Ankle Avulsion Fracture: Symptoms, Causes, Treatment, Recovery Time, Exercises

An avulsion fracture is a fracture when any injury or damage to the tendon or ligament causes a fragment of the bone to break off along with the ligament or the tendon. This fracture occurs at the point where the ligament or the tendon attaches to the bone. Any force or trauma to the tendon or ligament results in a piece of bone being fractured and pulled off with the tendon or the ligament.

Symptoms of ankle avulsion fracture are similar to ankle sprain. An X-ray or MRI scan helps in confirming the diagnosis.

• Pain occurs following a forceful and twisting motion to the ankle.
• Instant and rapid swelling.
• Bruising develops after some time.
• Difficulty in moving the ankle.
• Difficulty in weight bearing.
• Swelling is present.
• Tenderness to touch.

Avulsion fractures commonly occur at the joints, although they can occur anywhere in the body. One of the most common sites for this fracture is the ankle. If the ankle is sprained or twisted forcibly, then this force passes through the ligaments and tendons resulting in their rupture and sprain. When the force is strong, the ligament or the tendon ruptures it also pulls off a small piece of the bone to which it is attached. An x-ray helps in differentiating a sprain from the avulsion fracture.

Treatment of ankle avulsion fracture and ankle sprain is more or less the same. Treatment also depends on the severity of the fracture. Severe avulsion fractures or fractures occurring in the children usually require casting for 6 to 8 weeks for immobilization and healing of the bone in place. After complete healing, the patient should start a rehab program comprising of stretching and strengthening exercises to regain mobility, flexibility, and range of motion.

For severe fractures, surgery is required to fix the bone fragment with the help of screw and plates.

In majority of the cases of Avulsion Fractures, the casting is placed for a period of at least eight weeks in order to give time for the bone to heal. Once the bone has healed and the casting is removed then aggressive rehabilitation measures with stretching, strengthening, and range of motion exercises are done for complete recovery from the injury.

A complete rehabilitation from Avulsion Fracture constitutes of three phases which are the Acute Phase, Recovery Phase, and Functional Phase.

Acute Phase: The Acute Phase of rehabilitation is started at two weeks after the procedure to correct the fracture. This phase includes passive range of motion exercises and cryotherapy. This phase is aimed at controlling pain and inflammation along with edema and reducing muscle atrophy in the lower extremities.

Recovery Phase: Once the first phase of rehab is completed successfully the patient is advanced to the second phase or the Recovery Phase of rehabilitation. This usually is done after three to four weeks post repair of the fracture. The second phase involves range of motion exercises, strengthening exercises for the lower extremities using Theraband, and proprioception exercises. At the beginning of the phase the resistance used is comparatively less than at the end of the phase where more emphasis is given to kinetic chain activities of walking and loading.

Functional Phase: The final phase of rehabilitation starts at eight weeks post repair of the fracture. This phase involves further strengthening of the lower extremities, increasing neuromuscular control, and recreating sport specific exercises to ensure that the patient is physically and mentally ready to perform the sporting activity one is involved in.

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