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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  • Shaan

    I was playing basketball today at a camp and I stepped on somebody’s foot and rolled my ankle. I heard a pop/crack noise and I couldn’t walk for the first couple of minutes. After about 10 minutes or so, I got up and I could walk with a limp pretty easily, and then I tried to walk normally and it was fine, but it still hurt when I moved it in any direction. I went to the trainer and she said it was a sprain. It is pretty swollen and it hurts when I move it in any direction. I know to use RICE, but I am still not completely sure if it is a break or a sprain. It is tender on the outside of my left foot and swollen. It is a lot harder to walk now but I can manage to limp around. Does anything hint to a break or is it certainly a sprain? Thanks

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

      That’s what this post is all about. Another sign should be if it’s not getting progressively better with time. I don’t have concrete evidence to back it up but, my experience has been that if the ankle swells quickly and a lot just after the injury, it’s more likely to be a break. On the other hand, many breaks don’t swell at all. If in doubt, see a doctor.

  • Rik Banuelos

    I sprained my ankle almost ten years ago playing basketball…..all we did was ice it and was pkaying by the end of the week….now when i play it aches and hurts sometimes when im not playing…..is it cause i broke it ten yrs ago

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

      Any past sprains or breaks can ache occasionally long after the injury. If it’s giving you a lot of problems or getting worse, you should have it checked out for things like bad arthritis or chips of bone in the joint.

  • Bianca

    Do you think I’ve broken my ankle

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

      Bianca, it’s possible but there’s no way of telling for sure without an x-ray.

  • Brianna Amador

    A few data ago i was doing handstands as i went down it twisted and I heard a loud pop at first I thought it was a sprain bit o Sony know whats really happening whitg my ankle it hurts wgen I Wall on it or put it/place it in a diffrent diretion

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

      Brianna, it’s a little hard to read your comment, but it sounds like you should have it checked out.

  • Kathan

    Hello! I do not know whether i sprained my ankle or break it, i was playing basketball 2 days before and i just fell unevenly. Initially i was not able to even walk, after 10-15 minutes i was able to walk(limping), it is been 2 days and i tried to apply ice and creme, but there is no progress. I just feel better than the day i fell. I can walk but not that much of limping either. There was no sound either. Do you think it is serious and should i consult a doctor? Should i ride bike in this condition? Thank you in advance.

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

      If it hurts to do it, don’t do it, until you have it checked out.

  • meg

    any advice?

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

      Meg, it depends on the type of break. That’s a question you should definitely ask your treating doctor. If you’re not to see her/him soon, I’d call the clinic.

  • meg

    have a broken ankle had splint now in full below knee cast, can I weight bear

  • autumn

    I hurt my ankle jumping off my pourch and fell to the ground and couldn’t get up its been a week now been resting it and icing and it still hurt to walk on it really bad what should I do??

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

      It’s been a week? You should see a doctor for a possible x-ray.

  • autumn

    I week ago I jumped of my porch and fell to the ground and then rested it and the swellen won’t go down and it hurts to walk on it I was on crouches for a couple days and wrapped it but what should I do??

  • crazzzy

    I was skateboarding. I did a trick off a 2.5 ft ledge but I landed directly on my ankle with my full weight. I didnt hear anything though. It felt like my ankle got pulled out of its socket by an inch when i landed. My foot was numb for under a minute and I couldn’t feel my toes. I couldn’t walk on it at all. About 10- 20 minutes later, the numbness returned for a while, then went away. My ankle didn’t noticeably swell until 30-60 minutes later. But I think it may have swelled on the inside at first because it really hurt. I can put SOME weight on my foot BUT only if I put weight on the ball of my foot. I know about RICE already. I think its a bad sprain but Im not sure.

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

      Your call but if it still hurts to bear weight, I’d consider having it checked out.