You’ve been told you have a ankle avulsion fracture (grade 3 ankle sprain) but struggling to find specific information, especially about the healing and recovery time?
As a physical therapist, I answer the most common questions from my patients on this topic! I also provide photos and videos for reference.
Feel free to ask questions in the comments if needed. 🙂
Take-home message: A foot bone avulsion is essentially a type of ankle sprain. The healing/scar tissue formation time is around 6 weeks, but you can often resume walking well before!
♻️ Last updated: October 2023.
👩⚖️Diclaimer: None directly financial interest related to the subject. My full disclosure of financial interests is in the legal notices.
Written by Nelly Darbois, physical therapist, and scientific writer.
Is an avulsion fracture a real fracture?
If you’re here, you’ve probably seen something like this on your X-ray report (or that of your patient):
- Small avulsion of the lateral malleolus.
- Fracture with avulsion of the medial malleolus.
- Ankle sprain with bone fracture
- Ankle ligament avulsion.
Are all these terms (and more!) related to the issue I’m going to discuss here!
So, is a avulsion a fracture? Yes, it’s a somewhat specific type of fracture.
The primary difference between a bone avulsion fracture and a typical fracture is the origin of the fracture.
In the case of an avulsion fracture, the force applied by a ligament or tendon in the ankle can cause a small piece of bone to separate.
In a typical fracture, the bone itself breaks into two or more pieces. Please refer to my articles on ankle fractures.
I’ve created a simple diagram because I couldn’t find one already made. As you can see, I’m not an artist 🙂
⚠️ If it says “Avulsion Fracture of the Calcaneal Tuberosity” or “Calcaneal Avulsion Fracture” on your medical report, it’s not the same type of issue I’m discussing here. An upcoming article on this topic soon!
What’s the difference between ankle avulsion and ankle sprain?
When we talk about a avulsion facture at the ankle, we are actually talking about… a type of ankle sprain!
There are 3 types of ankle sprains, and all of them can affect the inner (medial) or outer (lateral) malleolus on the right or left side.
- Grade 1 ankle sprain
- Grade 2 ankle sprain
- And grade 3 ankle sprain, referred to as “severe,” with bone avulsion.
In the case of a sprain with avulsion, the ligaments are torn, not just stretched or lengthened.
Even though the term “severe sprain” may sound a bit mild, it’s something that happens relatively often and is well-known and studied!
How long does it take to recover from a ankle avulsion fracture?
Several factors come into play when it comes to the healing time of a avulsion fracture:
- Your overall health.
- Smoking or alcohol consumption (both slow down healing and consolidation).
- Whether there was significant displacement of the broken malleolus fragment.
- Genetic predisposition to heal more or less effectively.
- If you’ve had other sprains with or without avulsion on this ankle before.
However, even taking all these factors into account, it’s very difficult to predict: you will fully recover in X weeks, and you will walk perfectly without crutches in X months.
Here’s a rough estimate, based on my experience with patients and some empirical data (for ankle sprains in general, regardless of the grade):
Here’s a table summarizing the typical timeframes before resuming different activities.
|You can drive your car||Several days to a few weeks|
|You have much less pain||A few days. Two out of three people have no pain at one year (van Rijn 2008)|
|Swelling in the foot decreases||A few weeks (ankle swelling sometimes lasts for several months after a sprain)|
|Ligament has healed, bone fragment has consolidated||Several months. Ligament healing is well advanced after one month, and bone consolidation after one and a half months|
|You can remove the cast, walking boot, or brace||Within 3 to 6 weeks, often after a follow-up X-ray|
|You can start cycling again||2-3 weeks to 6 weeks|
|You walk with crutches||Immediately, often with support, sometimes without support|
|You walk without crutches||Often within a few weeks, maximum 1 or 2 months|
|You can resume walking on unstable terrain||A few weeks|
|You begin ankle rehabilitation||Immediately or when you remove the cast or walking boot|
|You stop physiotherapy sessions||Very variable: some people may not need it and perform self-rehabilitation, while others have physiotherapy sessions for several months|
|You can gradually start running||A few weeks|
|You can resume other sports activities||1 to 6 months, depending on the activity and its intensity|
|You are completely healed||A few weeks to a few months|
How to speed up healing time for an ankle avulsion fracture?
There is no medical, surgical, natural, or physical therapy treatment that can directly speed up the healing time of your bone avulsion.
Your body does this quite well on its own. However, you can facilitate the natural healing and consolidation process by not hindering it.
Here are some suggestions:
Limit your consumption of tobacco and alcohol, as these substances can slow down consolidation.
Stay as active as possible, aiming for at least 150 minutes of moderate-intensity physical activity per week.
Activities like indoor cycling, seated cycling, walking, swimming, and more are suitable.
Physical activity stimulates bone cells to produce new cells, accelerating blood circulation. Besides aiding bone healing, it offers numerous other physical and mental health benefits.
If you have osteoporosis or are over 65 years old, consider taking vitamin D and calcium supplements or ensure that you have adequate intake through your diet and sun exposure. Typically, 800 to 1000 international units (IU) of vitamin D per day and 1000 to 1200 milligrams of calcium per day are recommended.
You’ve reached the end of this article about healing time after an ankle avulsion fracture. I hope I’ve answered your main questions.
If you have more questions, feel free to leave them in the comments, and I’ll respond to the best of my ability. Wishing you a smooth recovery and a return to your regular activities! 😊
If you feel the need to learn more about the recovery period after a sprained ankle, I wrote this guide in eBook format:
You may also like:
McCoy JS, Nelson R. Avulsion Fractures. [Updated 2023 Aug 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559168/
Pepper 2008. van Rijn RM, van Os AG, Bernsen RM, Luijsterburg PA, Koes BW, Bierma-Zeinstra SM. What is the clinical course of acute ankle sprains? A systematic literature review. Am J Med. 2008 Apr;121(4):324-331.e6
Hubbard -Turner, Tricia & Hicks-Little, Charlie. (2008). Ankle Ligament Healing After an Acute Ankle Sprain: An Evidence-Based Approach. Journal of athletic training. 43. 523-9.
Written by Nelly Darbois
I love writing articles based on my experience as a physiotherapist (since 2012), scientific writer, and extensive researcher in international scientific literature.
I live in the French Alps 🌞❄️, where I work as a scientific editor for my own website, which is where you are right now.