Ankle Fracture
Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod, October 2026
An ankle fracture is a break in one of the ankle bones. It is common, making up to 10 per cent of all bone injuries, and it is becoming more common. The main signs are pain, swelling, bruising and trouble putting weight on the ankle. Most ankle fractures heal without surgery, usually after about 6 weeks in a cast or boot. Breaks that are unstable, out of place or through the skin are more likely to need an operation. With the right care, most people recover well, though pain can last for weeks.
What is it?
An ankle fracture is a break in one of the bones of your ankle. It happens when more force is put on a bone than it can take. It usually involves the fibula (the smaller of the two lower-leg bones). The tibia (the larger one) can be broken too. The break can be below, at or above the ankle joint.
Breaks come in different kinds. A small crack where the bone stays in place is called undisplaced. In a displaced fracture, the bone shifts out of place. In a comminuted fracture, the bone breaks into several pieces.
Doctors also describe a break as stable or unstable. In a simple break where the ligaments (the tough bands that hold the joint together) are still intact, the ankle stays stable. Whether a break is stable is one of the main things that decides your treatment.
You may hear names such as bimalleolar fracture, trimalleolar fracture or Weber fracture. These are ways doctors describe and group ankle breaks.
Who does it affect?
Ankle fractures are common. They make up to 10 per cent of all bone injuries, and they have become more common over recent decades. They are the third most common injury to bones, joints and muscles in older people.
Women around the age of 60 have the highest rate of any group, and the rise has been biggest in older women. One type, the trimalleolar fracture, is most common between ages 60 and 69. Exact figures may differ from one population to another.
Signs and symptoms
The most common signs are swelling, bruising and tenderness. It is usually painful or hard to walk, or to put weight through the ankle.
Some people notice sudden, sharp pain at the time of the injury. You may hear a snap, grinding or popping noise. Your ankle or foot may look out of shape or sit at an odd angle. Very bad pain can also make you feel faint, dizzy or sick.
What causes it?
Most ankle fractures follow a twist of the ankle, a fall or a direct knock. Falls from standing height, with the ankle twisting under you, are the most common cause. Some breaks, such as trimalleolar fractures, usually come from low-energy injuries like this. A different ankle bone, the talus, tends to break after high-energy injuries, such as a major accident.
In older adults, several things are linked with ankle fractures from a simple fall: age, sex, body weight, diabetes, smoking and thin, weak bones (osteoporosis). The link with bone strength is small and not consistent. These are links, not proven causes.
Diabetes, smoking and alcohol matter mostly for how well you heal afterwards, not for whether you break your ankle.
How is it diagnosed?
Your practitioner will examine your ankle and ask how the injury happened. An X-ray usually follows. Ligament tests that move the ankle are done only after the swelling has gone down.
In adults, clinicians often use a set of checks called the Ottawa Ankle Rule. If your result is negative, a break is unlikely. A positive result is less reliable, because it flags many ankles that aren't broken. So your practitioner will weigh it up with their own judgement before sending you for an X-ray.
A sprain (an injury to the ligaments) can feel like a break, and a break can look like a sprain. A talus fracture, or an infection, can also cause severe pain and trouble walking. That is why a sore, swollen ankle that you can't walk on is worth getting checked.
For complex breaks, you may have a CT scan (a detailed scan). It helps plan surgery and can pick up rare problems, such as a tendon caught between pieces of broken bone.
Treatment
Treatment depends mainly on whether the break is stable. Most ankle fractures heal without surgery.
Looking after it at home
If you have a cast or splint, a few simple habits protect it:
- Keep it dry. Cover it with a sealed plastic bag when you wash.
- Don't scratch under it with sharp or pointed objects.
- Don't take a splint off unless your doctor says it is okay.
- Don't carry heavy things while you recover.
If you are given blood-thinning injections because of your risk of a blood clot in the leg, finish the whole course.
Stopping smoking, keeping alcohol under control and managing your diabetes all help your bone to heal.
Treatment from your podiatrist
Most ankle fractures heal on their own, as long as the ankle is protected in a cast or boot. This usually takes about 6 weeks, though it varies with the person and the type of break. Some people need a period of no weight on the ankle. Your podiatrist and the rest of your treating team will tell you which applies to you.
A simple, stable break with intact ligaments is expected to heal without surgery.
Surgery
Surgery is considered when a break is unstable, out of place or open (the bone has come through the skin). Surgery is also more likely if more than one bone is broken, such as with a trimalleolar fracture. The surgeon usually fixes the bones with metal plates and screws, and sometimes with a frame that sits outside the leg.
After surgery, the most common problems are with the wound, such as a build-up of blood under it or the skin edge not healing well. Infection happens in about 2 per cent of people. Tell your team promptly about any change in your wound.
In older adults, surgery used to carry high complication rates. Newer techniques and team care before, during and after the operation have improved results. Treatment is fitted to your other health conditions, how well you were moving before, and what you want.
Recovery
For a simple break, expect a cast or boot for about 6 weeks. The ankle may stay painful for 6 to 8 weeks. Recovery can be longer if the break is more complex, and your own timeline may differ.
Some things make healing harder. Diabetes, smoking, poor blood flow in the legs (vascular disease) and open fractures are linked with more wound problems and poorer results. Smoking slows healing and, in extreme cases, can stop it altogether. In the most serious cases, these problems can lead to amputation below the knee. Tell your team about these early so they can plan around them.
Rarely, a complex break can trap a tendon, and it may be found late. Later signs can include the foot turning outwards, pain when you move it and, in severe cases, a flat foot.
Preventing it
It isn't yet clear how to prevent another ankle fracture. In older adults, bone strength is linked with ankle fractures, so it is worth asking your GP about your bone health.
When to see a podiatrist
Book an appointment if
You want to plan how to get back to work, sport or heavy activity, or you want to talk through how diabetes, smoking or alcohol could affect your healing. Book an appointment with your podiatrist or your treating team.
Seek prompt assessment if
Your ankle is at an odd angle or has changed shape after an injury, a bone is sticking out, there is a bad cut or wound, or your toes look blue or white or feel numb: go to the nearest emergency department. Don't drive yourself. Ask someone to drive you, or call your local emergency number for an ambulance. In a cast or boot, if your toes or skin turn pale, cold, blue or white, call your local emergency number. If you suddenly become short of breath, have chest pain, or cough up blood, call your local emergency number. If you have a wound or infection and you also feel very unwell, with confusion or slurred speech, severe shivering or muscle pain, severe breathlessness, mottled or discoloured skin, or little or no urine, this could be sepsis: call your local emergency number.
See your GP or another doctor today if you have severe ankle pain, feel faint, dizzy or sick from the pain, heard a snap, grinding or popping noise at the time of injury, or can't walk. These can be signs of a break or an infection. If you aren't sure whether your ankle is broken, get it checked rather than treating it yourself. See your GP or another doctor today if, in a cast or boot, you have pain getting worse despite your pain relief, pins and needles or numbness in your foot or toes, or sudden swelling or tightness. See your GP or another doctor today if you have a hot, red, swollen, painful calf (it can be a blood clot), or sudden pain or swelling in your calf or thigh. See your GP or another doctor today if you have a fever, swelling or discharge from your ankle, or increasing pain, especially after surgery or if you have a wound or pins. If your GP can't see you today, go to an urgent care clinic or an after-hours GP.
See your GP, your podiatrist or your fracture clinic soon if your pain is getting worse rather than better after two weeks, numbness or pins and needles aren't improving, your ankle feels unstable, or your pain hasn't improved by 6 to 8 weeks.
Frequently asked questions
How can I tell if my ankle is broken or just sprained?
You can't tell for sure by looking or by how it feels. A break and a sprain can feel alike. Your practitioner will examine your ankle and may arrange an X-ray. Don't assume an ankle that looks like a sprain isn't broken.
When can I put weight on my ankle?
Follow your treating team's instructions exactly. Some people need a period of no weight on the ankle while it is in a cast or boot. After surgery, starting to put weight on it early, within about 3 weeks, probably gives slightly better ankle function than waiting. It may also mean returning to work sooner, without more complications. This mostly applies to lower-risk people, so your team will decide.
Does diabetes change my recovery?
Yes. People with diabetes have about twice the overall risk of complications after an ankle fracture, and about three times the risk of infection. The risk is higher again with advanced diabetes, and higher with surgery than without it. Tell your team about your diabetes early so they can plan your care with you.
When can I drive, go back to work or play sport?
It depends on your break, your treatment and your job or sport. Your treating team will agree a plan with you for building back up, including how and when to return to heavy activity. Ask them before you restart.