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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  • Josh

    I was jumping on a trampoline, and my right foot came down sideways. It’s swollen, and its immediate pain when i try to walk on it.

  • graham

    i rolled my ankle skateboarding down stairs and i didnt hear a popping sound or anything as my skateboard also hit the ground at the same time. the tendons and ligaments on the left side hurt when i push my ankle the same way i rolled it. its been 2 months now and theres still some really bad pain when i skateboard and use my foot to flick my board.(only sometimes it hurts though) and in the bottom right half of my foot it feels like something is dislodged, it feel like i need to crack my ankle but it cracks and the feeling doesnt go away, should i go to the doctor or am i ok as the pain in my ligaments has gone away. id say its at 90% after a month and a half to 2 months

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

      I’d have it checked out if I were you.

  • Rhys Harbottle

    I was playing football (soccer you may call it) over a week ago. I was running full speed and my left ankle suddenly twisted and I heard a pop. The pain eas bad at the time but I got up and played another hour of the game the pain was seeming to get better. The next day it was swolen on the inside of my left ankle. I have been applying the rice rule it has been getting a little better but I still have pain. Do you think this could be something more serious than a grade 1 sprain?

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

      It’s certainly possible. If it’s not a lot better you should have it checked out.

  • Charity

    I was playing a Volleyball game 2 days ago, and I stepped in a hole. my ankle was twisted and I fell down and stayed there while the pain faded away it took 15 minutes for the pain to go away then afterwards when I walked I limped and it was swelling it hurt . my friend suggested ice 20 minutes on 20 minutes off till the swelling went down.the swelling went down a bit but I could feel the bone When I touched it.don’t know if it’s broken or sprained?

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

      You should have it checked out if it’s still no better.

  • Damian Farias

    Hi my name is Damian. I fell off a Latter Six days ago. I went to the emergency room. Dr. Said my ankle wasn’t broken. I am in more pain now then I was when it happened. I can not put any weight on It and it’s still Swollen And Bruised. Is this normal?

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

      Bad sprains or bone bruises can hurt as badly as a break. On the other hand some breaks don’t show up on X-ray for several days. I’d see about getting it rechecked.

  • Tas Andrew Streatfield

    on Thursday I rolled my ankle at work hurt like hell swelled up right away medical team use RICE then whent to the docs and then ED for xray they showed nothing was put in a cast any way just incase as I was unable to put weight on it or anything then this morning the pain was completely gone and iam able to put weight on it and and not have it hurt but the cast is still on is this normal is it possible its not a fracture at all

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

      By cast, I’m assuming you mean splint-like cast that you could take off without cutting it off.. And that you’re to follow up with someone in a few days. Sometimes a fracture won’t show up on X-ray for a few days so they were being careful with your symptoms–I think you’d be interested in my 2 latest posts. It would be unusual for a sprain or a break to get completely well within just a few days but, with either, it’s not too unusual to be able to bear weight.

  • Teagan

    I feel down the stairs on my bunk bed and landed sideways on my ankle. I am a dancer and dance 4 days a week and I have been trying to ignore it but it has been a week now and it is still hurting to weight bear and flex my foot on the lateral malleoulus. There is only a tiny bit of swelling and is tender to touch. Could it just be muscle related? I would like to avoid a trip to the docto or physio.

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

      Sounds like you have two options–use a cane or crutches and no dancing for 3-7 days. If it’s hurting after that see a doctor, or go ahead and see one now to make sure it’s not broken and to get specific recommendations on what to do.

  • Francisco Leon

    I slipped on the lowest stair step but twisted my ankle and heared a few tiny cracks. It hurt a bit but was moveable and i was able to get up the stairs with a little support from objects. If i let my foot hang it really hurt. The next day the pain is worse. I can now only jump on 1 foot to move around. There is also a jiant bumb to my left. It feels like bone but its feels squishy beneath it and thats where it hurts. But it also hurts on the top of my ankle. This injury is on my left foot. And compare to my right, my right is much more slimmer.

  • srinivas L

    2 weeks back when i was playing football i fell down onto the ground so hard and on the very next day i came to know that my ankle got injured …. in the beginning it swollen but after i haven’t noticed any kind of that .. i am continually doing rehab exercises … walking freely , moving my feet to much extent but when i put pressure on the injured leg alone like jumping or doing situps making me suffer pain … its like the pain is gushing out at the bulged bone …. so is it necessary to consult a doctor ? or should i continue with rehab exercises ?? and is it sprain or a fracture??

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

      If it’s not getting progressively better, you should have it checked.

    • srinivas L

      right side of the bulged bone on the right leg

  • Cat

    I was rollerskating and fell onto my ankle it twisted and I heard a crack. Lot of pain now and swelling to both inside and outside of ankle. Can’t weight bear and when I got up after it I almost blacked out. I can move my ankle but restricted movement. What should I do?