Ankle Fracture Surgery

A fracture is a break or crack in a bone. The ankle is formed by three bones. These bones are the tibia, fibula and talus. Treatment depends on where and which bones are affected, if the fragments are badly aligned or if it causes joint instability.

Sometimes this can be managed by putting a plaster cast or splint on.

Sometimes surgery is carried out to realign and hold the bones together to improve healing.

Sometimes this is followed by a period in a plaster cast or splint and by keeping your weight off that foot using crutches.

The aim of surgery is to realign and stabilise the bone while it is healing. This is to try and prevent permanent stiffness, weakness and pain. Some ankle fractures can be treated in a plaster or splint if the bone is not displaced and stable, you accept the displacement or surgery would be too risky for you.

Surgery involves the bone being held with plates and screws that sit on the bone under the skin. More than one bone may need to be fixed and this sometimes needs to be done through more than one cut (wound) in the skin. The most common wounds will be on both sides of the ankle. There are always risks of surgery, these will be explained to you before surgery takes place by your surgeon. Surgery will either involve a general anaesthetic (going to sleep) or a spinal anaesthetic (numbing your leg so you don’t feel the surgery). This will be decided between you and your anaesthetist.

You will usually be discharged from hospital on the same or next day after surgery. Before you go home a doctor or nurse will discuss with you whether you need to take any blood thinning medication. They may also discuss whether some of your appointments may be carried out using a videophone or telephone. You will usually have follow up at 2 weeks and 6 weeks after surgery. These appointments will should be given to you before you leave hospital.

At around 2 weeks after your surgery, you will be seen by one of the fracture clinic nurses or podiatrists. They will examine your wound and ankle. They will change your cast or offer you a new walking boot and remove your clips/stitches. They may then send you for an X-ray of your ankle. They will then make sure you have another appointment booked for week 6 with either the fracture clinic or podiatry clinic.

At around 6 weeks after your surgery, you will come back to hospital for an X-ray and to see a healthcare specialist. Most people will be discharged after this appointment to patient initiated return but some may need more appointments or a physiotherapy referral.

Some problems patients can develop after surgery are infection, blood clots in the leg, poor bone healing, arthritis, nerve damage, tendon irritation, complex regional pain syndrome, irritating or prominent metalwork, walking difficulties, poor balance, pain, stiffness or weakness. If you are suffering from any of the list below, it may mean you have a problem from your surgery.

Infection – You might feel unwell or feverish with increased pain, swelling or stiffness in the ankle. Sometimes the wound can become red, painful or start to leak. If you develop any of these problems contact the clinic using the contact details below. If it is out-with clinic hours and you feel unwell then go to your local Emergency Department.

Pain – This can be caused by many problems. If your pain is getting worse or you still have moderate or severe pain 12 weeks after surgery then contact the clinic using the details below.

Stiffness – If you are having problems with ankle stiffness that is affecting your ability to do things at 12 weeks after surgery you should arrange physiotherapy using the details below.

Swelling – If you have new or worse swelling after you have been to your final clinic appointment then contact the clinic using the details below.

Breathing problems – For around 1 in 100 patients, a blood clot can form in the veins of the leg after surgery. This might cause pain and swelling in the leg. Very rarely a clot can travel to the lung through the bloodstream. This can give people chest pain or breathing difficulties. If you think you have one of these problems phone an ambulance or NHS24 immediately.

Walking difficulties or balance problems – There are different reasons why patients can have problems with walking or balance after surgery. If these problems continue for more than 12 weeks after surgery you may benefit from speaking to a healthcare professional. You may also have stiffness or pain that affects your ability to walk. If your problem is mainly caused by pain, you should contact the clinic. If it is mainly caused by stiffness, or you have balance problems, you should arrange to see a physiotherapist. It is ok to call the clinic to discuss this first if you are not sure.

If you have a problem related to your ankle fracture or surgery that is not listed here but you would like to see someone about it then please contact the clinic using the details below.

Queen Elizabeth University Hospital Fracture Clinic – 0141 452 3210 (Monday – Friday, 09:00 – 16:00)

Victoria ACH Fracture Clinic – 0141 347 8754 (Monday – Friday, 09:00 – 16:00)

This depends on your injury and the surgery you have. Your surgeon will advise you about this after your surgery. Most patients will be allowed to walk as their pain allows them immediately after surgery. You will need to wear a walking boot while you are walking for the first 6 weeks after surgery. You can take it off when you are sitting down, sleeping or doing your exercises.

If you are wearing a cast, you will usually not be allowed to put any weight through that leg for 2 weeks. Once the cast is changed you might be allowed to put some weight through it from week 2 – 6 after surgery. Sometimes people need to use crutches for some of this period. This will be assessed by a physiotherapist before you go home.

This depends on the demands of your job. It is likely that you will require 2-3 weeks off to recover from the surgery and allow the discomfort to settle. If you have an office job, returning to work after this for light duties might be possible, but you should avoid anything which makes your ankle uncomfortable, such as prolonged standing or walking. For manual work requiring lifting, you will need at least 6 weeks off, which may be longer depending of the extent of your injury. If your job involved driving you will be off work for at least 6 weeks.

You should not drive while you are in a cast or walking boot. You cannot drive for at least 6 weeks after surgery. After this you can drive when you are able to control your vehicle and safely perform an emergency stop. This is your decision. You can discuss this with your doctor or physiotherapist if you are unsure. You must be safe and in control of the vehicle. The law is very clear that you have to be able to prove to the police that you are ‘safe’ to drive, so it is entirely your own responsibility and we cannot give you permission to drive.

It is advised that you do return to sport until at least 12 weeks after your injury – please seek advice from your doctor or physiotherapist who will guide you.

If you carry out the exercises in this leaflet your movement will probably return to normal. If you are having problems with stiffness and this is affecting what you can do discuss this at your clinic appointment and you may need a physiotherapy referral. If you have been discharged from Orthopaedic clinic, please self refer to your local physiotherapy department or arrange this with your GP.

Below is a rough guide of what most patients will be able to do after ankle fracture surgery. Everyone is different and some people may take longer or shorter to be able to do these things. If you are unsure please discuss them with your nurse or surgeon.

Weeks 0-6

• You will be in a cast or walking boot depending on your injury
• Keep foot elevated when you are not walking to reduce swelling
• If you are in a walking boot you will be allowed to weight bear as your pain allows. Move your toes often.
• If you are in a walking boot you can remove this when you are sitting down or in bed.
• If you are in a walking boot you can begin stage 1 exercises.

If you are in a cast you will not normally be allowed to weight bear on that leg.

Weeks 2-6

• Continue stage 1 exercises
• Return to desk based work if required and comfortable.

Weeks 6-12

• The fracture is united (healed)
• You can begin to resume normal activity but be guided by any pain you are experiencing.
• Carry out day to day activities.
• Carry out stage 2 exercises
• If you no longer require to wear a walking boot you may wish to consider driving provided you can safely operate a car.
• If you were in a cast and it has now been removed you can start stage 1 exercises followed by stage 2 as your pain allows.
• Heavy tasks, heavy lifting or sport may cause some initial discomfort.

Week 12

• Return to manual work, sport and heavy activities.
• If you are still experiencing significant pain or swelling then please contact the Fracture Care Team for advice.

• Lying on your back or sitting. Bend and straighten your ankles. If you keep your knees straight during the exercise you will stretch your calf muscles.

• When sitting or lying, move your ankle slowly in large circles. Repeat in opposite direction.

• Sitting on a chair, alternatively raise your toes and your heels.

Repeat each exercise 10 times, 5 times per day.

When you are comfortable doing these exercises you can begin the gentle resistance exercises below.

• Sit on a chair or on the floor. Put one foot on top of the other foot. Try to point the toes of the foot that is on top while preventing any movement with the foot that is underneath.

• Sit on a chair or on the floor. Put the inner borders of your big toes together. Press the inner borders of your big toes together. Hold approx. 5  secs.

• Sit on a chair or on the floor. Cross your feet and put the outer edges of your little toes together. Press the outer edges of your little toes together. Hold approx.  5  secs. 

• Sitting on a chair. Cross the ankle to be stretched over the other knee. Place your hand on top of your foot and help to point your toes. This will stretch your ankle. You should feel the stretch in the front of your shin.

• When standing, place your foot on a chair. Line your heel up with the front edge of the chair. Hold the back of the chair for balance. Gradually move your knee towards the back of the chair keeping your whole foot in contact with the chair.This will stretch your ankle. You may feel a stretch in your calf and at the front of your ankle.
• Note: if you walked with assistance of a walking stick or walking aid prior to ankle injury then please do not attempt this exercise.

• Sit on the floor or on a chair with one leg out straight in front of you. Put a rubber exercise band or towel around your foot.Use the band / towel to gently pull your foot up towards your body. You will feel a stretch in your calf.

• 1. Sit with operated leg crossed over and hold foot as shown
  2. Turn foot (forefoot and heel) upward so that you feel a stretch,
  3. Hold 3 seconds
  4. Then turn foot downwards, feel the stretch and hold for 3 seconds. Hold each exercise for 10 seconds. Repeat 10 times, 5 times per day.

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• Sit on a chair or on the floor. Put one foot on top of the other foot. Try to point the toes of the foot that is on top while preventing any movement with the foot that is underneath.

• Alternatively, sit on the floor or on a chair with one leg out straight in front of you.
• Tie a rubber exercise band to something secure and put the rubber exercise band around your foot (make sure there is some tension on the band to pull against). Pull your foot up towards your body against the resistance of the band.

Hold each exercise for 5 seconds. Repeat each exercise 10 times, 5 times per day.

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• Sit on a chair or on the floor. Put one foot on top of the other foot. Try to lift the foot that is under while preventing any movement with the foot that is on top.

• Alternatively, sit on the floor or on a chair with one leg out straight in front of you. Put a rubber exercise band or towel around your foot. Pull the band/towel towards you to provide some resistance. Point your toes towards the floor, against the resistance of the band/ towel. Slowly return to starting position.

Hold each exercise for 10 seconds. Repeat each exercise 10 times, 5 times per day.

The exercises in this section are not intended for anyone who required assistance of a walking stick or walking aid prior to injury.

The exercises in this section should be completed along side on-going physiotherapy input with the aim of returning to specific hobby or sport that demands higher level rehabilitation. If you are not attending physiotherapy and wish to return to sport please request referral through fracture clinic or self- refer to your local physiotherapy department.

It is normal to feel some discomfort when starting a new exercise. If any of these exercises cause increased pain at your ankle then stop the exercise and speak with your physiotherapist. 

• Mini Band Resisted Marching: Start by standing with a mini band around both feet and arms relaxed by your side.
  Lift one leg and bring your knee towards your chest against the resistance from the band. At the same time keep the hip of the supporting leg straight. Keep your upper body upright and let arms swing by your sides at the same tempo as your legs march.
  
  Repeat 10  times.

• Stand as pictured below. 
  Start in standing with your feet hip-width apart and a mini band around both feet close to your ankles. Feel how the band pulls your feet inwards.
  Step to side keeping your toes pointing forwards. 3 steps in each direction.
  Note: Keep your toes relaxed during this exercise.
  
  Repeat 3-5 times in each direction.

• Stand. Step sideways and place your foot on a balance pad/ folded pillow.
  Hold 10  seconds, increase as you are able.
  Repeat 10  times.

• Stand on one leg holding onto support of chair. Push up on your toes.

         This can be progressed into a walking exercise. As you walk try to push up on

          to your tip toes, you should feel like your heading bobbing up and down.          Repeat times 10 times.

• Stand on one leg on a step with your heel over the edge holding onto support. Let your heel drop downwards. Push up on your toes.
  Repeat 10  times.

• Stand on one leg on a step facing down. Slowly lower yourself by bending your knee to 30 degrees. Return to starting position.

Repeat 10  times.

• Stand with feet together.When you feel ready try initially to jump on the spot, as you get more confident try jumping forward and backward in a Z pattern. Reverse the Z pattern.

• Stand on one foot.
  When you feel ready try hopping on the spot, this will be closer to the 12 weeks and may even take longer than that.
  Once hopping on the spot becomes easy try to hop forward and backward, then try side to side and finally try to hop in a Z pattern. Reverse the Z pattern.

Contact Details

Queen Elizabeth University Hospital main switchboard – 0141 201 1100

Queen Elizabeth University Hospital Fracture Clinic – 0141 452 3210 (Monday – Friday, 09:00 – 16:00)

Victoria ACH Fracture Clinic – 0141 347 8754 (Monday – Friday, 09:00 – 16:00)

Appointments booking office – 0141 347 8347 (Monday – Friday, 08:00 – 20:00)

Physiotherapy – 0141 452 3713 (Monday – Friday 8.30- 1600)

MSK Physiotherapy Self Referral  https://www.nhsggc.org.uk/your-health/health-services/msk-physiotherapy/

Further information is available at https://www.nhs.uk/conditions/broken-ankle/

At the end of your final appointment you will usually be discharged from further follow up. This information sheet has advice on problems to watch out for and advice on exercises you should carry out. You should read through this leaflet closely as they will tell you about what you should expect for your recovery. They will also tell you how to get arrange a further appointment should you have any problems.

Once you have finished at your final appointment, if you develop a problem related to your ankle fracture or surgery, you can contact the clinic and arrange a new appointment yourself. You do not need to contact your GP to do this.

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