The goals of treatment are to have the tibia and fibula located in the correct position with respect to each other and to heal in that position. It is very important to note that these injuries can take a lot longer than typical ankle sprains to heal. In the absence of a broken bone, the treatment immediately following the injury is to rest the leg, ice for 20 minutes every two to three hours, provide gentle compression in the form of an Ace wrap, and elevate the leg with the toes above the nose. The patient will commonly have enough tenderness that they need a CAM Walker boot (removable walking boot). Aggressive therapy when weight bearing is possible is very important. This includes strengthening those tendons on the outside of the ankle called the peroneals and doing proprioception (teaching a patient to feel how the ankle is positioned and moves).
It usually takes six weeks or more to return to play, but can sometimes take even longer. One good indication that a person is ready to go back to sports is if they can hop on the foot 15 times. This type of treatment is acceptable if there is no obvious widening between the tibia and the fibula on the x-rays. If there is widening, which is called “diastasis,” or if there is an ankle fracture (broken bone) in the same setting, surgery is often needed. There is debate as to how to properly fix these injuries, but the idea is to put the fibula and tibia back together and hold them with either screws or new devices that contain a suture, which is the same type of material used to close wounds.