The ankle is the joint that connects the bones in the lower leg to the foot bones. It can be divided into two parts: the upper and lower ankle. The upper ankle allows us to move our feet upwards, downwards, and a little to the side. It is made up of three bones, which include:
- The tibia (shinbone) – the primary bone in the lower leg.
- The fibula (calf bone) – a thinner bone on the outer side of the lower leg.
- The talus (ankle bone) – the foot bone that connects to the shinbone and calf bone.
A Pott’s fracture is a type of ankle fracture that is characterized by a break in one or more bony prominences on the sides of the ankle, known as the malleoli. This condition is also known as a broken ankle, ankle fracture, and malleoli fracture. Pott’s fracture often occurs in combination with other injuries such as a sprained ankle or other fractures of the foot, ankle, or lower leg. The injury is caused by the patient stumbling and falling with the foot anchored to the ground and the body twisting. This action strains the powerful medial (deltoid) ligament of the ankle, often tearing off the medial malleolus due to its strong attachment. If the malleolus is pushed, the fracture is oblique; if it is pulled, the fracture is transverse. It is mostly due to contact sports or injury. Therefore, skiers, footballers, and climbers are more prone to experiencing Pott’s fracture.
Causes & Symptoms
Pott’s fracture is usually caused by activities that place intense stress on bones of the leg (known as the tibia and the fibula). The common causes of Pott’s fracture include the following:
- Jumping from a high spot and landing on an uneven surface may result in the fracture of the medial or lateral malleoli.
- When you make a sudden change in direction, that directly affects the ankle joint, such as in sports like football or ice hockey.
- A direct force to the ankle during an accident, such as a road traffic accident.
Here are some signs and symptoms you may notice if you experience Pott’s fracture:
- A bump or a deformity is seen in the ankle due to a dislocation of one of the bones of the ankle from the joint following the fracture.
- A sudden feeling of intense ankle pain.
- A tearing sound can be heard in the ankle during the time of injury.
- Pain at the back, front, or sides of the affected ankle.
- Numbness in the affected ankle.
Who Gets Pott's Fracture?
Risk factors of Pott’s Fracture include:
- Participating in high-impact sports – The stresses, direct blows, and twisting injuries that occur in sports such as basketball, football, gymnastics, tennis, and soccer can cause Pott’s fracture.
- Improper equipment – Faulty equipment, such as shoes that are too worn or not properly fitted, can contribute to stress fractures and falls. Improper training techniques, such as not warming up and stretching, also can cause ankle injuries.
- Increase of activity intensity – Whether you are a trained athlete or someone who has just started exercising, suddenly boosting the frequency or duration of your exercise sessions can increase your risk of Pott’s fracture.
- Smoking – Cigarette smoking can increase your risk of developing osteoporosis; studies have shown that healing after a fracture may take longer in people who smoke or chew nicotine.
- Certain conditions – Having decreased bone density can put you at a higher risk of injuries to your ankle bones.
- Car accidents – The crushing injuries common in car accidents can cause breaks that require surgical repair.
How Does It Affect You? How Serious Is It?
Complications following a Pott’s fracture are uncommon, although may include the following:
- Arthritis – Fractures that extended into the joint can cause arthritis years later. If your ankle starts to hurt long after a break, it is recommended to seek medical attention for evaluation.
- Bone infection – If you have an open fracture, meaning one end of the bone protrudes through the skin, your bone may be exposed to bacteria that cause infection.
- Nerve or blood vessel damage – Trauma to the ankle can injured nerves and blood vessels, sometimes actually tearing them. Lack of blood flow can cause a bone to die and collapse.
- Compartment Syndrome – This type of condition can rarely occur with Pott’s fractures – however, when it does it causes pain, swelling, and sometimes disability in the affected muscles of the legs.
Recommended Treatment & Rehabilitation
A thorough subjective and objective examination from a physiotherapist or doctor is essential to assist with the diagnosis of a Pott’s fracture. If your signs and symptoms suggest a break or fracture, your doctor may suggest one or more of the following imaging tests:
Most ankle fractures can be visualized on X-rays. The technician may need to take X-rays from several different angles so that the bone images will not overlap too much. Pott’s fractures often do not show up on X-rays until the break actually begins to heal.
Computerized Tomography (CT) scan
CT scans take 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 also help your doctor determine the best treatment for your broken ankle.
A bone scan can help your doctor diagnose fractures that do not show up on X-rays. A technician will inject a small amount of radioactive material into a vein. Therefore, the radioactive material is attracted to your bones, especially the parts of your bones that have been damaged. Damaged areas, including Pott’s fracture, show up as bright spots on the resulting image.
Magnetic Resonance Imaging (MRI)
MRI uses radio waves and a strong magnetic field to create highly 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.
If you visit a physiotherapist after an injury and a Pott’s fracture is suspected, your physiotherapist will perform the following:
- Use of the RICE formula (rest, ice, compression, and elevation).
- Applying ice to help reduce pain and swelling.
- Immobilizing your ankle by wrapping it with an ice wrap or applying a stirrup brace, to limit motion and control swelling.
- Instructing you to keep the injured ankle elevated to control swelling.
- Instructing you to walk without putting weight on the injured ankle, using crutches or a walker.
If you have Pott’s fracture, treatment will depend on how many bones are broken, and if it is a simple, complex, or compound fracture.
Generally, the bony and ligament injuries should be treated simultaneously. Therefore, accurate reduction of a Pott’s fracture has to be done whilst maintaining it in the same place is the basic and most recommended treatment. The conservative treatments are used for non-displaced ankle injuries. Immobilization and elevation will have to be used for 6-8 weeks. The procedure can be under either local, regional, or general anesthesia. An open reduction means the surgeon makes a surgical cut in the skin to reach the bones and then moves them back into their original position. Open reduction can be combined with a process called internal fixation in a procedure known as ORIF.
Internal fixation means fixing the bone in place with metal screws, plates, sculptures, or rods while healing is progressing. However, this Internal fixation is permanent and will not be removed. A radiograph may be taken after the bones are approximated and the implantable devices are finally attached. The surgical incision will then be closed with stitches or staples and covered with a bandage. A cast or splint will be put into place to shield the repair as it heals. The joint will have to be immobilized or splinted so the wound heals well.
Overall, other treatments for Pott’s fracture will vary, depending on which bone has been broken and the severity of the injury. These two main treatments include:
- Medications – Your doctor will recommend an over-the-counter pain reliever, such as acetaminophen.
- Therapy – After your bone has healed, you will most likely need to loosen up any stiff muscles and ligaments in your ankles and feet. A physiotherapist can teach you therapeutic exercises to help improve your flexibility, balance, and strength.
Therapeutic exercise is one of your main treatments to help you restore mobility after a Pott’s fracture. Your physiotherapist can prescribe the right exercises for you to perform at the right stage of healing to ensure that you can return to optimal mobility quickly and safely. These therapeutic exercises include the following:
To improve muscular flexibility around your ankle after a fracture, you can perform a few different exercises. Towel calf stretching can improve the flexibility of the muscles on the back of your lower leg. Simply wrap a towel around your toes and give a slow, gentle pull to stretch your calf. Standing runner’s stretches can also be done to improve the flexibility of your calf. To stretch the muscle on the front of your ankle, perform the kneeling anterior stretch. Kneel with your ankle and toes pointed, and gently press upon your foot to stretch the front of your lower leg. Hold each stretch for 15-30 seconds 3-4 times a day.
After a period of immobilization in a cast or brace, you may notice that the muscles around your ankle have become significantly weakened. This is common after a Pott’s fracture, and your physiotherapist will likely prescribe exercises to help improve your ankle strength. You can use a resistance band to perform ankle strengthening exercises. Simply play the band around your toes and have someone hold it as you move your ankle into inversion and eversion. Perform 15-20 repetitions of each exercise 3-4 times a day.
If you participate in high-intensity sports, you may want to perform plyometric exercises like jumping and hopping to prepare for a return to the sport after a Pott’s fracture. Learning to jump and land properly can ensure that your ankle can tolerate to forces placed upon it when running, cutting, and hopping during sports.
Alternative & Homeopathic Treatment
Common at-home treatments for a Pott’s fracture (or ankle injuries in general) include:
- RICE – Rest enough in order to stay off the injury for a few days. Afterwards, apply an ice pack to the ankle several times a day to help reduce pain and swelling. Next, apply an elastic compression bandage to help limit swelling. Finally, reduce blood flow and other fluids to the injury site by elevating the ankle above the heart.
- Over-the-counter Medication – Although an injured ankle is not typically a serious injury, it may still be painful. If you find the discomfort too much to handle, consider taking an over-the-counter pain medication that can help reduce the pain and swelling.
- Epsom Salt – After a few days, you can soak your ankle in a warm bath with Epsom salt. It is important to apply cold during the first few days after an injury. Epsom salt may help soothe sore muscles and connective tissues, and it may help with joint stiffness.