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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  • Emma

    About 4 months ago I chipped my distal fibula and had a hairline fracture too. The docs put me in a boot for a month and when they rechecked it they didn’t take any X-rays just pressed on my foot to see how it felt. Now 4 months later when ever I run on the treadmill ( I run in Nike so I do t think it had to do with support) my left ankle (the one I previously injured) hurts? Could this just be because of non supported shoes or did it no heal properly?

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

      Could be either. Also, even well-healed breaks can continue to hurt. But, if it’s bothering you, have it checked out.

      • LastNameEverFirstNameGreatest

        Hey Doc, hope all is well…Is it possible for part of the ankle to be fractured, but have it bear no pain when putting weight on it? had a bad sprain and slight fracture about 6 weeks ago…RICEd it and stayed off it completely for about 6 weeks with an ankle wrap and brace..now again, there is no weight bearing pain, only slight discomfort if I attempt to run, so i dont.

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

          Possible, yes. But pretty rare in the early days of the fracture. After a week or two or three, the pain is more likely to go away.

  • Me

    I got tangled up with another girl playing basketball. I could slightly limp on it and I went to urgent care. They said I might have fractured a growth plate and sent me home with an immobilized and crutches. It was really bruised yesterday but I woke up this morning and the whole right side of my foot and ankle is almost black. It hurts really bad even when I put the immobilizer on. What do you think?

  • chyna

    3 days ago I was playing touch football and rolled my ankle 2 times. afterwards I got really bad pains and hurt to walk. I did the rice method and it went away the day after. Yesterday I was running around a little (I thought it was fine) and it didn’t hurt then. Today I cant barely walk. the pain is around my ankle and shoots up my calf about half way every time I walk. it had little swelling and little bruising.

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

      Sounds like you should have someone check it.

  • emily

    i jump over a puddle and broke my ankle

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

      I’m so sorry to hear that, Emily. Hope you’re not in too much pain. Take good care of it.

  • Sasha

    I jumped from about 2 metres and landed hard a week ago. I didn’t twist my ankle, but it hurt a lot and there is bruising on the knot on the outside of my ankle. I can still walk through the pain but it hurts, especially when I turn my foot to the left (its the right ankle). Could it be broken?

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

      It could be, or bruised. Sounds like you need to get it checked out.

  • Kiara Brotherson

    i fell down the stairs last night and landed on my ankle. I didnt hear a crack but it hurts when i walk on it. i dont know if its sprained or broken or anything.

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

      You certainly don’t always hear a crack when you break a bone.

  • Berta Lamm

    I injured my ankle hiking years ago, and had to walk 2 and a half miles back, it was huge and purple, the doctor said it was a bad sprain. That was about 12 years ago, that ankle is now weaker and I twist it or step wrong a lot, and swells easily. In fact, I twisted it last night and it is swollen and sore, but no bruising.

  • Katie

    This is what it looks like

  • Katie

    I was playing soccer a goalie sat on my foot on the side It is super swollen and purple but I can still move my foot did I break it or sprain it?

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

      Sounds like you should have someone check it.

  • chloe fryer

    today I was walking and turned quick. hurt my ankle. im in lots of pain. only slight bruising and a small swell. my mom dosent think I need to go to the doctors, im staying home from school tomorrow and possibly see the doctor
    does it sound like it may be broken I heard a crack

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

      It’s possible.