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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  • 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.

  • Ethan

    Hey guys I rolled my ankle outwards last night why’ll exercising and heard a loud rip/crunch sound another two people spectating also heard being an amateur athlete I’m very worried how long this will take to heal and how long I’ll be out for its painful to walk on but I can do it if needed but very painful I’m suspecting a high ankle sprain but am unsure any advice or help ? Thanks

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

      You should have it checked to see if it needs x-rays. Different sprains take varying times to heal depending partly on if one or more ligaments are pulled or torn. A typical sprain takes about 6 weeks. High ankle sprains take a lot longer.

  • nik

    for a week off and on i’ve had this pain on the top of my foot right beside my ankle, its maybe an inch away from my ankle, the pain was so severe for the first 2 days, but then for a day it didn’t hurt as long as i didn’t walk on it and since yesterday the pain has been so severe, at times i will hop around on my other foot because i can’t put any weight on this foot, and honestly it feels like someones running my ankle over, it’s slightly swollen and red, but it’s not bruised. and i highly doubt it’s a twisted ankle or a sprain since i’ve had some of those when i was a teenager and it didn’t feel anything like this. one of my friends was saying she thought it sounded like a tendon was pulled, but i’m just not sure… any advice anyone could give would be greatly appreciated.

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

      If it’s getting worse, it’s time you had it checked out. That way you’ll better know what to do for it. It could even be cracked bone. They can rarely happen with no known trauma. If it were to be tendonitis, usually a heating pad, moderate heat, for 20 minutes several times a day and ibuprofen or naproxen might help. But, if it hurts to bear weight, use crutches or a cane until you have it checked out.

  • basketball star

    Hi i am Talor 7th grade basketball player , i have had ankle problems since 6th grade and every time we play it swells up so big and purplish but i just thought it came with the sport . What should i do ?

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

      Have the coach and your parents check it out. You probably should see a doctor before you continue to play.

  • Anonymous

    While running cross-country I twisted my ankle. It did not feel like anything ripped, although a dull pain began on the outside of my ankle. When I arrived home, I tried to stabilize it with an Ace bandage/brace. However, about four days later, it now hurts with sharp pains when I put pressure on it, and a dull pain is always there. Could this be a minor sprain, a pulled ligament/tendon…?

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

      It could be any of the above. Any sprain is going to hurt when applying pressure to the injured area. Most sprains take about 4-6 weeks to heal. Continuing to run on it will usually prolong the healing time. Be sure someone, at least a coach or trainer, checks it out.

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

        By the way, that’s what a sprain is–a pulled or, sometimes torn, ligament or tendon.

  • Lauren

    The other day I was on the trampoline and landed on my ankle and so after that it was pretty sore.and a couple of days ago(after all ready not putting any weight on it) I kept missing my step and twisting it! Now it is all bruised and swollen. I can’t bend it and it’s hurts like there is no tomorrow!

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

      Sounds like you should have it checked out to see if it needs an x-ray.