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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  • Mikki

    I bent my ankle to the right and I couldn’t walk properly some points I couldn’t walk. I went to sleep until I woke up in pain and my ankle was hurting even more without me even Moving it

  • Daksh

    Yesterday, In Physical Education (PE) I was Playing handball,When I was training,I ran as fast as I could and I jumped to throw the ball,When I landed I landed on my Left foots’ Ankle,I was hurt and thought it was gonna get better soon,So just ignored it and In the night,It became Swollen and My ankle hurt a lot so I went to the Doctor,He took the X-ray and I just had a Severe Twist,Just use the RICE Techique And visit the doctor Everything is going to be Alright

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

      Thanks for sharing.

  • hannah

    I hurt my ankle 10/11 days ago. And we got it x-rayed today and it turns out that it was broken. So I’m glad I got it checked out. So everyone else you will too. If you get it checked out. My mom and I now have peace of mind about this.

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

      Great, Hannah. Thanks for sharing.

  • Hannah

    When I was at a pumpkin patch place I saw this unusual slide and I wanted to try it out. It had a hard wooden frame with a small amount of hay at the bottom for a cushion. I climbed up and went down,but I must have landed the wrong way. Because immediately I felt this unbearable sharp aching pain and started to cry. My mom and dad helped me hop on one foot, to a place to sit. At home I used my mom’s crutches from her knee surgery. And it has now been 10 days and it is still very sore.I can bear a little weight for about 20 minutes before the pain is to bad. My mom has noticed new bruising ( at least she thinks so). And I have noticed that too. And yesterday she said that my foot changes colors when it is not elevated for a couple minutes. Should I go see a doctor or do you know if it is broken or not by what I have told you. Thanks!!!

  • annonymous

    I was practicing a back handspring in cheer and i all of a sudden i felt this awkward pop feeling, it hurt a lot before but last night(when it happened) on a scale of 1-10 the pain was like an 8 and when i walk it is excrutiating and there is a little bruising on thr ball of my ankle, and on my foot, but no swelling, and my parents think its just bruised but when i sprained my ankle over thd summer it didnt hurt as much- what do i do

  • Layla Lee

    Woke up two days ago and my ankle was hurting. Every time I step on it it gives out and it is pretty swollen. Went to the doctor and they said its very hard to tell and that they couldn’t see a completely obvious break but I was wondering your opinion. Oh and it’s shaded a little darker.

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

      I couldn’t possibly know without an exam. Did they say they couldn’t se a completely obvious break or did they say there was no break? Many times, if there’s a suspicion, you might be put on crutches and have a follow-up X-ray in about a week. Sometimes cracks don’t show up initially but will later. And, of course, if there’s still no answer, sometimes a CT or MRI is needed.

  • Leah Spatafora Blackmon

    I hope this thread is still getting answers. I rolled my ankle on Saturday (10/11/14) on a boy scout camping trip, seemed fine, I was still limping a bit, but could walk on it. Two nights ago I was setting up Halloween decorations and fell again, twisting my ankle in the process. I heard a loud POP and couldn’t move it or put weight on it for a few minutes. I’ve had it wrapped since then, and keep it elevated when I can (I work two jobs and have two kids, it’s hard to rest!). It is swollen on both sides, I can put weight on it, but only if my foot is turned sideways and I don’t bend my knee. I’ve been using crutches, which hurts other parts of my body. I guess what I’m asking is if I should go have it xrayed or not. We do not have health insurance, so I’ve been waiting because it’s hard for us to come up with the money to go to the doctor. It is swollen on both sides of the ankle, bruising on the right side, tender to the touch on both sides of ankle, but not the top nor the shin.
    Can anyone help me out?

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

      You should have it checked out either by your regular doctor or an urgent care. Call before and ask what an x-ray and exam will cost. Call around if you have choices. Some places give discounts for cash, no insurance. Even the stand alone x-ray facilities will sometimes do that. If a splint is suggested, ask how much it is. It may or may not be cheaper to buy it somewhere else. Stay on the crutches until you get checked out. When it’s thoroughly checked out, if it’s going to require further treatment ask what the options are, and what are the risks if you decline or wait.

  • meaghan marcus

    Last Sunday while running into my yard I twisted my ankle and heard it snap. What should I do?

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

      Is it painful? Has it gotten a lot better? Snaps can be anything from basically no hard to pulled muscles to tears to breaks. If it’s painful you should have it checked out

  • Kat

    I twisted my ankle about a month ago and it still hurts a bit. And then this morning I twisted it again. I can move all my toes just fine tho

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

      Moving toes tells you nothing about whether something is broken or not.

  • shelly

    I fell today twisting my ankle no swelling mild bruising and can put pressure on it but it keeps giving out on me could I have seriously injured my ankle it feels a bit funny while moving it around like things might not be in the right places

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

      Then you need to have it checked out.