When can you walk after a broken ankle?

What types of ankle fracture are there?

Ankle fractures involve the lower ends of the shin bone and the thinner outer leg bone, where they form the ankle joint. Stable fractures, often a small break of the outer bone with the joint in the correct position, can usually be treated in a boot or cast without surgery.

Unstable fractures, where more than one part of the ankle is broken or the ligaments are also torn and the joint has shifted, often need surgery with plates and screws to hold the bones in place while they heal.

When can I put weight on my ankle?

Weight-bearing advice varies with the fracture pattern, how the bones were fixed and the surgeon's judgement. Some people with stable fractures can bear weight as comfort allows in a walking boot from the start, while others are advised to use crutches and keep weight off the foot for up to six weeks.

A Cochrane review of 53 studies with 4,489 adults with ankle fractures found that early weight-bearing within three weeks of surgery probably leads to slightly better ankle function than delayed weight-bearing, though the difference was not clinically meaningful 1. There may be little or no difference in the rate of re-operation 1.

Is a removable boot better than a cast?

The same review found that, after surgical fixation, using a removable ankle support may lead to better ankle function than a non-removable cast, based on low-certainty evidence. After non-surgical treatment, there may be little or no difference between removable and non-removable supports 1.

A removable boot allows gentle ankle movement exercises and skin care, but it must be worn as instructed to protect the healing bone.

What does rehabilitation involve?

Once the surgeon allows it, rehabilitation usually focuses on restoring ankle movement, reducing swelling, rebuilding calf and foot strength, retraining balance and returning to a normal walking pattern. Stiffness, particularly in bending the foot up, is common after immobilisation.

Exercises progress from simple ankle circles and towel stretches to heel raises, balance on one leg, step exercises and, for those returning to sport, hopping and running drills.

How long is recovery?

Bones usually take around six weeks to heal enough for normal weight-bearing, but full recovery takes longer. Many people walk without a limp within three months, while swelling at the end of the day, stiffness and reduced confidence on uneven ground may persist for six to twelve months.

Return to driving depends on which leg is affected, being out of a boot or cast, and the ability to perform an emergency stop safely. Return to work depends on the job's physical demands.

How can I use crutches safely?

Crutches should be adjusted so that the handgrips are level with the wrist crease when standing, with elbows slightly bent. When not bearing weight on the injured leg, move both crutches forward first, then swing the uninjured leg through. When partial weight is allowed, move the crutches and the injured leg together.

On stairs, a common approach is to go up with the uninjured leg first and down with the crutches and injured leg first, using a handrail where available. Remove rugs and clutter at home and wear supportive shoes on the uninjured foot.

What complications should be watched for?

Seek urgent advice for increasing calf pain, swelling or redness, chest pain or breathlessness, which may indicate a blood clot. Wound redness, discharge or fever after surgery may indicate infection.

Pain that gets worse rather than better, new deformity or severe pain with numbness under a cast should be assessed promptly.

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