# Broken ankle > A broken ankle (ankle fracture) is a break in one of the ankle bones, usually the fibula, often after a twist, a fall or a knock. Many heal in a cast or boot over about 6 weeks, while unstable breaks often need surgery. Guide in [Ankle and Achilles](https://footanklelowerlimb.com.au/learn/topics/ankle-and-achilles), from Foot Ankle Lower Limb: https://footanklelowerlimb.com.au/learn/ankle-fracture Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod (Podiatrist) on 27 October 2026. Next review by 27 October 2027. - **It's a break in an ankle bone,** usually the fibula (the smaller lower-leg bone), after a twist, a fall or a knock. - **It can feel like a sprain.** If you can't put weight on the ankle after an injury, see your GP or a podiatrist the same day. - **Many heal in a cast or boot,** while unstable or open breaks often need surgery. - **Healing takes weeks,** and smoking, diabetes and poor circulation can make it harder. ## What is a broken ankle, and how common is it? A broken ankle, also called an ankle fracture or malleolar fracture, is a break in an ankle bone. It happens when more force is applied than the bone can take [1]. It usually involves the fibula, and the tibia (the larger lower-leg bone) can be affected too [1]. The break may be a small crack, a break where the bone shifts out of place, or one where it shatters into pieces [2]. Ankle fractures are common. They make up to 10% of all bone injuries [3], and they're the third most common injury of the bones, joints and muscles in older people [4]. ## What causes a broken ankle, and who gets one? Most follow a twist, a fall or a direct knock to the ankle [2]. A fall from standing height is the most common cause of complex breaks, and some are low-force injuries [3]. Older women seem to have the highest rate [5]. In older adults, age, sex, body weight, diabetes, smoking and osteoporosis (thinner, weaker bones) have all been linked with breaks from minor falls [6]. These are links, not proven causes. The link with bone density is small and not consistent [6]. ## What does a broken ankle feel like, and how is it diagnosed? Common signs are swelling, bruising, tenderness, and pain or difficulty walking or putting weight on the ankle [1]. Sudden sharp pain, a popping or snapping sound at the time of injury, or an ankle at an odd angle can also point to a break [7]. A sprain can feel similar, and a normal-looking ankle can still be broken. If you can't put weight on it after an injury, see your GP or a podiatrist the same day. A clinician will examine the ankle and then usually arrange an X-ray [8]. In adults, a checklist called the Ottawa Ankle Rule is good at ruling a break out: a negative result makes a fracture unlikely. A positive result is often a false alarm, so your clinician will combine it with their own judgement [9]. ## What helps first? A suspected broken ankle needs professional care from the start, so don't try to treat it yourself. Treatment depends mainly on whether the ankle is stable [10]. Most breaks heal without surgery in a cast or boot, usually for about 6 weeks [11]. You may be asked not to put weight on the ankle for a while [12]. Surgery, often with metal plates and screws, is more likely if the break is unstable, out of place or open, or if more than one bone is broken [2]. Diabetes, circulation problems and how active you are also shape the plan [2]. Follow your fracture clinic's weight-bearing instructions exactly. ## What helps if that isn't enough? After surgery, putting weight on the ankle earlier (your surgical team will say when) can give slightly better early function and a quicker return to work, without more complications, mainly in lower-risk people [13]. The difference in ankle function is too small to be clinically meaningful [14]. In older adults, treatment is fitted to other health conditions, how well you managed before the injury and your wishes [4]. If recovery stalls, go back to your fracture clinic or GP rather than waiting. ## How long does recovery take, and can I stop it happening again? A cast is usually worn for about 6 weeks, though this varies with the person and the type of fracture [11]. After a simple break with the ligaments intact, pain may last 6–8 weeks, and it should heal without surgery [15]. Smoking affects healing rates and in extreme cases can stop healing altogether [15]. Stopping smoking, controlling alcohol and managing diabetes all play a significant role in healing [1]. > [!see] If you have diabetes, smoke or have vascular disease > Diabetes, smoking, vascular disease (poor circulation) and open fractures raise the risk of infection, wound problems and poorer outcomes after an ankle fracture [3][16]. Tell your treating team early. It isn't clear yet what prevents a repeat ankle fracture. In older adults, ankle fractures have been linked with lower bone density, so it's worth asking your GP about bone health [6]. ## When to see a podiatrist Call 000 and ask for an ambulance if: - a bone is sticking out through the skin [17]; - your leg or foot suddenly turns cold and pale or blue, with pain or numbness, or you can't move it [11]; - you have chest pain, or sudden severe breathlessness; - you have signs of sepsis with a wound or infection, such as confusion, severe shivering or passing little or no urine. Go to the nearest emergency department if your ankle or foot is badly out of shape after an injury, or your toes turn blue or white in a cast or boot [17][11]. Ask someone to drive you rather than driving yourself. See your GP or a podiatrist the same day if: - you can't put weight on the ankle after an injury, or you have severe pain, feel faint, or heard a snap or pop [7]; - in a cast or boot, you have increasing pain that pain relief isn't controlling, pins and needles or numbness in the foot or toes, or sudden swelling or tightness [11]; - your calf is hot, red, swollen and painful, or you have sudden calf or thigh pain or swelling [15]; - you have spreading redness, heat, swelling, pus or discharge, or a fever, especially after surgery or with wounds or pins [2][11]; - you have diabetes and notice a wound, sore, blister or colour change on your foot. For urgent advice when it isn't an emergency, call healthdirect on 1800 022 222 (24 hours a day), or go to a Medicare Urgent Care Clinic. See your GP if pain is getting worse rather than better after two weeks, numbness isn't improving, the ankle feels unstable, or pain hasn't improved by 6–8 weeks [15]. ## Common questions ### How should I look after my cast or boot? Keep a plaster cast or splint dry: cover it with a sealed plastic bag when you bathe. Don't scratch under it with sharp or pointed objects, and don't remove a splint unless your doctor says it's okay. Avoid carrying heavy things while you recover. If you're unsure about anything, ask your treating team. ### When can I go back to work, driving or sport? There's no single date. It depends on your fracture, how it's healing and what your job or sport involves. Your treating team can guide you, and it helps to agree each step with them, including when to put weight on the ankle and when to return to heavy activity or sport. ## Further reading - [Broken ankle on Clindice](https://clindice.com/ankle-fracture) - [Ankle Fracture Internal Fixation](https://www.uhliverpool.nhs.uk/application/files/5316/9702/3534/Ankle_Fracture_-_Internal_Fixation.pdf), NHS - [Unstable ankle fractures](https://www.uhcw.nhs.uk/download/clientfiles/files/Patient%20Information%20Leaflets/Trauma%20and%20Neuro%20services/Trauma%20and%20Orthopaedics/Unstable%20ankle%20fractures.pdf), NHS - [Advice and exercises for ankle fractures](https://www.dbth.nhs.uk/wp-content/uploads/2019/01/WPR33522-Ankle-Fracture-Advice-Clinical-Therapy.pdf), NHS - [Physiotherapy following an Ankle Fracture](https://www.leicspart.nhs.uk/wp-content/uploads/2017/11/71-Physiotherapy-following-an-ankle-fracture.pdf), NHS - [Broken ankle](https://www.nhs.uk/conditions/broken-ankle/), NHS ## Sources 1. Ankle Fracture · NHS · 2024. https://www.nth.nhs.uk/resources/ankle-fracture/ 2. Ankle fractures — common questions · NHS. https://yourhealth.leicestershospitals.nhs.uk/library/musculoskeletal-specialist-surgery-mss/trauma-orthpaedics/4282-ankle-fractures-common-questions-answered/file 3. Current management of trimalleolar ankle fractures · Pflüger P, Braun KF, Mair O et al. · EFORT Open Reviews · 2021. https://doi.org/10.1302/2058-5241.6.200138 4. Ankle fractures in the elderly: Current concepts · Pearce O, Al-Hourani K, Kelly M · Injury · 2020. https://doi.org/10.1016/j.injury.2020.10.093 5. Epidemiology of Ankle Fractures in Korea: A Nationwide Population-Based Study · Kang HJ, Lee JW, Kwon YM et al. · Journal of Korean Medical Science · 2022. https://doi.org/10.3346/jkms.2022.37.e288 6. Association Between Bone Mineral Density and Elderly Ankle Fractures: A Systematic Review and Meta-Analysis · So E, Rushing CJ, Simon JE et al. · The Journal of Foot and Ankle Surgery · 2020. https://doi.org/10.1053/j.jfas.2020.03.012 7. Ankle pain · NHS. https://www.nhs.uk/symptoms/foot-pain/ankle-pain/ 8. Fractures of the ankle joint: investigation and treatment options · Goost H, Wimmer MD, Barg A et al. · Deutsches Arzteblatt International · 2014. https://doi.org/10.3238/arztebl.2014.0377 9. Diagnostic accuracy of the Ottawa ankle rule to exclude fractures in acute ankle injuries in adults: a systematic review and meta-analysis · Gomes YE, Chau M, Banwell HA et al. · BMC Musculoskeletal Disorders · 2022. https://doi.org/10.1186/s12891-022-05831-7 10. Current Concepts in Ankle Fracture Management · Patel S, Dionisopoulos SB · Clinics in Podiatric Medicine and Surgery · 2024. https://doi.org/10.1016/j.cpm.2024.01.008 11. Display Patient Information Leaflets · University Hospitals Plymouth NHS Trust · 2020. https://www.plymouthhospitals.nhs.uk/display-pil/pil-ankle-fractures-3956/ 12. Ankle Fracture · Worcestershire Acute Hospitals NHS Trust · 2024. https://www.worcsacute.nhs.uk/leaflets/ankle-fracture/ 13. Early vs Late Weight Bearing After Ankle Fracture Fixation: A Meta-analysis of Randomized Controlled Trials · Egu C, Akil H, Hakim RA et al. · Foot & Ankle International · 2026. https://doi.org/10.1177/10711007251392223 14. Rehabilitation for ankle fractures in adults · Lewis SR, Pritchard MW, Parker R et al. · The Cochrane Database of Systematic Reviews · 2024. https://doi.org/10.1002/14651858.cd005595.pub4 15. Orthopaedic Surgery - Discharge advice following Simple ankle fractures · NHS. https://www.northerncarealliance.nhs.uk/patient-information/patient-leaflets/orthopaedic-surgery-discharge-advice-following-simple-ankle-fractures 16. Diabetic ankle fracture complications: a meta-analysis · Lopez-Capdevila L, Rios-Ruh JM, Fortuño J et al. · Foot and Ankle Surgery · 2021. https://doi.org/10.1016/j.fas.2020.10.015 17. Broken ankle · NHS. https://www.nhs.uk/conditions/broken-ankle/ --- This page is general information, not a diagnosis or a treatment plan for you. For advice about your own feet or legs, see a podiatrist or your doctor. In an emergency, call 000.