The classification is according to Weber and indicates the extent of the fracture and concomitant injuries. The fracture in the most minor injury, Weber A, is below the joint gap, with intact syndesmosis ligaments. In Weber B, the fracture is generally still stable at the level of the joint gap or in the area of syndesmosis. In a Weber C, the fracture lies above the syndesmosis and these ligaments are torn, making the entire ankle unstable.
The right load
Whether or not the patient can be loaded again depends on the extent of the injury and the treatment of it. For all fractures, weight-bearing is prescribed for 6 weeks. This time limit should be adhered to urgently, since the ankle is subject to the entire weight of the body and healing may be delayed.
After the 6 weeks, the load can be worked on gradually. In the case of a Weber C fracture, a set screw is used to suture the syndesomes, which limits rotational movement and up and down movement of the foot. This is removed after 6 weeks and the partial weight-bearing can be worked on.
Often the physician prescribes a further partial weight-bearing up to 12 weeks to slowly bring the foot closer to the load. This should only be done in consultation with the doctor, who will determine when more weight can be placed on the foot. Once complete immobilization has been lifted, the condition of the foot can be easily assessed in terms of swelling and pain. If these become worse, the load should be increased carefully and further measures such as cooling, elevating and taping should be taken. You can find exercises for this in the article: “Ankle exercises”.
Return to sport
As already mentioned above, the foot must not be fully loaded until 12 weeks of age at the earliest. This means that walking can be done without supports and without a splint. However, this period is still much too early for other sporting activities.
From the time the foot is fully loaded, stability training can be started via physiotherapy. This includes balance training on uneven surfaces, weight transfer to the affected leg, and strengthening of the muscles surrounding the foot. Depending on which sport is normally performed, the return to this sport takes longer.
Strength training in a gym is allowed from the permitted load, unless specific leg training is performed. Gymnastics in water or swimming can also be done again once the full load is reached. Cycling can also be tried out on an ergometer with a low wattage and if pain occurs, it can be started later. Jogging can be tried from half a year on, but it is important that a proper rolling of the foot is possible again. All sports with jerky movements, such as tennis, squash, handball, soccer, etc., should only be started carefully after one year on the recommendation of the doctors.
