THE ANKLE AND FOOT

Group 7
Andres, James Brian Paul, Ashik
Camonayan, Kate Lynne Rosario, Karisma Jel
Espinosa, Roselyn Soriano, Geraldine Marie
Magat, Janea Verzosa, Shaira
 The total weight of the body is transmitted through the ankle to
the foot
 The ankle and foot must balance the body and absorb the impact
of the heel strike and gait
 Despite thick padding along the toes ,sole and heel and stabilizing
ligaments at the ankle ,ankle and foot are frequent sites of sprain
and bone injury
 HISTORY AND PHYSICAL
EXAMINATION OF THE ANKLE AND
FOOT
  Take a HISTORY
 What is the patient’s chief complaint?
 Pain?
 Where? When? How bad?
 What is it like?
 What makes it better?
 What makes it worse?

HISTORY
 Acute Injury vs. Chronic
 Progression of Symptoms?

TAKING  HISTORY TAKING: Background Information

 Any Previous Injuries
 Past Surgical History
 Past Medical History
 Medications
 Allergies
 Social History
 Work situation (laboring type job?)
 Home situation
  STEPS IN THE PHYSICAL
EXAMINATION
 CONSENT

EXAMINATI  PRIVACY
 EXPOSURE
ON OF THE  GAIT ANALYSIS

FOOT AND  OBSERVATION

 PALPATION
ANKLE  RANGE OF MOTION
 NEUROVASCULAR
ASSESSMENT
 SPECIAL TEST
  Built
 Posture
 Weight bearing: equal on both
sides

OBSERVATI  Compare weight bearing and non

weight bearing position of foot in:
ON/  Anterior view
 Posterior view

INSPECTIO  Lateral view

 See for contour of foot

N  Soft tissue swelling
 Bony callosity
 Deformities
 Nodules
 Swellings
 Calluses
 Corns
 Weight • Equal on both feet and
bearing forefoot/hindfoot

STANDING
Position of
AND WEIGHT foot
• Supination/pronation

BEARING:
ANTEROPOS Ask the
• Give the idea about muscle
patient to
TERIOR walk on heel
power or functional range of
motion
VIEW and toes:
Does the
• Use of cane on opposite side
patient use decrease the load on ankle
Cane or by 1/3 of body weight
Stick?
 check the toes If
parallel/straight

STANDING
AND WEIGHT
BEARING: Spurs/exostosis/swelling
ANTEROPOST
ERIOR VIEW

Check for tibia / knee

 Bulk of calf: compare
on both sides
STANDING Achilles tendon:
AND WEIGHT vertical on both sides
BEARING: Observe calcaneum
POSTERIOR for: shape position
VIEW and callosity
Position of malleolus
 Local rise of
temperature
PALPATION Local tenderness
Palpation of
specific areas
 ZONES OF PALPATION ASSOCIATED PATHOLOGY
1. HEAD OF 1ST METATARSAL BONE Gout, hallux valgus, bunion
2. NAVICULAR TUBERCLE AND TALAR HEAD Ankle dislocation
3. MEDIAL MALLEOLUS Rheumatoid nodules & tenderness,
bursitis, tendinitis, Achilles tendinitis

4. DORSUM OF FOOT BETWEEN MALLEOLI Bogginess & tenderness of the 3 tendons

(TA,EHL, EDL)

5. LATERAL MALLEOLI Pathologies associated with ligaments

(anterior & posterior talofibular,
calcaneofibular)

6. SINUS TARSI Ankle sprain

7. HEAD OF THE 5TH METATARSAL Tailors bunion
8. CALCANEUM Pathologies associated with retrocalcaneal/
calcaneal bursa

9. PLANTAR SURFACE Plantar fasciitis

10. TOES Gout, RA
FOOT
AND TOES
BONES NUMBER LOCATIO
GROUPS OF N
BONES
TARSUS 7 TARSAL HINDFOOT
+
MIDFOOT

METATARSUS 5 FOREFOOT
METATARSAL

PHALENGES 14
PHALENGES
 Ingrown Toenail
INSPECTION Hammer Toe
Corn
ABNORMALITIE
Callus
S OF THE TOES
AND SOLES Plantar Wart
Neuropathic Ulcer
INGROWN NAILS

 Injury of the lateral nail fold

caused by the sharp edge of
toenail
 Great toe is most often
affected
 A tender, reddened,
overhanging nail fold,
sometimes with granulation
tissue and purulent
discharge
CORN

 Painful conical thickening of

skin that results from
recurrent pressure on
normally thin skin
 Characteristically occurs
over bony prominences
 Soft corns - when located in
moist areas such as pressure
points between toes
 CALLUS

 Area of greatly thickened skin

that develops in a region of
recurrent pressure
 Involves skin that is normally
thick
 Usually painless
 Tender to direct pressure
**Painful callus - underlying
plantar wart
PLANTAR WART
 Hyperkeratotic lesion caused
by Human papillomavirus
 Located on the soles of the
foot
 Characteristic small dark
spots that give a stippled
appearance to wart
 Normal skin lines stop at the
wart's edge
 Tender if pinched side to side
NEUROPATHIC ULCER

 Pain sensation is diminished

or absent at the pressure
points on the feet
 Seen in diabetic neuropathy
 Underlying osteomyelitis and
amputation may ensue
METATARSAL BONES
& PHALENGES
FRACTURES OF THE METATARSAL BONES
 The base of the 5th metatarsal can be fractured
during forced inversion of the foot, at which
time the tendon of insertion of the peroneus
brevis muscle pulls off the base of the
metatarsal.
 Stress fracture of a metatarsal bone is common
in joggers and in soldiers after long marches; it
can also occur in nurses and hikers.
 It occurs most frequently in the distal third of
the 2nd, 3rd, or 4th metatarsal bone.
 Minimal displacement occurs because of the
attachment of the interosseous muscles.
 MORTON’S NEUROMA
 Injured or compressed nerve most
often between the 3rd and 4th toes.
 Symptoms:
Burning / pain on the ball of the
foot or toes
Hyperesthesia
Numbness
 TEST

• A mass felt or audible

click is elicited by
Mulder's test palpating (grasping)
the forefoot (web
 Morton’s neuroma space) with the index
finger and thumb of
the examiner
• METATARSOPHALENGEAL
JOINT
• TARSOMETATARSAL JOINT
 Hallux Valgus
Gouty Arthritis
INSPECT Hammertoe
FOR Deformity
Claw toes
DEFORMITY Hammer toes
Mallet toes
HALLUX VALGUS
 Lateral deviation of the great toe
 Enlargement of the first
metatarsal on its medial side,
forming a bursa or bunion
 Its incidence is greater in women
than in men and is associated
with badly fitting shoes
 Later, osteoarthritic changes
occur in the
metatarsophalangeal joint,
which then becomes stiff and
painful; the condition is then
known as hallux rigidus.
GOUTY ARTHRITIS
 Metatarsophalangeal joint of
the great toe --> initial site
of attack in 50% of episodes
 Characterized by very
painful and tender, hot,
dusky red swelling that
extends beyond the margin
of the joint
THREE MAIN FORMS OF
TOE ABNORMALITIES IN
THE HUMAN FOOT
 Claw toes
 Hammer toes
 Mallet toes
 A claw toe involves abnormal positions of all three joints in the toe. It consists of
an extension contracture with dorsal subluxation of the metatarsophalangeal
(MTP) joint, together with flexion deformities of the proximal interphalangeal (PIP)
and distal interphalangeal (DIP) joints.

 A hammer toe shows extension of the MTP joints and the DIP joints. The PIP joints
are hyperflexed.

 A mallet toe shows a flexed DIP joint, most commonly of the second toe.
 PALPATION
 Look for a bunion and bunionette
(bony deformity) at the MTP joint.
 It’s a deformity of the joint
connecting the big toe to the foot.
The big toe often bends towards the
other toes and the joint becomes red
and painful.
 Metatarsalgia is a common overuse injury.
The term describes pain and inflammation in
metatarsal bone
TEST
The
metatarsophalangeal
joints
Move the proximal phalanx
of each toe up and down.
 Pain suggests acute
synovitis.
 Instability occurs in chronic
synovitis and claw-toe
deformity.
TARSAL BONES
• Calcaneus
• Talus
• Navicular
• Cuboid
• 3 Cuneiform bones
FRACTURES OF THE
TALUS
 Fractures occur at the neck or body of
the talus.
 NECK FRACTURE
 occur during violent dorsiflexion of the ankle
joint when the neck is driven against the
anterior edge of the distal end of the tibia.
 e.g., when a person is pressing extremely hard
on the brake pedal of a vehicle during a head-
on collision
 BODY OF THE TALUS FRACTURE
 Occurs by jumping from a height, although the
two malleoli prevent displacement of the
fragments.
FRACTURES OF THE
CALCANEUM
 Compression fractures of the calcaneum
result from falls from a height.
 The weight of the body drives the talus
downward into the calcaneum, crushing
it producing a comminuted fracture.
 A calcaneal fracture is usually disabling
because it disrupts the subtalar
(talocalcaneal) joint, where the talus
articulates with the calcaneus.
ACHILLES TENDON
 TEST
• Patient lies is prone on
the bed or kneel on a
chair. The examiner
gently squeeze the
Thompson’s test gastrocsoleus muscle
(calf).
 Achilles’ tendon • If the tendon is intact,
rupture then the foot
passively plantar
flexes when the calf
is squeezed.
BURSA
• ANKLE JOINTS
• Tibiotalar Joints
• Subtalar( Talocalcalcaneal
) Joints
• Tibiofibular joint
Ankle joint:

• The ankle (talocrural) joint

is composed of a superior
mortise, formed by the
weight-bearing inferior
surface of the tibia and the
two malleoli, which receive
the trochlea of the talus.
• About 70° of dorsiflexion
and plantar flexion is
possible at the ankle joint
DISTAL
TIBIOFIBULAR
JOINTS:
 distal tibiofibular
syndesmosis,
consisting of:
 anterior tibiofibular
ligaments.
 Interosseous
membrane
 posterior tibiofibular
ligaments.
 TEST
The ankle (tibiotalar) joint.
Dorsiflex and plantar flex the
foot at the ankle. DORSIFLEXION
 Pain during movements helps
localize possible arthritis.
 Arthritic joint: pain when
moved in any direction. PLANTAR FLEXION
 Ligamentous sprain: pain
when the ligament is
stretched.
LIGAMENTS
DELTOID LIGAMENT
• Extremely strong and triangular
shaped ligament on the medial
side of the ankle
• Its split into two parts:
• SUPERFICIAL
• ANTERIOR FIBERS
• Tibionavicular
• MIDDLE FIBERS
• Tibiocalcaneal
• POSTERIOR FIBERS
• Posterior Tibiotalar
• DEEP
• ANTERIOR TIBIOTALAR
LATERAL LIGAMENT
• Composed of 3 parts:
• Anterior talofibular
• Posterior talofibular
• Calcaneofibular
ANKLE SPRAINS
 Most ankle sprains involve foot inversion and injury to
the weaker lateral ligaments (anterior talofibular and
calcaneofibular), with overlying tenderness, swelling,
and ecchymosis.
 Ankle fractures due to trauma.
ANKLE SPRAIN
 HIGH ANKLE SPRAIN
 Most commonly associated with
external rotation injuries
 External rotation forces the talus to
rotate laterally and push the fibula
away from tibia
 1-10% of all ankle sprains
Symptoms
 Anterolateral ankle pain proximal to
AITFL
 May have medial sided ankle
tenderness/swelling
 Difficulty bearing weight
 HIGH ANKLE SPRAIN
(CONT.)
PHYSICAL EXAMINATION:
PALPATION: Syndesmosis tenderness

PROVOCATIVE TESTS

SQUEEZE TEST (Hopkin's)

The examiner grasps the lower leg at midcalf
and squeezes the tibia and fibula together
(+) pain at syndesmosis
 HIGH ANKLE SPRAIN
(CONT.)
COTTON TEST
The examiner stabilizes the distal
tibia and fibula with one hand and
applies a medial and lateral
translation force

(+) Any lateral translation (3-5mm)

or clunk indicates syndesmotic
instability
 LOW ANKLE SPRAIN
 Lateral ankle sprain (Inversion sprain)
 Most common mechanism of ankle
injury
 inversion of the plantar-flexed foot.

 The anterior talofibular ligament is the

first or only ligament to be injured in the
majority of ankle sprains

 Stronger forces lead to combined

ruptures of the anterior talofibular
ligament and the calcaneofibular
ligament
 LOW ANKLE SPRAIN
(CONT.)
 ANTERIOR TALOFIBULAR LIGAMENT 
- most commonly involved ligament in low
ankle sprains
mechanism is plantar flexion and inversion
- physical exam shows drawer laxity in
plantar flexion

 CALCANEOFIBULAR LIGAMENT
- 2nd most common ligament injury in lateral
ankle sprains
mechanism is dorsiflexion and inversion
- physical exam shows drawer laxity in
dorsiflexion
subtalar instability can be difficult to
differentiate from posterior ankle instability
because the CFL contributes to both.
LOW ANKLE SPRAIN
(CONT.)
• Symptoms
• pain with weight bearing (may or may not
be able to bear weight)
• swelling and ecchymosis 
• recurrent instability
• catching or popping sensation may occur
following recurrent sprains
• Physical exam
• focal tenderness and swelling over-involved
ligament(s)
 LOW ANKLE SPRAIN
(CONT.)
ANTERIOR DRAWER TEST
 It tests for the integrity of anterior talofibular
ligament. It detects excessive anterior
displacement of the talus on the tibia.

 The test is performed with the patient’s foot

in the neutral position (slightly plantar flexed
and inverted). The lower leg is stabilized by
the examiner with one hand, grasp the heel
while the patient foot rests in the anterior
aspect of the examiner’s arm. An anterior
force is applied to the heel while holding the
distal anterior leg fixed.

(+) Foot slides forward and/or makes a clunking

sound
LOW ANKLE SPRAIN
(CONT.)
TALAR TILT TEST
 It tests for integrity of calcaneofibular
ligament
 The patient lies in supine or side-
lying position with the foot relaxed.
The foot is held in the anatomic 90°
position, which brings the
calcaneofibular ligament
perpendicular to the long axis of the
talus. Talus is then tilted from side to
side into adduction and abduction
 (+) Excessive movement on
adduction (no firm endpoint can be
ANKLE FRACTURES
CAUSES OF ANKLE
FRACTURES:
 Twisting or rotating your ankle
 Rolling your ankle
 Tripping or falling
 Impact during a car accident
LATERAL MALLEOLUS
FRACTURE
 FRACTURE OF THE FIBULA
 The talus is externally
rotated forcibly against the
lateral malleolus of the fibula
 Fractures spirally
 Talus moves laterally, and
the medial ligament of the
ankle joint becomes taut and
pulls off the tip of the medial
malleolus
MEDIAL MALLEOLUS
FRACTURE
 A break in the tibia, at the
inside of the lower leg
 Overinversion
 The talus presses against the
medial malleolus
 Vertical fracture through the
base of the medial malleolus
 POSTERIOR MALLEOLUS
FRACTURE
A fracture of the back of
the tibia at the level of
the ankle joint
 RARE
 Occurs secondary to
pushing the brake pedal
during a traffic accident
 BIMALLEOLAR EQUIVALENT
FRACTURE
In addition to one of the
malleoli being fractured,
the ligaments on the
inside (medial) side of
the ankle are injured
 Deltoid ligament
ruptures
TRIMALLEOLAR FRACTURES
 Involve fractures of the
medial and lateral
malleoli along w/ a
fracture of the posterior
lip of tibial plafond
 Avulsion by the posterior
tibiofibular ligament at
its site of attachment to
the tibia
OTTAWA ANKLE RULE
 Derived to aid efficient use of radiography in acute
ankle and midfoot injuries.
 Sensitivities range from the high 90-100% range for
“clinically significant” ankle and midfoot fractures,
defined as fracture or avulsion >3 mm.
 Specificities are approximately 41% for the ankle and
79% for the foot, though the rule is not designed or
intended for specific diagnosis.
 The Ottawa Ankle Rule is useful for ruling out fracture
(high sensitivity), but poor for ruling in fractures (many
false positives).
 Palpate the entire distal 6 cm of the fibula and tibia.
 Do not neglect the importance of medial malleolar
tenderness.
 “Bearing weight” counts even if the patient limps.
 Use with caution in patients under age 18.
 An ankle X-Ray series is only required if there is any pain in
the malleolar zone and...
 Bone tenderness at the posterior edge or tip of the lateral
malleolus (A)
 OR
 Bone tenderness at the posterior edge or tip of the medial
malleolus (B)
 OR
 An inability to bear weight both immediately and in the
emergency department for four steps
 A foot X-Ray series is only required if there is any pain
the midfoot zone and...
 Bone tenderness at the base of the fifth metatarsal
(C)
 OR
 Bone tenderness at the navicular (D)
 OR
 And inability to bear weight both immediately and in
the emergency department for four steps
 Clinical judgment should prevail if examination is
unreliable for any of the following reasons:
 Intoxication.
 Uncooperative patient.
 Distracting painful injuries.
 Diminished sensation in legs.
 Gross swelling which prevents palpation of malleolar tenderness.

 Always provide written instructions.

 Encourage follow-up in 5-7 days if pain and ability to
walk are not better.
CLASSIFICATION OF ANKLE
FRACTURES
Lauge- Hansen Classification
Danis- Weber classification
AO classification of Malleolar Fractures
LAUGE-HANSEN
CLASSIFICATION
 Based on foot position and force of applied stress/force
 Has been shown to predict the observed (via MRI)
ligamentous injury in less than 50% of operatively treated
fractures
 Types:
 Supination External Rotation
 Supination Adduction
 Pronation External Rotation
 Pronation Abduction
SUPINATION - EXTERNAL
ROTATION (SER)
Sequence:
1. Anterior tibiofibular
ligament sprain
2. Lateral short oblique fibula
fracture (anteroinferior to
posterosuperior)
3. Posterior tibiofibular
ligament rupture or avulsion
of posterior malleolus
4. Medial malleolus transverse
fracture or disruption of
deltoid ligament 
SUPINATION ADDUCTION
Sequence:
1. Talofibular sprain or distal
fibular avulsion
2. Vertical medial malleolus
and impaction of
anteromedial distal tibia
PRONATION - ABDUCTION
(PA)
Sequence:
1. Medial malleolus transverse
fracture or disruption of
deltoid ligament
2. Anterior tibiofibular
ligament sprain
3. Transverse comminuted
fracture of the fibula above
the level of the
syndesmosis
PRONATION - EXTERNAL
ROTATION (PER)
1. Medial malleolus transverse
fracture or disruption of
deltoid ligament
2. Anterior tibiofibular ligament
disruption
3. Lateral short oblique or spiral
fracture of fibula
(anterosuperior to
posteroinferior) above the
level of the joint
4. Posterior tibiofibular
ligament rupture or avulsion
of posterior malleolus
DANIS-WEBER
CLASSIFICATION
 Based on location of fibula fracture relative to mortise
and appearance
 the more proximal, the greater the risk of syndesmotic
disruption and associated instability
 Types
 A - Infrasyndesmotic (generally not associated with
ankle instability)
 B - Transsyndesmotic
 C - Suprasyndesmotic
Type A - Infrasyndesmotic

• This involves a fracture of

the fibula below the level of
the tibial plafond
• an avulsion injury that results
from supination of the foot
and that may be associated
with an oblique or vertical
fracture of the medial
malleolus.
• This is equivalent to the
Lauge-Hansen Supination-
Adduction injury.
Type B - Transsyndesmotic
 This oblique or spiral fracture of
the fibula is caused by external
rotation occurring at or near the
level of the syndesmosis
 50% have an associated
disruption of the anterior
syndesmotic ligament, whereas
the posterior syndesmotic
ligament remains intact and
attached to the distal fibular
fragment
 There may be an associated injury
to the medial structures or the
posterior malleolus
 This is equivalent to the Lauge-
Hansen Supination-External
Rotation injury
Type C - Suprasyndesmotic
 This involves a fracture of the
fibula above the level of the
syndesmosis causing
disruption of the syndesmosis
almost always with associated
medial injury.
 This category
includes Maisonneuve-type
injuries
 corresponds to Lauge-Hansen
Pronation-External
rotation or Pronation-
Abduction stage III injuries
AO CLASSIFICATION OF
MALLEOLAR FRACTURES
 AO classification divides the three Danis Weber types
further for associated medial injuries.
 Types:
 44A - infrasyndesmotic
 44B - transsyndesmotic
 44C - suprasyndesmotic
Type 44A
44A-1: Isolated
44A-2: with Medial
Malleolar Fracture
44A-3: with
Posteromedial
fracture

Type 44B
44B-1: Isolated
44B-2: with Medial Lesion
44B-3: with Medial Lesion
and Volkmann’s
fracture

Type 44C
44C-1: Fibular diaphyseal
fracture, simple
44C-2: Fibular diaphyseal
fracture,
multifragmentary
44C-3: Proximal Fibular
Lesion
MUSCLES
 DORSI FLEXION
PRINCIPAL ACCESORY MUSCLE
MUSCLE
Tibialis Extensor Digitorum
Anterior Longus
Extensor Digitorum
Brevis
Extensor Hallucis
Longus
Peroneus Tertius
 INVERSION
PRINCIPAL MUSCLE
Tibialis Posterior & Anterior

EVERSION
PRINCIPAL MUSCLE
Peroneus longus & Brevis
 1. Assess flexion
and extension at
the tibiotalar
(ankle) joint.
RANGE OF 2. Assess inversion
MOTION and eversion at
the subtalar and
transverse tarsal
joints
Ankle and Foot Movement Range of motion Possible causes of
restriction
Ankle Flexion (Plantar 40° - 55° Anterior
Flexion) capsule/ligaments
20° – 25° (when walking) contractures
23° – 30° (ascending Posterior impingement
stairs)
24° – 31° (descending
stairs)

Ankle Extension 10° - 20° Tight Achilles tendon

(Dorsiflexion) Tightness of the posterior
10° – 15° (when walking) ligaments
14° – 27° (ascending Loss of flexibility in the
stairs) ankle syndesmosis
21° – 36° (descending Impingement of anterior
stairs) soft tissue or osteophytes
Inversion 20° - 30° Tension in the joint
capsules and the
lateral ligaments
Eversion 10° - 20° Tension in the joint
capsules and the medial
ligaments
STANDING AND
WEIGHT
BEARING:
LATERAL VIEW

 Observe longitudinal arch of foot

 Medial longitudinal arch should be higher
than lateral
 Flat Feet
 apparent only when the patients
stands
 longtitudinal arch flattens
 normal concavity of the medial side of
the foor becomes convex
 tenderness from medial malleolus
down along the medial plantar surface
of the foot
 swelling anterior to the malleoli
 seen in:
posterior tibial tendon dysfunction
obesity
diabetes
prior foot injury
 FOOTPRINT
PATTERN

 Light film of baby’s

oil on patient foot
and apply powder
 Ask the patient to
step on piece of
colored paper
 Observe for
pattern of foot

NORMAL BROAD HIGH

 TEST
• Ask patient to stand
on tiptoes.
Pes planus test • If the medial arch
forms and heel going
 Differentiate between into varus then it is
structural vs functional flat foot.
functional pes • Beware of rupture
planus tibialis posterior
tendon or tarsal
coalition
 Functional Pes Planus = if medial
longitudinal arch is restored when the
client is either standing on the toes or
seated = due to muscle or ligament
weakness

 Structural Pes Planus = if medial

longitudinal arch remains flat when the
client is standing on toes and when
seated.
 • First, mark the
navicular tuberosity.
Next, measure the
height of the navicular
bone with the subtalar
joint in neutral and
the patient bearing
Navicular drop test most of the weight on
the contralateral limb.
 Function of the • Finally, have the
patient assume equal
medial weight on both feet
longitudinal arch and remeasure the
height of the navicular.
• The difference between
the first and second
measurement is the
navicular drop. A
difference of >10 mm
is considered
significant excessive
foot pronation. 
TREATMENT
 TREATMENT OF SPRAINS
Treatment for sprains depends on the severity of the injury.
They are graded as mild, moderate, or severe:
MILD SPRAINS or grade 1 are treated with the RICE
approach for several days until the pain and swelling
improve
MODERATE SPRAINS or grade 2, treated with the use of
RICE approach but allow more time for healing to occur. May
also use a device such as a boot or a splint to immobilize
the ankle.
SEVERE SPRAINS or grade 3 involves a complete tear or
rupture of a ligament and takes considerably longer to heal.
It's treated with immobilization of the joint followed by a
longer period of physical therapy for range of
motion, stretching, and strength building
R.I.C.E. METHOD

•Rest. Avoid activities that cause

pain, swelling or discomfort.
•Ice. Use an ice pack or ice slush
bath immediately for 15 to 20
minutes and repeat every two to
three hours while you're awake.
•Compression. To help stop
swelling, compress the ankle
with an elastic bandage until the
swelling stops.
•Elevation. To reduce swelling,
elevate your ankle above the
level of your heart, especially at
night. Gravity helps reduce
swelling by draining excess fluid.
TREATMENT OF
FRACTURES
 The type of fracture and the stability of
your joint will determine the type of
treatment used
 Initially, following a fracture, the R.I.C.E..
Method may be applied to reduce
swelling
 An X-ray will be done to assess the
severity of the fracture
 If your bones are not aligned properly,
the doctor may realign them before
placing the splint or cast.
 If the bones cannot be realigned
properly in the emergency department,
then you may require an operation.
 An operation will also be needed if any
bone has broken through the skin. If the
bone breaks through the skin, the
fracture is then called a compound
fracture. This is more serious than a
simple fracture.
Follow-up care for an ankle
fracture depends on the
severity of the fracture.
 You may need emergency
surgery, next-day follow-up,
or follow-up in 1-2 weeks
with an orthopedic doctor.

 You may require only follow-

up with your family doctor.

 If you were splinted on your

initial visit, you may need to
have a cast placed on your
ankle during your follow-up
visit.
 The average fracture requires 4-
8 weeks for the bone to heal.
THANK YOU!