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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  • Georgia

    I was dancing this morning and was doing a jump where both feet touch one after another in the air. I did it on the right and then did it on the left I slipped and came crashing down and Hurd 3 loud cracks. I can’t walk on it or put any pressure on it. It is swollen and very bruised and three bumbs have come up on my foot. Do you think this is ligament damage or possibly a break, I’m in agony.

  • jhobert99

    About 3 days ago I was playing football, and I faked left to go right and my ankle rolled and I heard and felt the cracking in my ankle. I stayed down for a minute or two and then hobbled over to the sideline. I thought it was okay so I decided to stand off to the side to watch the rest of the game. However as I stood there and limped around it got significantly worse, and in the minutes time I could barely take 2 steps without falling… should I go see a doctor bc theres consistent pain, swelling, and a throbbing sensation, not to mention it’s tender to the touch. Or is it just a bad sprain?

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

      I’d have your coach and parents check it first.

  • Gareth

    I was playing football with friends and I jumped up and landed in a hole and rolled over my ankle. It hurts to walk and touch it. It is not swelling a lot and no discoloration. Should I go to a doctor.

  • viro

    I anklev. Twisted rotationally downward from side. I heard 2 poping sound first the pain was unbearible bt after few seconds it was ok. Bt after some rest. When i walk …i cant. At last it sweels very large and if i press the bone it hurts …bt after a pain killer and a bandage. After 12 hours. Some of sweeling reduced. … M confused is it broken or sprained

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

      Who knows for sure without an exam and possibly an x-ray. Both sprains and fractures can pop, hurt, and swell. It’s better to be safe than sorry so use a cane or crutches if it hurts to walk on it. The initial treatment for either is RICES http://www.thesurvivaldoctor.com/2013/02/28/rice-for-injuries/

  • Michelle Blue

    I slipped off rv steps last Saturday and when I got up to try and walk I hard a loud pop then feel to the floor I have been to the er twice now the night it happened and then in Monday they said it’s just sprained but I feel that’s not true the pain has gotten worse and now my whole ankle is bruised looks deformed and I can’t put any weight on it and I get a burning feeling and it goes numb they gave me an air cast but after a few hours if having it on it hurts my ankle from the swollen but I keep it on if I try to move my ankle at all I get a sharp pain that goes up my leg I am worried I did something not just sprained it please help me my Dr wants me to wait 4 weeks to see if it gets better before a follow up i can’t wait anymore this pain in unbearable and i have rods pins and screws my back this is more painful then that I also have Nerofibromitosis

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

      Sprains can give you all the symptoms of a break including pain with movement, but if the pain is unbearable and you tried otc meds, and RICE, you could all the doctor back and tell him you have to do something for severe pain or seek a second opinion.

  • Summersingh

    I was running with my slippers and suddenly fell down..I heard a pop falling down,I felt sharp pain in my leg (ankle region) ..I walked for some distance and literally crawled on the stairs..The pain was too much at that time,I put some pain relief gel and slept.I stayed at home and couldnt put the hurt ankle on floor..next day I felt better and went to school,Pain was not that bad..I thought It started healing..I put some gels and took some tablets that the doctor advised
    Its been over a month now and I still feel pain sometimes when i stand up ..or walking (sometimes) and when i run my ankle feels like its broken in two pieces and the 2 bones are laying pressure on the base of my foot.
    Please help me with this..I am 17 and my parents are not taking me seriously m

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

      Well, sprains can about 6 weeks to 2 months to heal and it sounds like it’s already better. Oh, and I would never go against parents unless it’s abuse. Perhaps you could have your school nurse or one of the coaches check it and see what they think.

  • Jaden

    I just woke up and my foot hurts bad and every time I walk my foots hurt so bad that I can’t walk on it but I moved my foot in circles and I hear a pop but it hurts at the same time

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

      Sounds like you need to have it checked out. Three things come to mind. Gout, a stress fracture, or arthritis. Please let me know what they find.

  • Izzy HK

    I dunno if i sprained or broke my ankle but last night I tripped and sacked my ankle and foot into the bed and I cant walk at all.

    I heard a big crack noise and i was crying for 3 and a half hours non stop. I’m going to hospital now.

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

      Please let us know what they find.

  • nancy

    About two weeks ago my ankle started to hurt minor swelling but now it stings and hurts when I put my feet up

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

      Sorry to hear that, Nancy. If it’s getting worse and you don’t know why perhaps you should have it checked.

  • halle

    ok thats dissapointing, but thank you so much, im doing pysical therapy after i get my boot off. thank you again