Key takeaways
- An ankle fracture happens when enough force breaks one or more bones around the ankle joint, most often from twisting, rolling, falling, or a direct blow.
- The same injury can cause a sprain or a fracture. The force involved, the direction of the twist, and the foot’s position determine which one you get.
- Stress fractures develop gradually from repeated activity such as running. There’s no specific moment of injury with a stress fracture.
- A minor-looking fall can still break an ankle. Being able to walk afterwards does not rule out a fracture.
- Severe pain, marked swelling, an odd angle, or a bone visible through the skin all need urgent medical assessment.
An ankle fracture occurs when enough force breaks one or more of the bones that make up the ankle joint. This usually happens when you twist or roll your ankle, fall, sustain a sports injury, or suffer a direct blow to the ankle. This guide covers the causes of ankle fractures and breaks, the symptoms to watch for, and when to seek help.
What Is an Ankle Fracture?
An ankle fracture is a break in one or more of the three bones that meet at the ankle joint. The tibia is the larger shin bone on the inside of the leg. The fibula is the thinner bone on the outside. The talus sits between the two and forms the hinge the foot pivots on. Ligaments hold these bones together and keep the joint stable.
A fracture and a sprain often come from the same kind of accident, but they are different injuries. A sprain damages a ligament. It stretches or tears while the bone stays intact. Our guide explains ankle sprains and how they are treated. A fracture is a break in the bone itself. The two can feel very similar in the first hour, which is why X-rays are usually used to assess an ankle injury.
What Causes an Ankle Fracture?
Twisting or Rolling Your Ankle
Twisting or rolling the ankle is the most common cause of ankle fracture. When the foot rolls inward or outward faster or farther than the joint can absorb, the ligaments take the strain first. A mild twist stretches them and can cause a sprain. Once a twist goes further than the ligaments can stretch, the force passes into the bone itself, usually the fibula. That is why “just a bad twist” can turn out to be a fracture. This is just as likely on flat pavement as on a sports pitch.
A related condition is the high ankle sprain, or syndesmosis injury. It involves the ligaments higher up between the tibia and fibula and can occur alongside a fracture in more forceful twisting injuries.
Trips and Falls
Falls are the other major cause, and they range enormously in force. A trip while walking, a missed step, or a foot caught on an uneven surface can be enough. This is especially true if the ankle rolls at the same time. Falling while running adds speed and momentum. Falls down stairs or from a height, such as off a ladder or scaffolding, involve extra force and are more likely to cause a serious or complex fracture. Landing heavily after any fall, even from a low height, can break a bone rather than simply bruise it.
Sports Injuries
Sport is a leading cause of ankle fractures because so many sports combine speed with sudden changes of direction. Football and rugby players commonly suffer ankle injuries, particularly from tackles, collisions, and studs catching in the ground mid-turn. Any sport involving pivoting, jumping, or a high-impact landing carries the same risk because the ankle absorbs sudden force at an angle it isn’t braced for.
Awkward Landings and Missteps
Landing with the foot slightly turned, whether from a jump, an uneven kerb, or a misjudged stair, can force the ankle into an unnatural position. When the whole body’s weight comes down through the joint at once, even a small misalignment can fracture bone.
Direct Impact and Accidents
Not every fracture involves twisting. A direct blow to the ankle can break bone without any rotation. These high-energy injuries often fracture the ankle differently than a twisting injury, and are more likely to affect more than one part of the joint.
Stress Fractures From Repetitive Activity
A stress fracture develops gradually from repeated loading that slightly exceeds what the bone can comfortably absorb, without a single major impact. Running, hiking, and a sudden increase in training volume are the most common triggers. Bone constantly rebuilds itself, but if load increases faster than it can adapt, tiny cracks form and can progress into a full fracture. With no single injury moment, stress fractures are easy to miss. Persistent ankle pain that builds with activity and eases with rest is worth having checked, especially after a recent jump in training.
Can a Minor Fall Cause a Broken Ankle?
Yes. How serious an accident looks doesn’t tell us how serious the injury it causes might be. What matters is how strong the bone is, the direction the force travelled, and the position of the foot at the moment of impact. A fall that leaves one person with a bruise can fracture another person’s ankle outright.
Reduced Bone Density and Fracture Risk
Osteoporosis and other causes of reduced bone density do not directly cause an ankle to fracture, but they lower the force needed to break it. Weaker bone gives way under forces that stronger bone would usually absorb. Bone density declines with age, so a low-energy fall from standing height is a far more common cause of fracture in older adults. Children have growth plates, softer areas near each end of the bone, which can fracture from a force that would only sprain an adult’s ankle.
Think you may have broken your ankle?
Mr Francesc Malagelada is a Consultant Trauma and Orthopaedic Surgeon and a senior trauma consultant at the Royal London Hospital, where he treats ankle fractures of all severities. You don’t need a GP referral to book a specialist assessment.
Which Bones Can Break in an Ankle Fracture?
Any of the three ankle bones can fracture. The fibula is the bone most commonly broken in a twisting or rolling injury. The tibia is usually injured by significant twisting or a direct impact. Talus fractures tend to involve higher-energy or more complex injuries.
Clinicians describe ankle fractures by where the break sits. This reflects how the injury happened and affects treatment. Our guide to the most common foot and ankle fractures covers these in more detail.
- Lateral malleolus fracture: a break in the lower end of the fibula, on the outside of the ankle. It is the most common single fracture type and typically results from a rolling or twisting injury.
- Medial malleolus fracture: a break in the lower end of the tibia, on the inside of the ankle.
- Posterior malleolus fracture: a break at the back of the tibia where it meets the ankle joint, usually alongside another fracture.
- Bimalleolar fracture: two of these areas broken at once, usually from a more forceful twisting or impact injury.
- Trimalleolar fracture: all three areas broken together, generally from a high-energy injury such as a fall from height or a road traffic accident.
What Does a Broken Ankle Feel Like?
More forceful injuries tend to cause more immediate, obvious symptoms. This is not a reliable rule on its own, though. Common symptoms include:
- Sudden, sharp pain at the moment of injury
- Swelling, often appearing quickly
- Bruising around the ankle
- Tenderness when the area is touched
- Difficulty putting weight on the foot
- Restricted or painful movement at the ankle
- Visible deformity, where the ankle looks an unusual shape or angle
- Numbness or tingling in the foot or toes
The NHS highlights severe pain, swelling or bruising, difficulty putting weight on the ankle, and any deformity as reasons to seek medical help without delay.
How Can You Tell if Your Ankle Is Broken or Sprained?
Because a sprain and a fracture can feel identical, it helps to know what might indicate each one.
- Broken ankle: the bone is fractured. Pain can be severe, with significant swelling and bruising. Putting weight on the foot may be very difficult or impossible. There might be visible deformity. An X-ray usually confirms it.
- Sprained ankle: a ligament is stretched or torn, but the bone is intact. Pain varies with the severity of the sprain. Swelling and bruising can still occur. Weight-bearing may still be possible, even if uncomfortable. There is usually no bony deformity, and many sprains can be diagnosed on examination alone.
Symptoms alone cannot reliably distinguish them, particularly in the first hour or two. A clinical assessment, often including an X-ray, is the only way to know for certain. If a sprain is confirmed rather than a fracture, prompt care such as the RICE approach for ankle sprains can still make a real difference to early recovery.
When Should You Seek Medical Help for a Suspected Broken Ankle?
The NHS advises going straight to A&E for more serious signs, such as a visible deformity, an open wound, or a foot that looks pale or feels numb. If you have pain and swelling without those signs, the next step is to seek prompt advice from NHS 111, an urgent treatment centre, or your GP. Being able to walk on the ankle does not reliably rule out a fracture, so “I can still walk on it” is not a safe reason to avoid getting it checked.
Once any emergency has been dealt with, patients who want a specialist opinion or a clear recovery plan can book directly with Mr Malagelada without a GP referral.
How Is an Ankle Fracture Diagnosed?
Diagnosis usually starts with a physical examination. This includes checking where the pain and swelling are concentrated, whether the ankle can bear weight and whether there is any visible deformity. An X-ray is the standard next step to confirm whether a bone is broken and, if so, where and how. For more complex injuries, a CT or MRI scan may be used to check how the joint surfaces line up and whether the ligaments are also damaged. These assessments confirm how displaced the fracture is and how stable the joint is, allowing appropriate treatment to be provided.
How Are Broken Ankles Treated?
Treatment depends on how the fracture happened and how stable the joint is afterwards. It’s not the same for every break.
- Rest and protection, often in a walking boot, for stable fractures that do not need repositioning
- A plaster cast, to hold the bones still while they heal
- Manipulation, where a clinician repositions the bones without surgery, if they have moved out of place
- Surgery with plates and screws, for fractures that are unstable, badly displaced or involve more than one part of the joint
- Physiotherapy, once the bone has healed enough, to rebuild strength and movement
For certain stable fracture patterns that still need surgical fixation, surgeons can sometimes hold the bone in place through smaller incisions rather than a fully open approach. This can reduce soft-tissue disruption. Mr Malagelada’s research background in minimally invasive foot surgery informs this decision, which is assessed case by case.
The NHS confirms that treatment depends on the fracture’s severity and can range from a boot or plaster cast to repositioning the bones or surgery.
How Long Does a Broken Ankle Take to Heal?
The NHS benchmark for a broken ankle to heal is around six to eight weeks. This varies with the severity of the fracture and whether surgery was needed. Our guide on how bone fractures heal covers the stages of bone repair in more detail. More serious or surgically treated fractures can take longer. Regaining full strength, balance and movement through physiotherapy often continues well after the bone itself has mended.
Can You Prevent an Ankle Fracture?
Most ankle fractures happen for one of a few reasons. Taking steps to reduce those risks can lower the likelihood of a fracture.
- Wear properly fitting footwear for the activity, and replace worn-out trainers or boots
- Use safe technique in sport, particularly around landing, pivoting and changes of direction
- Increase training load gradually to reduce the risk of a stress fracture
- Build ankle strength and balance, particularly after a previous sprain or fracture
- Address bone health, especially if you have osteoporosis or other risk factors for reduced bone density
- Reduce trip hazards at home and at work, such as loose rugs, clutter and poorly lit stairs
- Use protective equipment for higher-risk sports
Get an expert opinion on your ankle injury
Mr Malagelada can guide you through diagnosis, treatment and recovery. He sees patients at Welbeck London in Mayfair, King Edward VII’s Hospital in Marylebone, Cromwell Hospital in Kensington, and Wharfside Health Centre in Canary Wharf, and is recognised by Bupa, AXA Health, Aviva, Vitality, WPA and Cigna. Self-pay patients can also spread the cost of treatment with Chrysalis finance.
Frequently asked questions
What is the most common cause of an ankle fracture?
Twisting or rolling the ankle is the most common cause when the foot turns faster or further than the joint can absorb. This can happen from a misstep, an awkward landing, or a change of direction in sport.
Can rolling your ankle cause a fracture?
Yes. A mild roll usually causes a sprain, but a harder or more forceful roll can push the ligaments beyond their limits and break the bone instead, most often the fibula.
Can you break your ankle without falling?
Yes. A hard enough twist while standing, running, or changing direction can fracture the ankle without a fall. Stress fractures can develop from repeated activity with no single injury moment at all.
Can a sprained ankle turn into a fracture?
One condition doesn’t progress into the other. A sprain damages ligaments, and a fracture breaks a bone. However, the same twisting injury can cause a sprain, a fracture, or both together, depending on the force involved.
Can you walk on a broken ankle?
Sometimes, particularly with certain stable fracture patterns. Being able to walk on the ankle afterwards does not reliably rule out a fracture, so it should not be used as a reason for not getting it checked.
Can a minor accident cause a broken ankle?
Yes. How serious an accident looks does not reliably predict whether the ankle is broken. Bone strength, the direction of the force, and the foot’s position all matter more than how the accident appeared from the outside.
What sports are most likely to cause ankle fractures?
Sports involving sudden changes of direction, jumping, pivoting, tackles, or high-impact landings carry the highest risk. In the UK, football and rugby players commonly injure their ankles, mainly through tackles, collisions, and studs catching the ground mid-turn.