Recovery from a broken (fractured) ankle
Broken ankles are one of the most common childhood fractures, usually occurring after a fall.
Fractured or broken ankles are a common childhood injury. Most heal well and cause no ongoing or long-term complications.
Broken bones heal quickly in children. They usually have to wear a cast for 4-8 weeks. In this time, the body has laid down a thick layer of new bone around the fracture to keep it secure and in place.
Treatment
Walking aids
Pain relief
After the cast is removed
Treatment
Where your child’s fracture is will determine what is used to support the bone’s healing:
- A full cast will be used if the fracture is either above or below the knee
- A backslab (a partial cast held in place by bandages) allows swelling to reduce before changing to a full cast
- An aircast boot (an ankle boot) allows distributed weight bearing whilst supporting bone healing. This can be removed to allow gentle range of movement exercises and cleaning.
Your clinician will explain which treatment is best for your child’s fracture. If your child is in a full cast or backslab they will usually be non-weight bearing until this is removed.
Whilst the cast is on, it is important to keep the other joints of the leg moving so your knee and hip don’t become stiff or tight.
Walking aids
If your child has been given a walking aid, it is important to use them appropriately.
For further information on using walking aids, please click here.
Pain relief
It is normal to experience mild pain and some children will require pain relief like Paracetamol or anti-inflammatories such as ibuprofen.
See NHS 111 Wales guidelines here on pain relief.
You can also seek advice from your local pharmacy.
After the cast is removed
Once the cast has been removed, it is normal for your child to experience some changes in their leg such as:
- The joints feel stiff
- The leg may be slightly smaller than the other side
- The fracture site is prone to swelling
- The skin will be dry, flaky and sometimes have changes in hair growth.
Exercises
Range of Movement Exercises
It is important to encourage your child to gently exercise and stretch the ankle. If your child is in a cast, these can be started the day the cast is removed, or from the day of injury if they do not require casting. Keeping your ankle moving will help speed up the healing process, avoiding stiffness and helping to reduce the swelling.
Try to complete these movements 5 times daily and you can ice your child’s ankle after completing.
- Point your toes up to the ceiling
- Point your toes down to the floor
Trace the alphabet with your toes
- Turn your feet in so the soles of your feet face each other
- Turn your feet out so the soles of your feet face away from each other
You may need someone to help you complete the exercises to start with, but over time they should become easier to complete independently.
Stretching exercises
Towel stretch
- Loop the ball of your foot into a resistance band or a rolled up towel.
- Sit with your leg straight in front of you.
- Hold the towel at both ends or the other end of the resistance band.
- Gently pull the towel/band toward you while keeping your knee straight.
- You should feel a gentle stretch, don’t push into pain.
- Hold this position for 30 seconds, and repeat 3 times.
Calf stretch 1
- Stand facing a wall with your hands on the wall for support.
- Keep your injured leg straight behind your other leg.
- Make sure to keep your back heel on the floor.
- Bend the front knee until you can feel a gentle stretch in the back of your calf.
- Hold this position for 30 seconds, and repeat 3 times.
Calf stretch 2
- Stand facing a wall with your hands on the wall for support.
- Keep your injured leg straight behind your other leg.
- Bend the front knee.
- Make sure to keep your back heel on the floor and bend your back knee until you can feel a gentle stretch on your back leg calf.
- Bend the front knee until you can feel a gentle stretch in the back of your calf.
- Hold this position for 30 seconds, and repeat 3 times.
Balance and Coordination (proprioception) exercises
Try to complete the following exercises once your physiotherapist has advised it is appropriate to do so;
Weight transfers:
Stand in front of a mirror and try to make sure you are taking an equal amount of weight on your left and right leg. Use the mirror to see if you are leaning to one side. Once you are comfortable doing this, progress to shifting your weight from side to side. If you need to, hold on to a sturdy surface when doing this to keep your balance.
Single leg stand
- Try standing on your injured leg.
- Balance.
- Try and keep your balance for 30 seconds.
- Have a sturdy surface nearby that you can use to steady yourself if you lose your balance.
Tandem walking
- Imagine you are walking on a tightrope.
- Place the heel of one foot in front of the toes of your other foot.
- Continue repeating this and walk forwards.
Strengthening exercises
Once you can stand and fully weight bear on your injured ankle without increased pain and swelling you should be able to progress to strengthening exercises. Try these exercises below, however if they cause increase pain and swelling then rest a little longer and continue when you feel able.
Complete these exercises 10 times, once or twice a day for 2-4 weeks. You can use resistance bands or the opposite foot to add resistance to the exercises.
Push up toes
- Stand tall and slowly push up onto your toes, raising your heels.
- Hold for 3-5 seconds and slowly lower.
- Repeat 10 times.
Lift against resistance
- Loop foot within a latex resistance band or a tightly held rolled up towel
- Lift your foot up against resistance.
- Hold for 3-5 seconds and slowly lower back down.
- Repeat 10 times.
Turn foot against resistance
- Loop foot within a latex resistance band or a tightly held rolled up towel
- Slowly turn your foot inwards against resistance.
- At the end of the movement hold for 3-5 seconds and then slowly return to the starting position.
- Repeat 10 times.
Turn foot outwards against resistance
- Loop foot within a latex resistance band or a tightly held rolled up towel and hold tight with the other foot.
- Slowly turn your foot outwards against resistance.
- At the end of the movement hold for 3-5 seconds and then slowly return to the starting position.
- Repeat 10 times.
If you have any concerns or queries about your child’s recovery please contact Dolphin Outpatients on 02921 847577.
If your child does not have an appointment arranged with physio and symptoms continue or are not improving gradually, then you can self-refer your child to the Paediatric Physiotherapy Outpatient Department by telephoning the our referral line on 02921 836908.
The Coral Reef Outpatients Department is open for plaster problems from Monday – Friday, 08:15 – 15:30. Contact 02921847991 or 02921847569
Outside of these hours please contact the emergency unit on 02920748018 or 02920748094
University Hospital of Wales, Heath Park Way, Cardiff, CF14 4XW
