How to Start Walking After a Broken Ankle?

Last update: May 2023
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What type of ankle fracture are we talking about in this blog post?

The term “ankle fracture” includes a large number of fractures with different names. These names vary according to:

• the location of the fracture: on which bone? It can be on 1 (uni-malleolar fracture), 2 (bi-malleolar fracture):
  • the tibia: medial/internal malleolus fracture;
  • the fibula (also called the peroneal bone): lateral/external malleolus fracture;
  • it is also called a tri-malleolar fracture when both malleoli are broken plus another part of the tibia.
• the type of fracture:
  • displaced or nondisplaced fracture: depending on the degree of gap between the different bone segments;
  • stable or unstable fracture: depending on whether the ligaments that allow the joint to be stable are also affected;
  • simple, complex, comminuted fracture: if the bone is broken in several places; closed or open fracture: in the latter case, the broken bone tears the skin and can be more or less visible;
• the classifications we use to name them.

In this blog post, I am talking about all these ankle fractures. The indications given are therefore generally applicable regardless of the type of fracture you have.

Is it safe to walk? Ankle fracture weight bearing; yes or no?

Once it is certain that you have a fracture (thanks to an ankle X-ray), a medical or surgical team will define the most appropriate treatment for you, according to them.

• Conservative or orthopedic treatment: non surgical treatment. Immobilization is sometimes recommended, with a cast, orthosis, or walking boot. Physical therapy sessions may also be prescribed.
• Surgical treatment: a surgery is performed, often in the case of a displaced or unstable fracture. Whether you are treated conservatively or surgically, you should normally have clear indications on the support and walking that is authorized/recommended in your case.

One of these 4 types of walking and support has normally been recommended to you:

• Full weight-bearing: you are allowed to put as much weight as you want on your fractured leg. You must adjust according to the pain and discomfort and gradually resume normal walking and support;
• Partial weight-bearing: you are allowed to put some weight while walking and standing, but not too much. In this case, a percentage of support has been indicated to you in relation to your weight. For example, something like “partial weight-bearing at 40% of body weight.” You must theoretically respect this dosage, regardless of your feelings. And therefore walk with crutches;
• Touch weight-bearing: you are allowed to place your foot on the ground, but with almost no weight on it. Around 10% of your body weight. You can also walk in contact support, thus relying also on 2 crutches to unload your weight on them;
• Non-authorized weight-bearing: you should not really put any weight on your ankle. And generally, this is until the control X-ray, 4-6 weeks after the diagnosis. However, this does not prevent you from walking! You can walk with crutches or a walker without putting your foot on the ground, hopping. If of course, you do not have other health problems that prevent you from moving like this.

The type of authorized support in your case has normally been communicated to you:

• verbally, by the doctor or surgeon who supervises the care;
• in writing, on your consultation, hospitalization, or operation report. And on letters to your physiotherapist or general practitioner.

In some cases, you may question yourself: do I really have to not put any weight for so long? Or, on the contrary, are you afraid to put weight on when you have been told you can?

In this case, I advise you to:

• discuss this further with the healthcare professionals (physiotherapists, doctors) who are following your case and have access to your medical records.
• do your own research and think about how you evaluate the risk-benefit ratio in your case.

In the rest of the blog post, I will provide information about what current international scientific publications say about resuming weight-bearing and walking after a broken ankle.

The medical or surgical team that made the diagnosis and prescribed the treatment should have informed you whether or not you are allowed to bear weight, and therefore walk by placing your foot on the ground or not.

Is there a risk of pain or worsening the fracture while walking?

You are right to ask if walking could cause pain or worsen the fracture. When weight-bearing is restricted or not recommended, it is done precisely because it is believed that it:

• Reduces pain
• Increases the chances of rapid and optimal consolidation and therefore healing.

However, not walking can also cause other problems, such as:

• Risk of deep vein thrombosis
• Loss of muscle or functional capacity
• Unwanted work stoppage with economic consequences
• And more

So, how do we know what is best to do? Researchers have conducted studies to get more precise information. They have:

• Selected people who have had an ankle fracture (often treated surgically)
• Allowed immediate full weight-bearing (according to pain) to some. They told others to wait 2, 3, or 4 weeks. And to others, they told them to wait for the follow-up X-ray, one and a half months later. To these last ones, they said to walk without weight-bearing or with contact weight-bearing.
• Observed how all these people do in the weeks and months following the ankle fracture:
• Who consolidated faster?
• Who had less pain?
• Who had more complications (infection, delayed consolidation, etc.)?
• Who returned to work or sports faster?

So, what do these studies conclude? Well, according to the studies, the results are mixed.

• Some conclude that complications are more frequent for people with weight-bearing.
• Others conclude that complications are equally frequent for both groups, but those who had immediate weight-bearing recovered functionally better and faster.

In any case, the further away from the date of the fracture, the more similar the results are between the different groups in terms of complications or functional capacity. (Sources: Khojaly 2021 & 2022)

Overall, the trend is moving more and more towards allowing weight-bearing based on pain rather than prohibiting it. Whereas the trend was the opposite in past decades.

Here is what a team of orthopedic surgeons from the UK concludes:

“Early weight-bearing in patients with ankle fractures, whether managed conservatively or surgically, results in very low rates of loss of reduction and should be considered routine management for the majority of patients.”

Bugler 2018

If you want to adopt this option, I recommend discussing it with the physiotherapists, doctors, or surgeons who are following your case.

This will allow you to have an external opinion to evaluate the risk-benefit balance more finely in your case. Especially if you are in a cast, which complicates weight-bearing!

Do we need a wheelchair if we have an ankle fracture?

A wheelchair is not always prescribed after a unimalleolar, bimalleolar, or trimalleolar fracture. It depends on several factors such as your health before the injury, your lifestyle, your apprehensions, the type of housing you live in, and your family or work obligations.

Physical therapists can prescribe a wheelchair for rent. This will be covered by health insurance and mutual insurance (in France). Doctors and surgeons can also prescribe them. The rental can be renewed.

As a home-based physical therapist, I usually see patients who are functionally limited due to their ankle fracture. Approximately 90% of my patients have used a manual wheelchair occasionally or regularly in the weeks (sometimes months) following the fracture. Sometimes at home, sometimes only outside.

After an ankle fracture, wheelchair is sometimes necessary, especially for long outdoor trips.

Is it better to walk with or without crutches?

No matter how much weight you can put on your fractured ankle, you’ll probably need crutches or a walker for a few weeks.

• Crutches will allow you to put a little less weight on the fractured ankle. You’ll be able to do things at your own pace.
• They can also allow you to walk faster or farther, for example, to do your daily activities or to stay physically active.

You’ll know when you can gradually stop using them altogether. For some people, this happens after 3-4 weeks, more often 6-8 weeks. For others, it takes several months.

In any case, the idea is to do it gradually. During the transition, you can use hiking/nordic walking poles.

After a broken ankle, crutches are often essential, at least for a few weeks.

Is it better to walk with or without a walking boot?

If you have a cast, there’s no question about it!

However, if you don’t have a cast, whether you’ve had surgery or not, you may have been prescribed a brace, an orthosis, or a walking boot.

Here’s what a walking boot (also called a fracture boot or orthopedic boot) looks like. It can be pneumatic or non-pneumatic.

We don’t have any high-quality studies that say whether it’s better to wear a walking boot or any other brace or not.

In my opinion, here are some situations where it might make sense to wear a walking boot:

For example, if you:

• have young children (or a pet) who might bump into your ankle when you walk;
• need to quickly resume outdoor activities in crowded areas;
• have difficulty putting weight on your foot and walking with crutches, but need/want to start walking with support quickly.

In my experience, some orthopedic surgeons always prescribe walking boots, while others never do. Walking boots may be useful in some situations, but they are not necessarily essential after a broken ankle.

How long to walk normally after an ankle fracture?

It’s normal to want to know when you will finally be able to walk again as you did before your fracture – without pain, discomfort, instability, or apprehension. However, it is impossible to give you a precise timeline. It depends on many factors, such as:

• your physical condition before and after the operation;
• the type of fracture and treatment you received;
• what you will do during the rest and rehabilitation period;
• your own criteria for “walking normally as before.”

Here is a graph that shows how people who have had an ankle fracture (operated on or not) typically recover:

What can we conclude from this?

• You will probably recover well in the first three months;
• Six months after the fracture, you should have regained about 80% of your pre-injury capabilities.

This is an average number. Some people, for example, report having regained 90% of their pre-injury capabilities in three months.

My patients with a plaster cast or who have had ankle surgery typically take an average of 2 to 4 months to walk again without crutches as they did before. For those who were not plastered or operated on, it’s a bit faster.

You will probably be able to walk again “as before” a few months after the ankle fracture.