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Broken bones in the foot and ankle can range in severity from very mild to a severe disruption and fracture.

 

If you have had a stable injury this means that the injury should heal with the structures in your foot being able to function again. Stable injuries often need time in a splint or even plaster, crutches, and physiotherapy.

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If you have an unstable injury it is much more likely than you will need surgery and you must prepare yourself for a longer recovery. If the broken bones can be held in the right position you may have the option of being treated in plaster but you will also need to be on crutches not putting any weight through the leg until the bones heal.

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Most unstable injuries to the bones of the foot and ankle require surgery. ORIF stands for Open Reduction Internal Fixation. Open means a surgical incision so the surgeon can access the broken bone. Reduction means the surgeon will align the bones back together (as perfectly as possible). Internal fixation means the surgeon will then hold the bones back together while they heal with an implant. Normally the implant is a metal plate and screws but many other implants are becoming available.

FOOT AND ANKLE FRACTURES //

IF I DON'T NEED TO HAVE SURGERY WHAT DO I NEED TO KNOW?

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Clear Advice About DVT

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A DVT is a Deep Vein Thrombosis or a blood clot in the leg. A blood clot occurs after breaking the ankle and foot because the foot is painful and patients find moving the leg difficult and also because patients are placed into plaster or a splint.  You can help prevent a blood clot by keeping your knee moving. Keeping yourself hydrated is also helpful to prevent a DVT. Finally elevating your leg to the level of your heart will minimise the amount of swelling you have which will also help to prevent a DVT. You will be given blood thinners for the first two weeks when you at your least active if you are immobilised in a plaster.

 

If you were to develop a DVT you would likely have some symptoms and so it is very helpful if know what to look for:

  • The leg (above the dressing/foot) would become hard, heavy, swollen, painful and/or red

  • If you were to have any of the above symptoms you would have to have a scan to look for a blood clot and then be treated with blood thinners

If the blood clot were to move to the lungs you would have a pulmonary embolism which is a medical emergency

  • The symptoms of a pulmonary embolism are breathless & chest pain- Call 911

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When can I drive?

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The best guide that you are safe to return to driving is that you are able to walk well without crutches out of a plaster or a splint. The usual time scale also depends on whether you had surgery on your right or left foot and whether you drive a manual or an automatic

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  • Right side and all car types: 4 - 6 weeks  (depending on your injury)

  • Left side and manual car:     4 - 6 weeks  (depending on your injury)

  • Left side &automatic car:      0 - 2 weeks

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How long should I take off work?

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The time you require off from work depends on what type of job you do and also how minor your injury was. If the fracture was fairly significant you may require a period of rest and the first two weeks of healing are critical for reducing swelling and so you may need to have this time off work. If the fracture was less significant and you are able to walk on the injured foot and ankle you may find you can go back to work quite soon.

 

Many people are able to work from home and so if your injury is more significant and you can avoid commuting for a period, you will find that your foot and ankle does better. If your employer can be flexible with your activity at work you may be able to do some lighter duties or reduced hours from 2-3 weeks onward. If you are going back to work on light duties, you must also consider how you will travel to work, If you work on your feet all day, do a manual job, or are required to wear dress shoes you may need 8-10 weeks before you are back at work.

The recovery after a stable foot or ankle fracture

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Instructions while in a plaster cast:

  1. Elevate Leg Above Heart

  2. Keep plaster dry

  3. Keep plaster intact

  4. Please remember that the more time spent standing or walking, the more swollen your ankle and foot will be and the worse your healing will be

  5. Follow the weight bearing instructions you are given

  6. Unless you are already on a blood thinner (for a medical condition) you will be given blood thinners.

 

Instructions once into a removable splint:

  1. Continue to elevate leg to level of heart

  2. Please remember that the more time spent standing or walking, the more swollen your ankle and foot will be and the worse your healing will be.

  3. You may need to wear a DVT stocking to help keep your swelling under control

  4. Follow the weight bearing instructions you are given

  5. You must use the aircast boot to stand and walk

  6. Work on range of motion exercises

  7. Contrast bathing

  8. Local modalities to reduce swelling

  9. Start to work on strengthening when swelling improves and range of motion is near normal

  10. Theraband Resistance

  11. Progress to the Surrey Stages to Strengthen Ankle

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You make take the boot off at night and to do your physiotherapy

Physio Exercises: Get your ankle moving! Do the following every waking hour 10-15 times

A)  Alternate the ankle between dorsiflexion and plantarflexion

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B) Alternate the ankle between inversion and eversion

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C) Draw the Alphabet with your big toe. This will encourage the ankle to move in all directions.

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D) Seated Calf Raise

  1. Sit in a chair

  2. Lift your heel as far as possible while keeping your toes on the floor.

  3. Repeat 10 x

THE ‘SURREY STAGES’ PHYSIOTHERAPY STRENGTHENING PROGRAM

 

BRONZE AWARD

DOUBLE HEEL RISES (DHR)

  • You can go up and down on tiptoes in sets of 3, slowly and 15 reps in each

  • You can stand on a skipping rope and adjust your foot position

  • You can hold a DHR for 15 seconds

  • It can be difficult to progress to the next award level because the ankle will take double the weight when you move to lifting the good leg to lower only on the operated leg.

  • You are better to stay at the bronze award level but to add in a back pack with increasing weight as you feel ready for more

  • When you have done this for some time you will be ready to progress to the silver award level

 

SILVER AWARD

DOUBLE HEEL RISES WITH A LIFT

  • May need to add weight in backpack on DHR to reach silver level

  • You go up on both feet but lift unoperated leg and lower slowly only on operated leg

  • 3 sets, working up to 15 reps in each

  • You can stand both feet on a wobble board

  • You can hold a solid DHR for 20 seconds

 

GOLD AWARD

SINGLE HEEL RISES

  • 3 sets, working up to 15 reps in each

  • You can stand on one foot on wobble board

  • You can hold a solid DHR for 40+ seconds

 

PLATINUM AWARD

  • Progress to hopping in all directions

  • Double Hops

  • Gentle jogging to reintroduce running

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