The ankle is one of the most versatile joint complexes in the body. It is specifically built for weight bearing, mobility, adaptability and stability. The foot and ankle allow us the ability to walk, stand, and serve as our connection to the ground. The ankle must be able to withstand the stress of body weight and also be able to adapt to and react quickly to changes in the environment and walking surface.
A fracture is a break, typically in a bone. If the broken bone punctures the skin, it is then called an ‘open’ or ‘compound’ fracture. Fractures often occur due to car accidents, falls, or sports injuries. Other causes are low bone density and osteoporosis, which cause weakening of the bones. Overuse can also cause stress fractures, which are very small cracks in the bone.
Lateral malleolus fractures are breaks in the bone on the outside of the ankle. The lateral malleolus forms the lower end of the fibula. It is a pyramidal form, and somewhat flattened from side to side; it descends to a lower level rather than the medial malleolus. Breaks in the outside of the ankle joint are the most common type of ankle fracture. They can occur when you take an awkward or uneven step that causes you to either twist or roll your ankle.
Most of these fractures are stable ankle fractures, where the ankle joint remains aligned and able to move regularly. Luckily, lateral malleolus fractures do not require surgery (with a recovery estimation of at least 6 weeks), however, there is a classified grading of its severity that may need surgical treatment if a patient reaches the third stage of a lateral malleolus fracture:
- Grade 1 ankle fracture – A first graded fracture involves small cracks which may not be visible in X-rays. The bone remains intact and no displacement occurs.
- Grade 2 ankle fracture – A grade 2 may involve a slight displacement and a larger part of the bone may have been damaged.
- Grade 3 ankle fracture – The bone is completely broken into multiple pieces and is largely displaced. Such injuries are serious and are accompanied by damage to the soft tissues as well as ligaments.
Causes & Symptoms of a Lateral Malleolus Fracture
Lateral malleolus fractures are often caused by a wide variety of ways depending on the location and orientation. Some of these include:
- Oblique fractures – An oblique fracture occurs along with a rotational that begins on the lateral side of the ankle. It is associated with an oblique fibular fracture and commonly happens at the corner of the ankle joint.
- Transverse fractures – A transverse fracture happens in the same direction as the ankle joint line and is generally a small bone fragment. While these fractures extend into the ankle joint, they do not extend into the weight-bearing portion.
- Vertical fractures – Vertical fractures usually occur when the force is oriented more in the leg bone. These fractures can extend into the weight-bearing portion of the ankle joint.
- Comminuted fractures – Comminuted fractures of the lateral malleolus are high-energy injuries that break the bone into many small pieces. Comminuted lateral malleolus fractures can be difficult to treat given the limited surface area by which a surgeon may reconstruct the bone fragments.
Certain signs and symptoms of lateral malleolus fracture tend to be obvious upon experiencing trauma from a sporting event, vehicle accident, or from occupations. Some of these are:
- Blisters – Blisters may occur over the fractured site of the ankle joint. A blister is a painful skin condition where fluid fills a space between layers of skin. Therefore, these should be promptly treated by a foot specialist.
- Pain – at the injured site, which in some cases can extend from the foot to the entire knee if left untreated.
- Swelling – There may be swelling which may occur along the length of the leg or may be more localized.
- Change in appearance – You may notice a significant change in your ankle appearance, which is a sign of deformity.
- Bruising – Bruising can develop soon after the injury. In most cases, redness will be present alongside the bruising of the lateral malleolus.
Who gets a Lateral Malleolus Fracture?
Risk factors that are associated with lateral malleolus fractures are similar to every other fracture, especially in the lower leg. Some of the most common are listed below:
Vehicle trauma
Vehicle / motorbike accidents resulting in head-on collisions can cause an inward impact on the front end of the car. The left foot resting on the floor or right foot on the accelerator gets impacted and jammed which may result in a forceful rotation, hyper-flex, or hyper-extended ankle joint. Such joint movement may cause a fracture of the lateral malleolus.
Occupational laborers
Some of the causes of a lateral malleolus fracture are also related to a direct blow to the ankle joint or its outer side of the ankle joint while at work by moving objects or operating certain machinery.
Sports
Sports that involve repetitive twisting and turning of the lower leg and foot can easily cause injury of the ankle joint that may result in a lateral malleolus fracture. Some of these sports activities include tennis, soccer, basketball, and martial arts.
Osteoporosis
Overuse of the ankle joint or over-twist of the foot and ankle can easily cause a fracture of your lateral malleolus due to osteoporosis (a disease that results in a decreased concentration of calcium).
How Does a Lateral Malleolus Fracture Affect You? How Serious is it?
Generally, fractured ankles are the most common fracture injuries because the ankle plays an important role in mobility. When an ankle is severely fractured, surgery may be required to repair the broken bone.
All surgical procedures carry minimal risks that are accompanied by anesthesia. Other complications may include bone infection or damage to a nerve or blood vessel which can be life-threatening. Therefore, if you seek surgery after a complete ankle rupture, the complications mentioned may be far smaller than the risks of leaving the injury untreated.
Recommended Treatment & Rehabilitation for a Lateral Malleolus Fracture
During a diagnosis for a lateral malleolus fracture, your doctor will begin by examining your ankle to check for any tenderness, bruising, and deformity. The accurate location of your pain can help determine its exact cause.
Next, your doctor may move your foot into different positions to observe and check your range of motion. You may also be asked to walk for a short distance so that your doctor can examine your gait. If your signs and symptoms suggest a break or fracture, he or she may suggest one or a combination of the following imaging tests below:
X-rays
Most ankle fractures can be easily visualized on X-rays. Your doctor may need to take X-rays from several different angles so that the bone images won’t overlap too much. Stress fractures often do not appear on X-rays until the break actually starts healing.
Bone scan
A bone scan can help your doctor diagnose fractures that do not appear on X-rays. He or she will inject a small amount of radioactive material into a vein. The radioactive material is then attracted to your bones, especially the parts of your bones that have been damaged. Damaged areas, including stress fractures, show up as bright spots on the resulting image.
Magnetic Resonance Imaging (MRI)
MRI uses radio waves and a strong magnetic field to create very detailed images of the ligaments that help hold your ankle together. This imaging helps to show ligaments and bones and can identify fractures not seen on X-rays.
Computed Tomography (CT) scans
CT takes X-rays from many different angles and combines them to make cross-sectional images of internal structures of your body. CT scans can reveal more detail about the injured bone and the soft tissues that surround it. A CT scan may help your doctor determine the most recommended treatment for your fractured lateral malleolus.
After a diagnosis has been successfully done, physiotherapy may be further advised. A physiotherapist can help treat a lateral malleolus fracture after it has been treated by a physician. After the bone is healed, your physiotherapist can help regain your strength, motion, balance, and sports skills.
After your leg is placed in a cast or a cast boot, he/she will then teach you how to properly walk without bearing weight on the injured ankle, using a set of crutches or a walker. Some of these other treatments your therapist will guide you through include:
- Reducing swelling – Swelling is commonly the first sign after a lateral malleolus fracture. Treatment may include gentle massage, the use of a compression wrap, ice, or heat, and elevating the affected ankle when at rest.
- Walking instruction – Your physiotherapist will help you begin to put some of your weight on the injured leg, gradually progressing to full weight.
- Gait training – Your physiotherapist will offer specific instruction and exercises to restore a normal walking pattern. The focus will be on how your foot and ankle move, and the timing of your steps.
- Restoring your ankle mobility – Your physiotherapist may use manual therapy to gently move your foot and ankle joints and surrounding tissues to reduce stiffness and increase the ankle’s bending range of motion.
- Returning to your regular activities – As you regain strength and flexibility, your physiotherapist will provide further training specific to your daily activities.
During your physiotherapy session, your therapist will design a specific exercise plan for you to begin after the cast has been removed to help you strengthen and regain motion from your fractured lateral malleolus. The following ankle exercises include:
Calf stretch
Sit with your affected leg straight and supported on the floor. Your other leg should be bent, with the foot flat on the floor. Next, place a towel around your affected foot just under the toes.
Hold one end of the towel in each hand, with your hands above your knees. Pull back gently with the towel so that your foot stretches toward you. Hold the position for 15-30 seconds, then repeat 2-4 times a day.
Ankle dorsiflexion
Sit with your affected leg straight and supported on the floor. Your other leg should be bent, with the foot flat on the floor. Keeping your affected leg straight, gently flex your foot back toward your body so your toes point upward. Then slowly relax your foot to the starting position. Repeat this method 8-12 times a day.
Resisted ankle inversion
Sit on the floor with your good leg crossed over your other leg. Hold both ends of an exercise band and loop the band around the inside of your affected foot. Then press your good foot against the band.
Keeping your legs crossed, slowly push your affected foot against the band so that the foot moves away from your good foot. Slowly relax, then repeat 8-12 times a day.
Resisted ankle eversion
Sit on the floor with your legs straight. Then, hold both ends of an exercise band and loop the band around the outside of your affected foot.
Next, press your good foot against the band. Keeping your leg straight, slowly push your affected foot outward against the band and away from your good foot without letting your leg. Repeat this exercise 8-12 times a day.
Alternative & Homeopathic Treatment for a Lateral Malleolus Fracture
Several homeopathic treatments include the use of certain helpful products or simply resting your injured ankle. Here are a few home remedies that will boost your recovery time from your fractured lateral malleolus:
- Rest – It is recommended to not carry heavy items or play sports for a few days or weeks after you have dislocated your ankle in order to reduce further pain.
- Eat healthy – Nutrients and vitamin D contained in meals can both help support your ankle recovery. You can also take vitamin D supplements as well.
- Epsom salt – You can soak your ankle in a warm bath with Epsom salt after a few days of injury. Epsom salt may help soothe sore muscles and connective tissues, and it may help with joint stiffness.
- Ice application – Apply ice to the ankle several times a day to help reduce pain and swelling.
- Compression – Apply an elastic compression bandage to help limit swelling.