Busted Ankle? What's Better, a Cast or Brace?

Modern, flexible boots may be just as good as old-school plaster casts when it comes to treating broken ankles, new research suggests.

Often related to sports, traffic accidents or falls, broken ankles can be simple breaks in one bone or more complicated fractures that involve several bones, according to the American Academy of Orthopaedic Surgeons. Ankle fractures don't always require surgery, but most folks will need to keep their foot immobilized in a cast or removable boot for around six weeks so bones can heal.

And people in the new study reported similar levels of pain and function after 16 weeks whether they received a cast or a removable boot to treat their ankle fracture.

"Keeping the broken ankle rigidly still in a cast is no better than allowing it to move," said study author Rebecca Kearney, a professor of trauma and orthopedic rehabilitation at the University of Warwick in Coventry, United Kingdom.

Many people prefer the brace, she said. "Functional braces can be removed to allow early movement and for patients to look after their skin and basic hygiene," she noted. By contrast, casts are rigid and can cause stiff joints and weakened muscles.

As part of the trial, about 670 people with broken ankles received a below-the-knee cast or a removable brace. People who got a brace were told how and when to remove the boot and asked to perform ankle strengthening exercises.

After about four months of follow-up, patients were asked about their pain when walking, climbing stairs, running, jumping and squatting as well as stiffness, swelling and use of any support devices. Their answers were combined into the Olerud Molander Ankle Score.

The bottom line? There was no difference in scores between the two groups. "When choosing a cast or brace, you need to consider patient preference and cost," Kearney said.

The study was published online July 6 in the BMJ.

Dr. Andrew Elliott is a foot and ankle surgeon at the Hospital for Special Surgery in New York City. He said there are merits to both casts and removable boots when treating a broken ankle.

"It winds up being a discussion between the patient and surgeon as to what they feel is the best course of treatment," said Elliott, who had no ties to the new research.

The new study did show that those people who received boots were more likely to develop an infection and/or need further surgery, but it was not designed to look at these issues specifically so no conclusions can be drawn. It does make sense though, he said.

"These wounds can occur with early motion, and the boot doesn't fit as snuggly as a cast so you can develop microtraumas and wound issues," Elliott explained.