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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  • 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.

  • Brittany

    My fiancee recently twisted his ankle and fell (kinda like getting your foot stuck in a hole and you end up twisting it as you fell). He can walk, but it hurts a lot. Now there’s a crease above the joint in his ankle which causes him pain (on a scale of 1-10, he said it would be 7 and enough pain to punch who ever touches it in the face). We’ve kept it wrapped up, but he stopped wearing the wrap due to being in pain and discomfort. We can’t exactly go to the hospital because we don’t exactly know if its broken or not and can’t afford to be wrong. If that’s enough information, please let us know if you believe its broken or not. Thank you for your help.

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

      Britanny, he needs to have it checked. It would be cheaper and more convenient for him to go to an urgent care clinic. Or, talk to his regular doctor if he has one.

  • Elvis Presley

    I did ice-climbing on a glacier in Alaska last week, and endured significant physical exertion during which I may have definitely put lot of strain on my ankle. However I was fine the same day and for 4 days after that. The fifth day, I woke up with severe pain and swelling in my left ankle (on the outside), there was some swelling on the inside and on the top as well. The day I had pain and swelling I was unable to put any weight on the bad leg, and could not even stand on both feet. However after 2 days of RICE and crutches, I am now able to stand on both feet, and limp to take a few steps as well. Since the 3rd rule mentions any weight immediately after the injury, does this possibly indicate a broken ankle? I am seeing slow improvement every day so I would like to think it is a sprain, but I want to make sure if it is recommended that I should see a doctor and get x-rays?

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

      Slow improvement every day is a good sign. However, it doesn’t sound like you’re able to put much weight on it without significant pain. It’s always up to you, but I’d have it checked out. Meanwhile, don’t force the weight bearing. If it hurts, use crutches.

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

    Perhaps, you could see your doctor or go to an urgent care clinic and get an exam. After that the doctor and you could go over the risks of getting an X-ray vs not getting it.