plaster? help manage your pain and swelling. Pain or discomfort - Application of ice: Place a wet tea It is normal to get some pain and towel directly over your skin, and discomfort after your fracture. If you have then place a bag of frozen peas on been given painkillers you should take top of the towel. Keep the peas in them as prescribed. By managing your place for 10- 15 minutes, checking pain it will allow you to complete your to make sure that your skin has not exercises and walk more comfortably. become very red; repeat this up to If your pain is severe or continuous or you 3 times a day. develop a painful, swollen calf you should contact your GP. Stiffness It is important to try to move your ankle as Dry, sensitive skin much as possible after your fracture has Your skin may be dry and flaky. You may healed to allow you to regain full function. find that soaking your foot and ankle in Completing your exercises and walking warm water helps to reduce the pain and will help to reduce stiffness makes moving your ankle easier. Exercising in water may therefore be a Power comfortable way of doing your exercises. Your ankle will feel weak and wobbly after Increased sensitivity of the skin around your plaster has been removed as you the ankle is a normal side-effect of being haven’t used it properly whilst you have in plaster. been in plaster.

Massaging your foot and ankle with plain You should gradually increase how much moisturiser or body lotion may also help you use your ankle and how much you with the flaky skin, desensitise and make walk and be guided by your pain. your foot more comfortable to complete your exercises

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Pain management Should I stop my exercises if my ankle swells or aches? Your ankle will be swollen and very You should expect slight increase in painful in the first few days, which is to be discomfort and swelling initially when expected as part of the healing process. doing your exercises. This should settle Utilising an ice pack or frozen bag of however within a short time of finishing vegetables can aid with relieving these your exercises. You may need to take symptoms. Use a towel to avoid applying your painkillers initially to allow you to do directly to the skin, and do this for 20 your exercises comfortably. minutes a time, 5 times a day. Elevating your ankle and leg will also assist in How will I know when to stop using my reducing the swelling. crutches? If you have had no restrictions to your Over-the-counter analgesia, such as weight bearing status, you should slowly paracetamol and ibuprofen, will also increase the amount of weight you put reduce your symptoms. If you require through your foot as pain allows. You can further information on pain relief, speak to wean yourself onto one crutch (using the your GP or pharmacist. Ensuring pain is crutch in the opposite hand to your injury) to a minimum, allowing you to move your as pain and ankle movement allows. ankle, is vitally important. Some people then progress on to a stick or discard their crutches completely. Frequently asked questions Exercises Why does my ankle look a funny shape? It is very important to start the following As a fracture heals, new bone is formed exercises as soon as possible to prevent at the site of the break in the bone stiffening and loosing range of motion (callus). This can result in a lump forming within your ankle. They should be done on the side of your ankle. This is normal as pain allows, with some discomfort and your ankle may change shape again being acceptable. If a sharp shooting pain over 12- 18 months as the bone remodels is provoked then ease off. However, itself. gently moving your ankle should begin to decrease the pain and not cause further When can I start driving? damage. It is important to move your You can start driving once you have knee as well, if it isn’t injured, as it too sufficient movement and strength to be can become stiff. able to control the pedals. You must be able to perform an emergency stop safely If you have been given an airboot or and pain free. This will vary between ankle support, try to wean out of it as individuals but is usually six to eight advised and remove initially for your weeks after removal of the plaster. You exercises. It may be beneficial to remove may wish to seek guidance from your it at night time to begin with and progress insurance company. to only wearing it in busy places before discarding it altogether.

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Doing the following exercises consistently 6) Sitting with your is essential to prevent stiffening, and we feet on the floor. recommend doing them little and often Push up onto your throughout the day. toes and then roll back through your The exercises feet and onto your heels. Early exercises: Movement

1) Gently move your Exercise progressions: Strength and ankles up and down balance to bend the ankle joint and point your 1) Place the theraband toes. around the top of your foot and to a stable surface. Pull your toes 2) Gently move your up towards you ankle round in against the band. circles, both clockwise and 2) Place the theraband anticlockwise or under your foot. Point write the alphabet. your toes against the band. Relax.

3) Gently move your ankle from side to 3) Place the theraband side, ensuring you on the inside of your keep the knee still. foot and hold in the opposite hand. Do not allow your knee to 4) Use a towel around move and pull your the bottom of your foot inwards. Relax. foot. Gently pull on the towel to bend 4) Place the theraband your ankle. Hold the on the outside of your stretch for 10 foot and hold in the seconds. opposite hand. Do not allow your knee to 5) Sitting with your move and pull your affected ankle foot outwards. Relax. crossed over the opposite knee. Point your toes and 5) Try to balance on your add pressure with affected foot. Start your hand to stretch with some support and the top of your gently wean this as ankle able.

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You may require one-to-one 6) Stand holding a physiotherapy if you are still stable surface. Roll struggling with your ankle after a few through your feet and weeks of following this advice. If so, push up onto your please contact us as below. toes. Slowly lower. Clinic 10, Physiotherapy Department Telephone: 01623 672384

King’s Mill Hospital Factors that influence healing Mansfield Road Sutton in Ashfield Staying on top of the following factors can Nottinghamshire help move the healing process along and NG17 4JL give your ankle the best chance of a swift recovery: Further sources of information NHS Choices: www.nhs.uk/conditions Stress relief – utilise techniques such as Our website: www.sfh-tr.nhs.uk mindfulness, meditation and deep breathing cycles. Speak to your health Patient Experience Team (PET) care professional for more information. PET is available to help with any of your compliments, concerns or complaints, Sleep hygiene – consistently getting 6-9 and will ensure a prompt and efficient hours is recommended by the NHS. Only service: King’s Mill Hospital: 01623 622515 use your bedroom for sleep, e.g. not TV. Newark Hospital: 01636 685692 Email: [email protected] Nutrition – make sure you have a balanced diet. Vitamin D has been If you would like this information in an correlated with reduction in joint pain. alternative format, for example large print or easy read, or if you need help with communicating with us, for example Alcohol – avoid alcohol in the early because you use British Sign Language, stages of healing (first three days). please let us know. You can call the Evidence has shown this can slow down Patient Experience Team on 01623 recovery and increase the chances of re- 672222 or email [email protected]. injury. This document is intended for information purposes only and should not replace advice that your relevant health Smoking – this has been linked with professional would give you. External websites may be musculoskeletal pain and delayed referred to in specific cases. Any external websites are provided for your information and convenience. We cannot healing. For more advice see smoking accept responsibility for the information found on them. cessation or ask you therapist for more If you require a full list of references for this leaflet (if relevant) information. please email [email protected] or telephone 01623 622515, extension 6927.

General exercise – general cardio- To be completed by the Communications office vascular exercise, such as a brisk walk Leaflet code: PIL202005-01-ANF each day, stimulates blood flow to the Created: May 2020 / Review Date: May 2022 area.

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