"I think I have an ankle fracture. Now what?"

XR of an ankle (fibular) fracture

XR of an ankle (fibular) fracture

Breaking any bone in your body is frightening. Not only does it hurt but fear of surgery and long term disability is on everyone's mind. My husband recently missed a step going down stairs, he was holding the dog's leash in one hand (and she was pulling) and his cell phone in the other (I don't see how this was a good idea to start with). His foot turned under him and ... SNAP! He heard and felt a pop, called me immediately and fortunately for him had concierge service from his favorite podiatrist. He told me "I think I fractured my ankle."

Luckily my office wasn't too far from where he was so I was able to drive him to the office and get xrays immediately, bypassing the emergency room. Of course, the whole time he was very scared that he would need surgery. He himself is a general surgeon and runs around all day and night going between patients traveling to different facilities and stands for long periods to operate nearly everyday. His job, like many others, requires him to ambulate independently without pain. So, what was next for him?

His xrays were negative for an ankle fracture. But what was that audible pop and the immediate bruising and swelling? He may have torn one of the lateral ankle ligaments but since he was not a professional athlete, I advised him to take the following protocol seriously so he can heal optimally without surgery, the acronym R.I.C.E. protocol is appropriate here:

1. REST - I realize many working people don't know how to do that. He was given a walking boot to protect the ankle and was instructed to wear it during working hours, then take it off when sleeping or driving. Functional recovery (continued protected movement) is important in ankle sprains. In the evening, he was to do passive range of motion exercises, drawing out the alphabet with his foot. Too much immobilization could stiffen the ankle and weaken the leg slowing down recovery. 
2. ICE - this will decrease the swelling
3. COMPRESSION - I applied an elastic ACE wrap to help with the swelling
4. ELEVATE - raising the affect leg above the heart while at rest will also decrease swelling

(or P.O.L.I.C.E. - Protect, Optimum Loading, ICE, Compression, Elevation)

He only took a few ibuprofens in the beginning but went straight back to work the following day taking it slow. Of course I'd occasionally find his boot laying around the house every now and then while he was at work, so you can say he was doing fine. After 6 weeks he felt pretty normal and went back to working out and running comfortably.

By the way, if it was an ankle fracture, that doesn't necessarily always mean surgery. Allow your surgeon to make the diagnosis and discuss treatment plans with you. The sooner you seek treatment, the better off you'll be.