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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  • Sammi096

    I’m not sure if my ankle is broken but i was running the other day on uneven ground and fell it hurts when I touch it and when I put weight on it it’s also forming a bruise its kind of purple and swollen and my toes are really stiff and have that tingling feeling

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

      Have someone check it.

  • janice

    do you bruse with a sprained

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

      Not always, but many times. A sprain damages tendons, ligaments, and muscle. One of the results of the damage may be bruising.

  • zoey

    my name is Zoëy I think I sprain my ankle like when I roll it around it has pain in it I have it raped up now do you know what to do

  • ir22

    Just yesterday I missed a step and twisted my ankle, I’m in so much pain and my ankle looks exactly like the picture above. What do I do? I can still move it, but when I do it hurts. I haven’t gotten any sleep.

  • Ginger Caron

    I broke my ankle 5 years ago. I rolled my ankle a week ago. It felt so much like my previous injury, but xrays came back negative for breaks.
    My concerns are that my entire foot, ankle, heel, and toes have been bruising (changing colors and locations daily), swelling is still present, just not quite as much. I feel a lot of tenderness, and pain with any pressure at the end of my tibia and fibula. Should I be concerned, and if this pain continues should I be seen again?

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

      Muscle sprains can cause as much or more tendon, ligament, and tissue damage as breaks. As my own general rule, I’ll want to check a sprain ankle again about a week or two after the injury. If it’s not a lot better, I may re-Xray it since some breaks tend to show up more clearly then than when they initially occurred. And, just because there’s no break doesn’t mean that, sometimes, the sprain will require a splint or cast for several weeks. A few may require surgery to repair tendons or ligaments. On the other hand, almost all sprains are going to require 4-6 weeks of healing.

  • Mitchell

    I rolled the outside of my ankle while playing basketball and heard a pop sound. Could walk on it without pain the next day but it did swell and bruise. Two weeks later though I have pain on the inside ankle bone. It is now baseball season and I am a starting pitcher. I am scared to go to the doctor because I will have to sit out my senior year. I can still play on it though. Do you think it is serious or can I wait until the season is over?

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

      If you’re having trouble, you should be seen. Not going doesn’t help the problem and could make it worse, even giving you trouble in years to come. And going doesn’t mean you can’t play. Perhaps you’ll be given some exercises or a splint at the most.

  • Hailey

    My ankle hurts to move it in any direction but when I touch it, it doesn’t hurt. I’m a gymnast so if it’s broken I mightt make it worse

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

      Have someone check it. A parent or trainer. if there are concerns, see a doctor. Yes, if it were broken, no short-term limits on activity might make it worse. But, even if it’s not, if you find the reason for the pain, perhaps you can be given suggestions on how to make it go away.

  • Micaiah Mangus

    I sliped of a curp when i came home from running then i landed on it. I cant move my foot up or down, side to side. But its not swolen there is a sharp pain all around it though

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

      If it’s still hurting, have someone check it.

  • Bree

    I don’t know….. I was just laying on the couch and all of a sudden my ankle just started to hurt and if I just try to stretch it to see if the pain would go away because I usually have a pain in my right foot which goes away when I stretch it but comes back instantly but now in my left foot its kind of a sudden pain that wont go away even if I try to stretch it @drhubbard:disqus please if I don’t see your provided info please email me @[email protected] please get back to my as soon as possible remember at my email :D

  • eva

    I was walking off my porch and fell and landed on my ankle really hard and heard a pop and it hurts to move it and I can barely walk on it cuz it hurts. It’s a little swollen but not much. Any time I touch it or even put weight on it hurts really bad. It hurts to even move it around or moving my toes. Could it possibly be broke or just swallow really bad?

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

      Have someone check it.