A broken ankle is a serious and painful injury. Many different types of fracture patterns may be seen in ankle injuries, and all contribute to mobility concerns, potential healing problems and the potential for lengthy recovery.
First Clue is Pain
As with any bone in the body, breaking bones in the ankle is painful. The force needed to break the larger tibia (shin) bone translates into significant pain. Couple that with breaking the lesser, but equally important, fibula bone sets you up for an extremely painful injury.
Swelling
Typically, the force required to break any bone usually involves additional trauma to surrounding soft tissue structures, such as ligaments, tendons and occasionally, muscle. When these structures are damages as is seen in fractures, they bleed. The bones lose blood through oozing from the marrow. Muscle is vascular (has many blood vessels) and the potential for blood loss and swelling is high.
Combine the soft tissue trauma with the bone fractures, and you get noteworthy swelling that can involve the toes and lower leg.
Bruising
Bruising (ecchymosis) is the visible collection of blood in the surrounding tissues after an injury, especially fractures. As the blood leeches from the immediate injury area of the bone and surrounding soft tissue, it migrates toward the more superficial layers under the skin. When blood cells accumulate outside the vascular system, they lose their oxygen content, becoming dark in color. The blue/purple hues to bruises are a visual sign of un-oxygenated blood in the tissue.
Deformity
Aside from the mild, hairline fractures that can occur in the ankle, the more significant injuries frequently demonstrate some level of deformity. The ankle is an inherently stable joint, but when both sides of the ankle are broken (bimalleolar fracture); the ankle becomes de-stabilized and can slip out of position, creating deformity. In severe cases, these deformities can disrupt blood supply to the foot and toes, making restoration of alignment (called "reduction") critical to prevent permanent vascular damage.
