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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  • jessica

    i twisted my ankle at basketball a couple of days ago and heard several cracks as fell, so i went tot he doctor and got an x-ray and nothing was wrong i had just twisted it but today i was walking down the stairs and twisted my ankle again i can put a little pressure on it but not much and its pretty swollen so I’m wondering if i should go to the doctor to get it checked out again?

    • jessica

      my ankle looks like the picture so does that mean it could be broken

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

        Sounds like you should get it rechecked.

        For the other, See my comment below

  • Courtney Draker

    I fell during roller skating and twisted my ankle, it clicked so I clicked it again myself and i can wriggle my toes but its hard to move on and is very swollen I think its a sprain but could it be more?

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

      See my comment below.

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

    For the thousandth time. I am sorry but I can’t diagnose or give specific treatment without an exam. I can’t tell from my computer whether your ankle or anything else is broken. The posts give information to help you decide when expert evaluation is impossible. When at all possible, if you have concerns, have a health care provider check out your problem. Even then, it may very well take an X-ray or other testing. For injuries to the lower extremities, until other otherwise told by an expert, if you have concerns, a general rule is to keep weight off off the injured side and consider RICES(S). http://www.thesurvivaldoctor.com/2013/02/28/rice-for-injuries/

  • B_Astrid17

    My ankle is like the one in the picture, so that means it’s broken?

  • Pranav Banerjee

    I twisted my ankle last week. I took medicines preferred by Dr. and it healed a lot. But now, the swelling and the pain is still there..could it be a fracture? REALLY URGENT-


  • daniel

    i can walk but i can’t run.
    Track season is in 2 weeks

  • SMHoff

    I rolled my left ankle back on Sept 27th coming down from a rope climb (slipped, hit the bottom knot and down I went after hearing a snapping sound like a thin stick) By chance, a PT who happened to be running same OCR looked at it and was uncertain if broken or sprained, I waited a bit debating the issue and then said I wasn’t quitting. I sucked it up and finished the final 3 miles of the OCR (skipped only a couple obstacles), I felt better if I kept moving. It has taken about 8 weeks but is almost back to 100% range of motion and only a teeny bit of edema on outside of ankle bone remains. I never did have it looked at, I’m thinking it was a severe sprain though as it didn’t cause me to feel light-headed or sweat as bad as when I rolled my right ankle a couple years back (never had that looked at either and now think maybe I should have) It healed up though too with use as I saw able…guess I’m just too stubborn for my own good. If I ever do it again to either I’ll most likely get it checked though, getting too old to chance the long term consequences.

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

      Thanks for sharing.

  • Belle

    Yesterday my friend body checked me and i twisted my ankle then fell, it really hurts, however i can still walk on it (Its really painful), i dont know if its broken, fractured, or sprained, but my grandma broke her foot and didnt even know it (her foot wasnt really swollen). My foot isnt that swollen, but its really painful to point my toes, or even move it. Could it be broken? Or is it just sprained or something?

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

      There’s no way I could tell that without an exam and possibly and X-ray.

  • pam

    i twisted my ankle for the 3rd time all recently, I had a stroke 11 years ago is this anything I should be concerned about?

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

      You should have it checked out. If nothing is broken or torn, perhaps physical therapy would help.

  • Djenk

    So yesterday I tried kicking a ball as hard as I could, midway I did a long step then jumped a bit to power up the foot then suddenly I step sideways of my ankle and I immediately fall on the ground with so much pain, a few hours later the pain became much worse. I didn’t hear any popping or breaking so I think I just sprained it but I’m hoping it’s not broken.

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

      I hope it’s not too. But if you have concerns, see a doctor.