Broken ankle: symptoms, treatment and how long it takes to heal

North Tees and Hartlepool NHS Foundation Trust says the most common symptoms of an ankle fracture are swelling, bruising, tenderness, and difficulty or pain when walking or putting weight through the ankle. The NHS says you should get medical advice as soon as possible if you think you have broken your ankle, because it may need treatment to heal properly, and not to worry if you are not sure: get it checked by a doctor.

The NHS says to get help from NHS 111 if you have injured your ankle and it is very painful or the pain is getting worse, there is a large amount of swelling or bruising, it hurts to put weight on it, or it feels very stiff or is difficult to move.

The NHS lists signs that need an emergency response after an injury. Do not drive to A&E: ask someone to drive you or call 999 for an ambulance, and bring any medicines you take.

• Go to A&E if your ankle is at an odd angle.

• Go to A&E if a bone is sticking out of the ankle, or you have a bad cut or wound on the ankle.

• Go to A&E if you are in severe pain, or your toes look blue or white or feel numb.

• Get help from NHS 111 if the pain is very bad or getting worse, swelling or bruising is large or worsening, it hurts to put weight on it, or it is very stiff.

• Get help from NHS 111 if you also have a very high temperature or feel hot, cold or shivery, as this could be an infection.

It can be hard to tell the difference without an X-ray, which is why the NHS advises getting it checked. A sprain is an injury to a ligament, the tissue that connects joints. The NHS says it is likely to be a sprain or strain if you have pain, tenderness or weakness, the area is swollen or bruised, and you cannot put weight on the injury or use it normally, and that most sprains feel better after 2 weeks. A broken bone can cause very similar signs.

Features that point towards a break, according to the NHS, include an ankle at an odd angle, a bone showing, severe pain and numb or discoloured toes. If you cannot put any weight on the ankle or walk more than a few steps, or it is not improving, the NHS says to get help from NHS 111 rather than treat it yourself.

The NHS says you will usually have an X-ray to check whether your ankle is broken and to see how bad the break is. If you have a very minor break you may not need any treatment. For a more serious break you may need a special boot to support the ankle, a plaster cast to hold it in place while it heals, the bones moved back into place by a doctor (after an injection to numb the ankle), or surgery to fix the broken bones. You may have follow-up appointments to check that the ankle is healing properly.

University Hospitals Plymouth NHS Trust describes the common casts. A backslab is a non-weight bearing cast with a gap at the front to allow for swelling, and you are given crutches or a frame and a fracture clinic appointment several days later. If swelling has reduced, a plaster of Paris cast is applied and the doctor will tell you how much weight you can put through it, which may remain non-weight bearing. An Aircast boot is usually used for fibula fractures.

Chelsea and Westminster Hospital NHS Foundation Trust explains that surgery repositions the bones as closely as possible to their original position and holds them with metalwork while healing occurs. Afterwards you are given a cast or boot, told whether you can weight bear, and given an appointment in fracture clinic roughly two weeks after the operation to check that the wounds have healed.

The NHS says a broken ankle usually takes 6 to 8 weeks to heal, but it can take longer, and the doctor will tell you how long you will have to wear a boot or cast and how much weight to put on your ankle. University Hospitals Plymouth says protected immobilisation in a cast normally takes approximately 6 weeks, although it varies with the individual and the type of fracture, and North Tees says the boot is normally used for the first 6 weeks after injury when standing and walking.

Full recovery of comfort and function takes longer. Chelsea and Westminster says ankle fractures can be serious injuries and that improvement in pain, swelling and function may be ongoing for over 12 months after surgery, with pain and swelling possibly persisting for 6 to 9 months. North Tees says as a fracture heals new bone forms at the break (callus), which can cause a lump on the side of the ankle, and the ankle may change shape again over 12 to 18 months as the bone remodels.

The NHS says it is important to follow any advice from the hospital or fracture clinic. While waiting to see a doctor, raise the ankle if possible, hold an ice pack wrapped in a towel on it for 15 to 20 minutes every 2 to 3 hours, and use painkillers such as paracetamol. Do not eat or drink anything in case surgery is needed, and do not put weight on it if possible.

To help recovery the NHS suggests resting and raising the ankle whenever possible, taking paracetamol or the painkiller your doctor has given you, and gently moving your toes and bending your knee while wearing the boot or cast to ease stiff muscles. Do not get a plaster cast wet or scratch under it, and do not carry heavy things.

North Tees says stopping smoking, controlling alcohol intake and managing diabetes play a significant role in healing, because these factors increase inflammation and reduce the ability to heal.

The NHS says to get help from NHS 111 if, while recovering, the pain in your ankle gets worse, your temperature is very high or you feel hot, cold or shivery, your leg, foot or toes feel numb or like they are burning, the cast is too tight or leg, foot or toes look swollen or turn blue or white, the cast or boot is rubbing or feels too loose, or there is a bad smell or discharge from under your cast.

University Hospitals Plymouth adds that fractures and lower limb casts carry a small risk of deep vein thrombosis (throbbing pain, calf tenderness, warm or red skin, swelling of the whole leg) and compartment syndrome (burning pain in the muscle, numbness, weakness or pins and needles). North Tees also mentions complex regional pain syndrome. These risks are very low but need prompt medical attention.

Plymouth says that while you are in a cast you cannot exercise the ankle joint, but you can squeeze the buttock muscles, bend the knee towards the chest, straighten the knee and squeeze the thigh muscle, and wiggle your toes as much as the cast allows to help circulation and reduce stiffness. After the cast, the NHS says to use your ankle as normal once it has healed because moving it stops it getting stiff, and a physiotherapist can give exercises.

North Tees describes early exercises such as ankle pumps and circles, and says a slight increase in discomfort and swelling is expected initially but should settle within 24 hours. For driving, Chelsea and Westminster says you can return when you can walk comfortably and perform an emergency stop pain free; North Tees says this is usually six to eight weeks after the plaster is removed. Ask your physiotherapist and check with your insurer. The NHS says to ask your doctor when you can return to contact sports and other activities that strain the ankle.

On the NHS, a suspected broken ankle is assessed in A&E, an urgent treatment centre or by NHS 111 advice, with X-ray, casting or surgery and fracture clinic follow-up, and referral to physiotherapy. Some people choose private orthopaedic care or physiotherapy for faster rehabilitation. In either setting, follow the weight-bearing instructions you are given, because they depend on the type of fracture and treatment.