Ask the Expert: Dr. David Levine, Orthopedic Surgeon, Answers Your Questions About Ankle Fractures
Q1. I am an active woman in her 20s and recently was diagnosed with a stress fracture in my ankle from breaking in new high heel shoes. I thought stress fractures only occurred in people with bone density issues? Are there other causes?
Stress fractures occur when bones are subjected to moderate forces that occur either too frequently or for too long. Consider the young gymnast performing too many practice vaults developing a tibia (shin) stress fracture or a runner increasing the length of their marathon training runs developing a metatarsal stress fracture. Alternatively, there may be an abnormality of bone quantity (osteoporosis) or bone quality (osteomalacia). Malalignment conditions, training errors and hormonal abnormalities are among the many additional predisposing conditions.
Q2. I’m a life-long soccer player and will be playing on a college team in the fall. Is there anything I can do to prevent ankle fractures on the field?
Soccer is considered ‘high-risk’ with respect to ankle injuries as it involves running, jumping, leaping and landing. Contact with opposing players contributes to this risk. Studies have suggested that artificial playing surfaces may predispose players to ankle injury. Appropriate conditioning, sport-specific strengthening and agility training all contribute to injury prevention. Beware of fatigue! Finally, prophylactic bracing has not been shown to reduce risk of ankle injury in contact sports.
Q3. Are there long-term effects from sustaining an ankle fracture?
Ankle fractures are very common. Posttraumatic arthritis (loss of cartilage) of the ankle is the most significant long-term effect of an ankle fracture. This can cause swelling, stiffness and limitation of one’s normal activities. Proper management of an ankle fracture and a carefully designed course of rehabilitation maximize one’s recovery.
Q4. What’s the best way to stabilize an ankle when fractured? Boot? Crutches?
Ankle fractures that do not result in instability of the joint can be treated in a removable boot. Patients can begin early motion and weight-bearing once discomfort is reduced. Ankle joint instability following ankle fracture should be surgically stabilized with metallic implants that restore mechanical alignment and allow early motion despite a period of non-weight bearing. Crutches, a walker or a knee walker are devices that assist patients during the recovery period.
Q5. Is post-traumatic osteoarthritis an unavoidable and inevitable condition that arises after an ankle fracture or an OCD if that can be considered a fracture? If so, is there anything that can be done to reduce the severity or progression of osteoarthritis at the injury site or into other joints after the initial injury is fixed?
Post-traumatic arthritis of the ankle can result from two different processes as a result of the injury – either biological or mechanical. Destruction of cartilage cells may occur at the time of fracture when scraping, scuffing or crush injury occurs to the surfaces that line the ankle joint. Inflammation and debris subsequently produced can cause swelling, pain and limited motion during the first year following injury. This early arthritis can be considered biological in nature. Alternatively, the destruction of cartilage can occur over many years following an injury due to subtle mechanical disturbances to the cartilage surfaces that are no longer smooth. This more common mechanical cause of arthritis can occur years or decades following the original injury.