Maisonneuve's Fracture

The Maisonneuve fracture (named after a French surgeon) is an injury to the ankle involving both a fracture and a sprain. It often arises from painful falling accidents associated with sporting activities.

Symptoms

Pain consistent with a sprain will be present in the ankle, and may be worsened upon moving the foot. It might feel impossible to put your body weight on the foot. If this is accompanied by tenderness in the fibula bone, which extends from the ankle to below the knee, then a Maisonneuve's fracture is likely. The area can become inflamed, bruised or reddened, and the ankle will feel substantially unstable.

Causes

When the foot hits the ground or another surface in an awkward manner – generally as the result of a fall – and the leg rotates unnaturally around the foot, the ankle can become strained and the fibula cracked. This can also cause a fracture in the tibia, much lower than the fibula fracture is usually sustained, due to the way in which the harsh force of the blow and subsequent leg twisting runs up the leg at the moment of impact. These can all combine to create a Maisonneuve's fracture, and commonly occur in athletes who partake in sports with a major leg element, a moving surface, or a risk of falling. Examples include skiing, cycling, dancing or gymnastics, though a fall of the described nature can strike in almost any sport.

You may be at greater risk if you have a history of ankle injury, and especially if any previous injury was rehabilitated incorrectly. Reasons for this vary, but can include not allowing sufficient time away from strenuous activity following an injury or not adequately following a doctor's instructions.

Medical Treatment

It is essential to consult a medical professional immediately after the fracture is suspected. The injury might take time to properly diagnose, due to the fact that it may appear as a combination of injuries or even as another ankle condition. In general the doctor will recommend surgery, which can involve the temporary placing of a syndesmosis screw to hold the unstable ankle in position while the surrounding ligaments begin to heal.

Rehabilitation

It will be necessary to avoid activity involving the foot for a number of weeks, and the exact timescale will depend on the severity of the injury, the speediness of healing and your doctor's individual advice. Activities unrelated to the feet may be pursued, but if in doubt these should be checked with a doctor to make sure they will not exacerbate the ankle injury. Physical therapy might be beneficial after the ankle begins to recover. This will involve gentle stretching and strengthening exercises designed to maintain mobility in the area, and the doctor can advise you on appropriate training methods. You may be prescribed pain or anti-inflammatory medication to treat ongoing symptoms, and icing the area every so often can also be effective in combating pain and swelling. Recovery is often very gradual and can take many months.