You can often still move your toes even with a fractured ankle. This ability to move the toes should not be used as a reliable indicator to rule out a serious injury, as a fracture involves damage to the bone, while toe movement is controlled by a separate system of muscles and tendons. A fracture, which is a break in one or more of the three bones that form the ankle joint, does not necessarily disable the motor function of the foot.
Why Toe Movement Is Often Retained
The movement of the toes is maintained because the muscle-tendon units responsible for toe flexion and extension originate well above the ankle joint. These muscles, known as extrinsic foot muscles, are located in the lower leg and calf area, not within the ankle bones themselves. The tendons from these muscles pass over the ankle joint and attach to the bones of the toes and foot, pulling the toes into motion.
When an ankle fracture occurs, the break typically affects the bones that form the ankle’s structural ring, such as the malleoli of the tibia and fibula. Because the fracture site is in the bone, it may not directly compromise the long tendons that cross the joint space to reach the toes. The tendons remain functional, allowing the toes to move despite the instability or pain in the ankle joint.
The major nerves that control the muscles responsible for toe movement, such as the tibial and peroneal nerves, are often unaffected by a non-displaced fracture. These nerves run along protected pathways. Unless the fracture is significantly displaced or involves a severe crushing injury, the neural signals to the toe muscles can still transmit normally. Pain may inhibit a person from attempting full movement, but the physical capacity to move the toes remains intact.
Key Indicators of a Potential Ankle Fracture
Since toe movement is not a dependable sign, other symptoms indicate a serious injury like a fracture. A reliable sign is sudden, intense pain that does not subside quickly after the injury. This pain is often localized directly over the bony prominences of the ankle.
The inability to bear weight on the injured foot immediately following the trauma is also a key indicator. If you cannot take at least four steps without severe pain, it suggests a high likelihood of a bone injury requiring medical attention. This functional limitation is a stronger predictor of a fracture than preserved movement of the toes.
Significant swelling, known as edema, and visible bruising, or ecchymosis, that develops rapidly around the ankle joint are common indicators of a fracture. The body’s response to a bone break involves bleeding and fluid accumulation, leading to noticeable changes in the ankle’s size and color. In cases of severe fractures, there may also be a noticeable deformity or misalignment of the ankle joint, which requires immediate emergency care.
Immediate Steps Following an Ankle Injury
If you suspect a serious injury, the immediate priority is to stabilize the ankle and reduce initial swelling using the R.I.C.E. protocol: Rest, Ice, Compression, and Elevation. Rest the injured foot immediately and avoid putting any weight on it to prevent further damage.
Applying ice to the injured area helps reduce pain and minimize swelling. Use a cold pack wrapped in a cloth for about 15 to 20 minutes every two to three hours during the first 48 hours. Compression with an elastic bandage, applied snugly but not so tightly that it causes numbness or tingling, also helps control the swelling.
Elevation of the ankle above the level of the heart uses gravity to drain excess fluid from the injury site, aiding in swelling reduction. Seek professional medical attention if you cannot bear weight, notice a severe deformity, or if the pain and swelling do not improve after initial first aid. Only diagnostic imaging, such as an X-ray, can definitively determine if an ankle fracture has occurred and guide the appropriate treatment plan.