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Workplace Injury of the Week: Ankle Fracture

Ankle fractures–whether they happen when Joe slips on the loading dock or by when Jody takes a bad step in the Saturday 1k running race–are a common injury that causes absence from work.

Our MDGuidelines brief on ankle fractures has helpful information for individuals, medical professionals and return-to-work case managers. Here are some of the major points:

Ankle fractures occur most commonly when there is a sudden twisting injury to the foot. The ankle may roll in (inversion injury) or out (eversion injury), and the force on the foot can be transmitted to the tibia and fibula, resulting in fracture.

The physician will often try to ascertain exactly how the injury occurred. Knowing the position of the ankle at the time of injury can help determine the mechanism of injury, which gives important information about which bones and ligaments were probably damaged.

Fractures also can occur in individuals with unstable ankle joints and a history of recurrent ankle sprains.

Risk: Individuals who participate in activities that potentially place excessive force on the ankle joint (e.g., skiing, snowboarding, ice skating, basketball, football, soccer, rugby) are at risk for ankle fractures. Ankle fractures commonly occur in motor vehicle accidents where the foot is braced against the floorboard. Most males experiencing ankle fractures are under age 50, while most women experiencing ankle fractures are over age 50.

Treatment and Recovery Time: The duration of treatment of an ankle fracture is related to the associated soft tissue involvement, location and type of fracture. The main focus of rehabilitation should emphasize restoring full range of motion, strength, proprioception and endurance while maintaining independence in all activities of daily living. Resumption of pre-injury status is the goal with consideration of any residual deficit. Appropriate early mobilization of the ankle joint hastens recovery; however, protocols for initial rehabilitation must be based upon stability of the fracture and fracture management (operative, nonoperative).

Bone healing may occur within 6 to 12 weeks; however, the bone strength and the ability of the bone to sustain a heavy load may take up to 1 year. Once healing has occurred, the individual may resume full activities of daily living. It is important to instruct the individual not to overload the fracture site until the bone has regained its full strength. The resumption of heavy work and sports should be guided by the treating physician. Rehab may require up to 20 visits with a PT within 10 weeks of the injury.

Rehabilitation: The goal of rehabilitation is to decrease pain and restore full function, with a painless mobile ankle. Local cold application may be beneficial for controlling pain and edema. Individuals should be encouraged to continue functional activities to prevent complications of inactivity and bed rest. Gait training using appropriate assistive devices is indicated to promote independent ambulation. Individuals may progress from walker to crutches to cane based on ability and weight bearing status. If casted, range of motion exercises of the adjacent joints may be beneficial unless contraindicated based on fracture stability. After cast removal range of motion, proprioceptive and strengthening exercises should be started at the ankle. Exercise intensity and difficulty should be progressed until full function is evident. Edema is a common problem and may be controlled using modalities such as cold packs and compressive wrapping. If operatively managed, the rehabilitation protocol will be directed by the treating physician.

More info about ankle fractures, including treatment, prognosis, complications, return-to-work durations and accommodations and issues of failure to recover at MDGuidelines.com.


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