Maisonneuve Fracture – The Ankle Injury That Hides in the Knee

Maisonneuve Fracture – The Ankle Injury That Hides in the Knee

You twisted your ankle, your lower leg hurts, but the ankle X-rays come back normal. Your doctor clears you to go home. Weeks later, you're still in pain and swelling hasn't improved. Could there be a fracture you've missed? Welcome to the Maisonneuve fracture—a deceptive injury where damage to your ankle actually involves a break much higher up in your leg. If you've had ankle trauma and lingering symptoms in Central Florida, understanding Maisonneuve fracture could explain your ongoing pain.

What Is a Maisonneuve Fracture?

A Maisonneuve fracture is a specific type of ankle injury involving two separate fractures in your leg:

1. A break in the fibula (smaller bone in the lower leg) near the knee
2. Disruption to the syndesmosis—the fibrous connection between the tibia and fibula at the ankle

The injury pattern resembles a simple ankle sprain or minor fracture on initial examination, but the fibular break near the knee is often missed because the injury occurred at the ankle, and doctors may not image the area of pain. The APMA sprains and fractures page is blunt about that overlap: a sprain stretches ligaments, a fracture is a break in bone, and the two can look identical until imaging sorts them out.

This fracture pattern is named after French surgeon Jacques Maisonneuve, who first described it in the 1800s. Despite its age, it remains frequently underdiagnosed in emergency departments and urgent care facilities across Florida and nationwide.

How Maisonneuve Fractures Happen

These injuries typically result from external rotation of the foot while your leg is fixed—imagine your foot turning outward while your knee stays pointed forward. Common causes include:

• Sports injuries—football, soccer, basketball, or any activity involving rapid directional changes
• Falls—particularly stepping off a curb or uneven surface and twisting your ankle
• Motor vehicle accidents—lower leg trauma with rotational forces
• High-impact activities—running on uneven terrain

The rotation forces fracture the fibula high up near the knee while simultaneously disrupting the ankle's syndesmotic ligaments. Because the pain is often perceived at the ankle, the injury site near the knee is overlooked.

Symptoms: Why They're Confusing

Maisonneuve fractures present with deceptive symptom patterns:

• Ankle pain and swelling—mimicking a standard ankle sprain
• Knee pain and swelling—which doctors might attribute to a separate injury
• Difficulty bearing weight—your entire leg feels unstable
• Persistent symptoms—pain and swelling don't improve with typical ankle sprain treatment
• Feeling of instability—your ankle feels loose or unreliable, even after supposed "recovery"
• Radiating discomfort—pain along the inside of the leg between ankle and knee

Many patients spend weeks treating what they think is an ankle sprain, growing increasingly frustrated when healing plateaus and standard interventions fail.

Diagnosis: Why These Injuries Are Missed

The challenge with Maisonneuve fractures is that imaging the ankle alone misses the fibular fracture near the knee. At CFFAI's Lake Mary (Waymont and MedPlex) and Downtown Orlando / SODO locations, Dr. People also drive in from Sanford, Altamonte, and Longwood — we do not have offices in those towns. Robert Hoover uses comprehensive diagnostic protocols:

Complete Physical Examination

We examine your entire lower leg—not just the ankle—looking for tenderness, swelling, and instability along the fibula from knee to ankle.

Proper Imaging

• Ankle X-rays—may show syndesmotic widening even without obvious fibular fracture at the ankle
• Full leg X-rays or knee X-rays—essential to visualize the fibular fracture near the knee
• CT imaging—provides detailed views of complex fracture patterns
• MRI—shows soft tissue damage and syndesmotic injury

Critical point: If your initial ankle X-rays were normal but your pain persists, insist on imaging of the entire lower leg, particularly around the knee.

Treatment: Why Standard Ankle Care Fails

Standard ankle sprain treatment—rest, ice, compression, elevation (RICE), and then progressive physical therapy—fails for Maisonneuve fractures because the fibular fracture requires immobilization and protected weight-bearing.

Conservative Management

For non-displaced fractures without significant syndesmotic injury:

• Immobilization—boot or walking cast for 6–8 weeks
• Protected weight-bearing—graduated progression based on healing
• Physical therapy—focusing on ankle stability, proprioception, and strength restoration
• Follow-up imaging—ensuring proper healing alignment

Surgical Intervention

For displaced fractures, significant syndesmotic disruption, or unstable injuries:

• Fibular fracture fixation—using plates, screws, or intramedullary rods
• Syndesmotic repair—restoring the ankle's structural integrity
• Post-operative rehabilitation—structured physical therapy for optimal functional recovery

Dr. Robert Hoover performs these surgical repairs, guiding patients through careful rehabilitation to restore full ankle stability and function.

Prevention: Protecting Your Ankle

While you can't prevent all traumatic injuries, you can reduce your risk:

• Proper footwear—wearing supportive athletic shoes during activity
• Ankle strengthening—exercises and proprioceptive training to build stability
• Gradual progression—increasing activity intensity slowly to allow tissues to adapt
• Environmental awareness—watching for hazards on uneven ground or athletic surfaces

When to Seek Immediate Care

After any significant ankle injury, especially if you heard a "pop," experienced immediate severe pain, or can't bear weight, seek immediate evaluation. If initial imaging was normal but your pain persists beyond 2 weeks, request comprehensive lower leg imaging.

Central Florida Care You Can Trust

At Central Florida Foot & Ankle Institute, Dr. Robert Hoover and our team recognize that ankle injuries are complex and require complete evaluation. If you've had an ankle injury and your symptoms haven't resolved, let's ensure nothing was missed.

Call (407) 307-0006 or book at https://floridafai.intakeq.com/booking today. Proper diagnosis is the first step to proper healing.

Related reading

• CT Scans for Foot and Ankle Problems — When You Need One in Orlando
• Foot Pain Relief in Lake Mary, FL – Expert Treatment & Solutions
• Meet the Physicians of Central Florida Foot & Ankle Institute — Family, Expertise, and a Community-First Approach
• Orlando Foot and Ankle Care — Why Patients Choose CFFAI