Sprain or Broken Ankle? 6 Clues

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6 Clues Your Ankle is Broken, Not Sprained

6 Clues Your Ankle is Broken Not Sprainedby James Hubbard, MD, MPH

Sometimes it’s not that easy to tell a sprain from a broken ankle.

Just this past year, a seventyish-year-old woman came limping into the clinic where I was working to have her ankle checked. Seemed she had twisted it a couple of weeks before and her husband was going to keep nagging her until she came in.

The X-rays revealed a break. A pretty bad one at that. She couldn’t believe it. I don’t know if she was more upset that she was going to need a cast and crutches or she’d have to acknowledge that her husband was right.

Many people come to the clinic convinced they have a break or just as sure it’s just a sprain. Often they end up being wrong. It’s not so easy for doctors to tell either. Fortunately we have the benefit of X-rays. But what if getting an X-ray is impossible? What can tip you off that it’s a sprain or a broken ankle? And why does it matter?

Well, why it matters is easy. If it’s broken, you must be much more careful to stabilize the ankle. Make it so the ankle won’t move. And if it’s any break other than the fibula (the littler of the two leg bones), then you shouldn’t bear a lot of weight on it because, again, the bone fragments could move around, not allowing healing.

The Ottawa Ankle Rules

Years ago, some docs in Canada, trying to cut down on the amount of X-rays done for ankles (Canada must not have as many malpractice suits as we do in the U.S.), came up with a set of guidelines to tell a break from a sprain. It’s called the Ottawa Ankle Rules. The rules aren’t perfect, but many studies since have shown over and over that these guidelines can reliably predict about 95 percent of breaks. They do, however, tend to overdiagnose (predict a fracture that turns out to be a sprain).

The bad news is that studies have also shown that if nonmedical people try to use the guidelines and make predictions they’re not nearly as accurate. So don’t use these to keep from getting your injured ankle checked out when a clinic actually is available. But maybe they can help a little if there ever comes a time when you can’t get expert medical help right away.

Next, the rules.


Photo by eltpics on Flickr.

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  • we are 5sos

    i twisted my ankle when i feel down the last step of the stairs my ankle did hurt for a little bit only for 8 hours but it was swelling. they day i twisted it i also walked on it for 3 hours, but now it doesn’t hurt at all but its still swollen and its starting to bruise on the side… i don’t know what is wrong its been three days… is it sprained or broken?

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      I wouldn’t know whether it’s broken or not but do know that the more you’re up on any foot or ankle injury the more it’s going to swell. As far as the bruise, any deep injury such as to a bone, ligament, tendon or deep muscle can cause deep bleeding that comes to the surface after a few days.

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  • kitty

    I was shaking a shake weight and drooped it on my ankle. It is started to swell,and it hurts. Is it broken??

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      I have no idea. I don’t know what a shake weight weighs. Even then I would need to examine it to give a guess. I’d have someone check it if you’re worried.

  • Joshua Pawlak

    I landed unevenly on very padded surface from about 5 feet high on my left foot only. My ankle rolled to the outsideto what felt like an extreme degree and there was a loud pop that I could feel run up my leg. I could not walk on it immediately after and still can’t, about 16 hours later. there is some swelling, but not too bad, and only pain with movement/weight. there is no visible bruising. The soonest I can see my doctor is in a week, and I really can’t afford a trip to the ER. I truly do not suspect it to be broken. Can I afford to wait a week?

  • Lauren

    Hi, I was running on the soccer field yesterday and I rolled my ankle outwards away from my other foot. I was in a lot of pain but I was able to walk on it but just on my heel. I was able to finish the last four minutes of my game. When I sat on the bench I tried to move it around and stretch it out because I had thought I had maybe not stretched it enough before the game started. It still hurt pretty bad but I tried to go back in. I made it for about 6 minutes then had to leave. (Considering I have very high tolerance of pain) so when I got home it was swelling but not too badly. I wrapped it up before I went to sleep. This morning it didn’t get any better, it got even worse, I was having a lot of trouble walking on it but I did. I wore my boot that I wore two years ago from a different break (When I was six I had broken my ankle, it healed after a while. Then 7 years later (two Decembers ago) I broke my other ankle the same way I hurt it this time. Except I was on brick pavement. I went to the doctor and was in a boot for 6 weeks.) anyways, I wore the boot the whole day and walked a lot I was still in very much pain. Once I got home I took off the boot and looked at my ankle and it was very swollen. It hurts very badly and I am not really able to walk without the boot unless it’s completely on my heal and it still hurts some then. I don’t know whether it’s broken or sprained?

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Almost any ankle injury will swell a lot if you continue to walk a lot. Anyway, you should have someone check it.

  • Valerie Jones

    I have rolled my ankle yesterday and I heard a pop. Its starting to get worst and the thing is its not my ankle that hurts it my foot. Where the area hurts is where my small toe is and down. What did I do

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      In general a foot injury can be a sprain or a broken foot bone. The outside part of the foot near the little toe is a common area to break. You should see doctor for evaluation.

  • Andrea

    2 weeks ago I rolled my ankle outward, it hurt some, not that much the next day it wasn’t bothering me.(I do have a very high pain tolerance) a few days later my ankle started hurting some. We’are working 60 hour weeks, 12 hour shifts. I’m on my feet most of the shifts. The area I have to walk is uneven and at an incline. Within a few days it was hurting like #&//. I was getting some relief from aspirin. Then I had a mellow weekend and it was feeling much better. I was thinking it was gout. But the pain is right under my outer ankle and a little furher back around my Achilles tendon. It huts to point my toes and to roll my ankle for stretching. The longer I’m on my feet it starts hurting more and more. There is swelling in same area as the pain…no bruising.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Injured part don’t like activity. Being on a sore ankle all day is only going to make it more sore. In general, for a sprain, it’s usually good to immobilize it with a brace so the weak ankle doesn’t get resprained. (Remember RICE(S) http://www.thesurvivaldoctor.com/2013/02/28/rice-for-injuries/ )Ankle exercises at home might help as well. You’re best bet is to have a doctor check it and give you specific advice including possibly a prescription to limit your work load for few days..

  • Emma

    I am 13 years old. I fell of of a step and my foot went sideways. i broke my ankle 3 times last year. I have a doctors appointment tomorrow. It only hurts when i move it or flex it in any way. It hurts right on the growth plate. what do you think?

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Someone should ask you doctor why you keep breaking it such as, is it not healing properly, are you low on calcium, have you torn ligaments?

      • Emma

        I am getting my bloodwork done today to see if it is genetic

  • Stephanie bohola

    I twisted my ankle two days ago and my ankle hurts and is bruised but not swollen what should I do.

  • josh

    i twisted my ankle 3 days ago, it didnt hurt much even though it was a full roll, but now my heel hurts like f…k and i cant support my weight on it. iam used to spained ankles from basketball and it feels nothing like that. there is no swolling or colouring. what should i do?

  • Amanda

    Hello, about 10 years ago I fractured my ankle and it was never fixed. The other day I fell on it and hurt it again, but am unsure if it’s fractured again or just sprained. The outside joint is really swollen and I can’t move it up or down. It hurts quit a bit. Can you give an opinion if it sounds broken or sprained? Thank you.