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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  • Shane Rogers

    2 weeks ago I fell down the basement stairs and hurt my ankles I put ice packs on them and wrapped them with ace bandages but till this day they still hurt when I walk and when I move my feet up and down and the pain shoots from my feet up to my thighs. Does this mean something is wrong????

  • Micala C Houle

    The round circle on the outside of my right foot, right side, is moved a little bit, hurts when I walk, sit, lay down. My foot is starting to bruise in that area & I’m getting bad pain all the way up to the knee. Is it broken or a sprain? I had an X ray done last night, but the doctor looked at them for 2 seconds & said it’s fine, follow up with your orthopedic doctor. Then, he said I can see your ankle bone sticking out a little bit.

  • Taylor Joseph

    I was playing basket at camp and two days later my ankles started hurted me it was not that bad so I thought it was nothing until a couple days after it was hurting really bad it was hot and when I twisted around it kept popping…I can walk but it really hurt if I put to much pressure.what shuld I do

  • Keirstin

    I don’t know I do cheer and I did a round off and I heard a pop I got x-rays and nothing showed up and she they are acting like it’s broken but my ankle looks the exact same as the pic

  • Kyra

    last sunday i was playing soccer and i was on a break away then the goalie can out and i went to shoot but i rolled my ankle outwards then stepped on it and fell. I continued to play then had to go out because it hurt so bad, luckliy it was about the end of the game. it didnt swell right away but it hurt to lay it down flat so i had to ice it with my foot held straight up. i did rice but had a really hard time sleeping because of the pain since it hurt every way i layed it. the next day i had to go to a college visit but it was somewhat swollen so i wrapped it. i limped around the college with lots of pain and had a hard time focusing because of the pain. toward the end of the day it started hurting on the inside of my ankle as well. at the end of the day i took off the wrap it my ankle was extremely swollen and hurt so bad the car ride home especially when we hit a bump and it moved. a week later and its only a little better. it still hurts when i touch it (the bottom part of my ankle on the outside) and i still cant apply full pressure without pain. it especially hurts when i apply pressure on my inner heel. it hurts to go up on my toes and walk and it hurts when my foot is straight up and my heel moves. also some ways when i step or move it its just so sore that i jerk off it and almost fall. any idea of whats wrong or what i should do? anything will help!

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

      Sounds like it’s time to get it checked for a possible break or torn ligament. Meanwhile do remember to keep it brace and minimal walking without assistance, if it hurts to do so.

      • Kyra

        thank you!!

  • max cohen

    I was playing football yesterday with low cleats on. I caught the ball and went to cut and my left ankle twisted bad and i heard a loud snap, also my friends next to me heard it too. I went to the ground and was in alot of pain. I took off my cleat and it instantly swelled up. It is still painful to walk and move but there is no bruising. What should I do?

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

      Start with RICES

  • willow

    about an hour ago I walked out side my house and down the stairs, but I missed a step and landed on my ankle sideways, it made some cracking noises and I now cant walk on it or move my foot side to side, mum wont take me to the doctor either,help

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

      Start with RICES.

  • Dessi

    so last thursday my ankle began hurting(along with bruising on the top of it) but since i’ve always had ankle problems i just took some painkillers and ignored but then friday i was walking to my moms car and stepped on uneven ground and landed on the outerside of my foot but just shook it off and went home. This past weekend(including monday) i stayed off of incase it was sprained but yesterday i was at band camp and it started hurting again(I just pushed through it..hardly but i did it) and when i woke up this morning it hurt so much. the pain shoot through my lower ankle and into my leg and it makes a popping noise when i move it and it hurts to apply pressure to it

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

      Sounds like you should have someone at camp check it before you continue activities.

  • Jaclyn Murray

    I twisted or something my ankle last night and my whole foot is swollen up. Even my toes a little. Ive broken this foot/ankle twice before in the last 4 years. Could it be broken again? It hurts to move or to touch. I couldnt walk on it this morning. I had to slide on my butt to go to the bathroom because i couldnt walk on it. And if its laying down it hurts to pick up. Like pick up flat with my whole leg.

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

      It could be. Sounds like you might need an x-ray

  • Amanda

    I have fallen twice and both times my ankle right ankle rolled and it was exactly a year apart from each other I could not walk on it at all after it happened both times had x-rays both times and they said just really bad sprain could they possibly have misdiagnosed it for a break???? Went through PT for three months and it seemed ok but I still have discomfort at times and ankle bone still huge from rolling it twice

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

      More likely you tore some ligaments. Depending on how bad they’re torn, some may not heal completely making it easier to re-sprain your ankle. In general. other than continued strengthening exercises, sometimes surgery may be needed. If it’s giving you a lot of trouble considered getting it checked again.