What is the treatment for an ankle fracture causing foot discoloration?

Treatment for Ankle Fracture Causing Foot Discoloration

An ankle fracture causing foot discoloration requires immediate evaluation with radiographic imaging followed by appropriate stabilization based on fracture type, with special attention to vascular compromise that may be causing the discoloration. 1, 2

Initial Assessment

• Evaluate for vascular compromise: Foot discoloration with an ankle fracture may indicate compromised blood flow requiring urgent intervention

  • Check for pulses (posterior tibial and dorsalis pedis arteries)
  • Assess capillary refill time
  • Note temperature and color changes in the foot
  • Document any sensory or motor deficits

• Apply Ottawa Ankle Rules to confirm need for imaging 1, 2:

  • Pain in malleolar zone AND:
    • Bone tenderness at posterior edge of lateral/medial malleolus, OR
    • Inability to bear weight for four steps immediately after injury

Diagnostic Imaging

• Standard three-view radiographs: Anteroposterior, lateral, and mortise views 1, 2

  • Weight-bearing views if possible (to assess stability)
  • Include base of fifth metatarsal in imaging

• Additional imaging if initial radiographs are inconclusive:

  • CT scan for complex fractures or suspected talar injuries
  • MRI if soft tissue injury is suspected to be contributing to discoloration

Treatment Algorithm

1. Stable Fractures (Weber A, non-displaced)

• PRICE protocol (Protection, Rest, Ice, Compression, Elevation) 1

  • Apply ice for 15-20 minutes every 2-3 hours for first 48-72 hours
  • Elevate ankle above heart level to reduce swelling and discoloration
  • Use compression bandage to control edema

• Pain management:

  • NSAIDs help reduce swelling and pain and may decrease recovery time 1
  • Caution: NSAIDs may suppress natural healing process 1

• Immobilization:

  • Semirigid or lace-up ankle supports preferred over elastic bandages 1
  • Walking boot with progressive weight-bearing as tolerated 2
  • Consider assistive devices (crutches, walker) initially

2. Unstable Fractures (Weber B/C, displaced, bi/trimalleolar)

• Emergency reduction if dislocated to prevent further vascular compromise 3

• Surgical fixation indicated for:

  • Medial clear space >4mm
  • Bi- or trimalleolar fractures
  • Displaced fractures
  • Open fractures
  • High-energy injuries 2

• Post-surgical care:

  • Non-weight bearing for 6-8 weeks with cast or boot
  • Monitor wound for hematoma, necrosis, and infection (2% risk) 3
  • Progressive rehabilitation once healing begins

Special Considerations

• If discoloration persists after initial treatment:

  • Reassess vascular status
  • Consider compartment syndrome (emergency surgical decompression required)
  • Rule out deep vein thrombosis

• For diabetic patients or those with neuropathy:

  • Use non-removable knee-high device 2
  • More vigilant monitoring for wound complications
  • Higher risk of infection and fixation failure 4

Rehabilitation

• Functional rehabilitation preferred over prolonged immobilization 1

  • Begin range of motion exercises when safe (typically 2-6 weeks depending on fracture severity)
  • Progress to strengthening exercises
  • Proprioceptive training to prevent recurrent injury

• Prevention of recurrence:

  • Consider ankle braces during high-risk activities 1
  • Proprioceptive exercises like ankle disk training 1

Follow-up

• Regular radiographic assessment until fracture healing is confirmed
• Monitor for post-traumatic arthritis (occurs in up to 10% of cases) 3
• Assess for return to normal function and resolution of discoloration

The presence of foot discoloration with an ankle fracture warrants careful attention to vascular status throughout treatment, as it may indicate compromised circulation that could lead to tissue damage if not properly addressed.