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Ankle Avulsion Fracture

Ankle ligamentsAn ankle avulsion fracture occurs when a tendon or ligament comes away from the bone often pulling a small piece of bone with it. Whilst this injury can be mistaken for a sprain, correct diagnosis and treatment is crucial, particularly in children as their skeletal development may be affected without the appropriate medical attention.

Ankle avulsion fracture symptoms

Symptoms of an ankle avulsion fracture are very similar to an ankle sprain, therefore it is very difficult to correctly diagnose without an X-ray or MRI scan. There will be pain in the ankle immediately after the injury occurs with immediate swelling. Bruising may develop later and the athlete will most likely have difficulty moving or putting weight on the ankle.

Avulsion fracture explained

Avulsion fractures can occur anywhere in the body, usually at joints. The ankle is one of the most common places for it to happen. When the ankle is sprained or twisted, a force is passed through the ligaments and tendons usually on the outside of the ankle. 

Ankle sprain or avulsion fracture?

Following the initial sprain one of two things can occur i) the ligament or tendon tears, resulting in a sprained ankle, or ii) the ligament or tendon pulls so hard on its composite bone that it pulls a small piece of bone off, resulting in an avulsion fracture. It is impossible to know which of these has happened following an ankle injury, without an x-ray. This is why it is always important to get an x-ray following a moderate to severe ankle injury.


Although treatment is often the same whether there is an avulsion fracture or a sprain, it may depend on the severity of the fracture and also its alignment. Children are also more likely to be offered alternative treatment for a fracture as otherwise this could affect their skeletal growth and development.

Plaster castMore severe avulsion fractures or fractures in children, may require casting for 6-8 weeks to allow the bone to heal. Following this, a period of rehabilitation will be required to ensure that full strength and mobility are regained.