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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  • Betty

    Like a year ago I injured my ankl then I left it alone and I couldn’t walk when I injured it now it’s been one year since it was injured and my mom said nothing’s wrong it hurts sometime and mostly what should I do?? And I’m 13

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

      Betty, many injuries hurt off and on for a long time and there’s not much to do. But if it’s bothering you a lot such as keeping you awake at night or makes you limp, or if it’s swelling, you might get the school nurse or coach to check it.

  • Neely

    A couple days a go I fell down the stairs and my ankle twisted outward and a big pop happened it hurts to walk on it and to move it. My parents think that I am faking the injury because I always get hurt. I have kept my ankle brace on it and it seems like the ankle that I hurt the leg is a bit discolored. My parents wont tale me to the doctor so what should I do. – Neely

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

      Make sure your parents check it. You could have a school nurse check it also, or a coach maybe.

  • Jasmyne Williams

    I JUST NOW sprained my ankle, I feel like i want to walk on it and i heard a pop. If i touch it it hurts alittle but im not in excruciating pain.. Can i still walk on it?

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

      In general if something is injured don’t do activities that make the pain worse. At least within the first day or two or until you’ve had it checked and given the ok. It’s the first rule of RICE.
      http://www.thesurvivaldoctor.com/2013/02/28/rice-for-injuries/ As with most medical advice, this has exceptions since every injury is different. So it’s more of judgment call depending on how much it hurts and how bad you think the injury was. Certainly a few steps is not going to make a difference unless the bone is badly broken.

  • amy

    I broke my ankle 2 weeks ago had a cast put on for 2 weeks took it off Monday Dr put me in walking boot still on crutches .and its still hurting and swollen pretty bad ..

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

      Amy, when you break a bone, you damage the tendons and ligaments also. In some part, the extent of that damage can make the swelling and pain worse. Elevating it when you’re sitting might help the swelling.

  • Mikaela Glass

    I’m In track and my ankle has been hurting all week. I was playing with my dogs in our yard and stepped in a pit and fell. It hurts like a mother… im just not gonna finish that. But I can’t walk at all on it. I’m 13 and my parents REFUSE to take me to the doctor. It hurts really bad, what should I do ? Please respond ASAP.

  • Bushra aden

    My ankle popped out while I was playing football then the physio popper it back in I’ve used the rice method but the pain in too much .. it hurts when I put any pressure or even try to move it

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

      No weight bearing until you see a doctor.

  • Marissa

    Tonight I landed on my ankle sideways and it popped really loud it isn’t swollen but it hurts to walk on it or move it to the left. What’s wrong?

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

      If it hurts to walk on it, have it checked.

  • jake

    It was in the tarsals

  • jake

    Hello i have flipped a utv and it landed on my leg there is swelling and it have been for maybe a month and it now does not hurt at all but the swealing is still here and a couple of bruises and when i touch it its tender but it does not hurt.

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

      And you didn’t get it checked?

  • kmengedoht

    my daughter was doing cartwheels in the living room and her ankle hit the door knob on the way down.. its swelling and she tried to walk on it but too painful, should I take her to the ER?

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

      That’s your call. Certainly it needs to be checked if the symptoms don’t subside quickly. Your regular doctor or going to an urgent care clinic are other options. Meantime, no weight bearing if it hurts (crutches?) and RICE. http://www.thesurvivaldoctor.com/2013/02/28/rice-for-injuries/

      • kmengedoht

        Thank you