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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  • Sonia

    I twisted my ankle two days ago, I was wearing heels and the sidewalk was uneven so i twisted my right ankle and feel. It was fine at the moment, i felt a little pain when it happened but was pretty much pain free for that day and the next. However, the 3rd day it starting hurting really bad, kept me up all night,it hurts even when im not walking on it and even more when i do. When i look at it, i can’t see anything majorly swollen any where. what could it possible be, did it get worse cause i’ve been walking on it? It wasn’t this bad when it first happened. The pain i mainly around my Achilles toward my inner ankle. should i go get it checked out? i just dont think its broken or anything and i dont want to go to the doc and get it x rayed if its not necessary. Thanks!

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

      Sonia, sounds like you need to get it checked to make sure.

  • Bojana

    I fell down my friend’s driveway yesterday afternoon and twisted my ankle it’s swollen and hurts a lot I can’t stand on it as it hurts too much. I iced it tried to keep it elevated what else should I do? I didn’t hear a pop around it happened but I’m worried I did some bad damage to it.

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

      Sounds like you should have it checked and, possibly, X-rayed.

      • Bojana

        Thank you

  • Laura

    I had jumped to get on my trampoline and hit my ankel on the outer poll, I dont have medical ormoney to see a doctor though. Its swolln and i have constant pain from it.

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

      Laura, my RICE post might be of interest, and don’t bear any weight you can’t do without pain. But if it doesn’t get better quickly, you’ll need to see a doctor.

      • Laura

        So more then likely I sprained it but if I take care of it the right way I shouldn’t have to see a doctor?

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

          Laura, without an exam, I couldn’t say. All I can offer you is the general info in the post.

  • Aisa

    Earlier today I fell down the steps and heard loud cracks/pops . First it only hurt a little so I put some ice on it then it stopped hurting. Now it hurts really badly and it’s hurts when I walk or try to bend it.

  • Kala

    On the 8.04.14 i went over on my ankle pretty badly and it reduced me to tears there was instant swelling and i could hardly walk after it my friends had to help me, when it occurred i heard a crack or a click and a week later it is still giving me bother i am unable to walk normally without discomfort. There is bruising and it’s still swollen and i think it’s starting to hurt more but that may be because I’ve tried to walk on it more. Do you think i should go and get it checked out at the hospital or wait a few more days?? And it hurts when i press on the actually ankle the fibula i think it’s called – the ball on the outer foot.

    Thank You,
    Any advice would be appreciated :)

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

      Kala, have it checked out. If there’s an urgent care around or a family doctor it would be a lot cheaper.

      • Kala

        Thank You. I live in the UK so Health care is free, on the NHS

  • Caitlin

    I was walking down the street and stepped off the curb, my ankle went sideways and I heard a loud pop. I came home and had it off and on in ice water. It seemed to tone down the swelling, and I can put full pressure on it. My only complaint is I can’t seem to turn it as far as my other foot. Also the bruising is a little off putting. Could I have broken something or put something out of place? Its a bruise going from my pinky toe all the way to the end of my foot and curving around the ball on the side of the foot.

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

      Injuries like that can be anything from a break to a sprain. You can see my posts for hints but if you have concerns, see a doctor to make sure.

  • makayla

    I was long boarding and I turned my.foot wrong and I heard 3 pops and it hurts when I touch it and when I put weight on it

  • kim

    I am 11 and my ankle makes this loud popping sound and yesterday I fell on my ankle the right and the left and I am always having pain on it and doctor’s always say u just pulled a tendon and I really think its something different. Like 6 month ago I sprained it but it still hurts and its worse.

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

      Pops are not necessarily bad especially if it’s a painless pop. If your ankles hurt you should tell your parents.

  • Cierra

    My ankle has been swelled for about 5 days now. I can walk on it but it hurts to. The pain isn’t as bad as it was on the first 2 days. Any ideas of what i might of done with it?

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

      Cierra, no. You’ll have to figure that out, or go to the doctor and have it checked. You could have injured it, have some arthritis in it. Really, there’s no way I could tell.

  • Angie

    About 8 months ago I was playing soccer and in an attempt to keep the ball inbounds I rolled, twisted and landed on my ankle. I crawled off to the side, as I was unable to walk. A few days later I could somewhat walk, I would hold my ankle in the air and step directly down so as to not move it in any direction. It slowly got less swollen and painful. I never went to the doctor. It still occasionally swells up and becomes uncomfortable. I had a rugby game last week and after the game my foot was numb, my ankle was very swollen, and painful. Is it worth going to the doctor now, 8 months later? i thought it was better.

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

      Angie, yes. You should go.