Video transcript

Let’s go through your injury and how to manage it over the next few weeks.

The fibula is the smaller of the two bones in your lower leg. It runs along the outer side of the leg, from the knee all the way down to the ankle. At the bottom end of the fibula, there’s a bony lump on the outside of your ankle — this is called the lateral malleolus.

Every joint in the body is supported by ligaments, which connect the bones together and help stabilise the joint. If too much force goes through a ligament, it can tear or rupture. But sometimes, instead of tearing, the ligament pulls away from the bone, taking a small flake of bone with it. That’s called an avulsion fracture.

So when we say you’ve had an avulsion fracture of the lateral malleolus, it means that one of the ligaments on the outer side of your ankle has pulled off from where it attaches, and taken a small piece of bone with it. This sort of injury usually happens if the ankle rolls or twists suddenly — often during a simple sprain or fall.

The good news is that lateral malleolus avulsions are almost always stable. That means the ankle joint itself stays properly aligned and the major structures remain intact. Even though a small part of the bone is chipped, we manage it more like a soft tissue injury to the ligament.

Because the main weight-bearing parts of your ankle aren’t affected, you can usually walk on the foot safely without risking further damage.

Once this injury is diagnosed in the emergency department, your ankle will normally be supported in a removable walking boot. This is usually preferred over a cast because it’s more comfortable, easier to keep clean, and lets you stay more mobile. That said, if you have existing nerve problems in your feet or reduced sensation, a plaster cast may be used instead for added protection at the start.

As long as the ankle is supported, you don’t need to restrict movement beyond what’s comfortable. Most people can begin putting weight through the leg straight away, as tolerated. This helps prevent the muscles from weakening and lowers your risk of blood clots. However, when you’re resting, it’s important to keep the ankle elevated. This helps reduce swelling and discomfort, especially during the first couple of weeks.

You’ll be reviewed in the fracture clinic around one to two weeks after the injury to check how things are going. Most people continue using the boot for four to six weeks, and after that, you can gradually transition into supportive footwear. Once you’re walking comfortably in shoes again, it usually takes another four to six weeks before you’re ready to return to high-impact activities or heavy lifting.

The first week or two are often the most uncomfortable, but most people can still walk using the boot and a set of crutches for support. Even though you may be back in regular shoes by six weeks, it’s not unusual to have a bit of swelling or weakness that lingers for a few months.

You probably won’t need formal physiotherapy. Most people naturally regain strength and movement just by going about their normal daily activities and doing light self-directed exercises at home. As long as there’s no ongoing pain or sense of instability, you can usually return to running, sport, or high-impact activities from around eight to ten weeks after the injury.