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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  • Shannon Kane

    i was playing soccer and rolled my ankle and heard a cracking noise and fell i cant walk on it or put pressure i cant move it it is not bruised or swollen but it kills .

  • Susan McGowan

    My foot got caught between 2 boards and I kinda fell to the side. My foot hurts to put any weight on it. I have to limp a lot and sometimes it shouts pain up my leg when I am limping. It has been 2 days and is still hurting pretty bad. I used ice on it. Could this be a slight fracture or just a sprain.?

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

      Could it be a fracture? Yes. If you have doubts, have it checked out.

  • Rae

    Yesterday while I was playing softball, i slid too early into third base and my ankle twisted about 350 degrees and popped. My parents won’t take me to the doctor because they think its just a sprain but its very swollen, it looks like the picture up top and my ankle is sideways/crooked. Should i keep bugging my parents about taking me to the doctor or are they right?

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

      Parents usually know best. If it’s not starting to get better in a few days they might reconsider. But do remember sprains can take several weeks to heal but it should be progressively getting better. Also remember RICES http://www.thesurvivaldoctor.com/2013/02/28/rice-for-injuries/

  • Natasha

    I have a few questions i fell down a day before mothers day on my foot and ankle it is hard to walk on it. Its hurts bad to walk on it. It feels like i have two bones rubbing together. What do you think it is? I went to the doctor he told me to buy a air cast but didn’t tell me how long to wear it or when i can walk on it. I still have a lot of pain in my foot and ankle now. Do you think i broke it or what? It is not better then it was when i went to the doctor. Help not sure what to do. Thanks

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

      Natasha, Different injuries will take different times to heal. If it is no better you should have it checked again within the next few days. In general, with most injuries, you can start walking within 1-7 days using crutches or a cane if needed. But, again, if it’s no better, have it rechecked or, at least, call your doctor and time him/her.

  • Thres

    hi i fell off thebeam at the playground last week on friday and myankle is brusied imy ankel and i wear flip flops to check on it and i would like to avoid a trip to the doctor and i’m only 9 i do not want surgury i am so young i had surgury on my nose and ears when i was a baby

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

      It doesn’t sound like you need surgery on your ankle but be sure to let your parents know what happened so they can check it and make sure it doesn’t need any other kind of treatment.

  • Haley

    A few days ago I rolled my ankle by running down the stairs an at the bottom of the stairs their was a tennis ball that I rolled it on. Today I was doing the mile and I tripped (i know I’m a klutz) anyway it Swelled up. I have broken and sprained my ankle before and this feels like a break. My mom is setting up a doctors appointment for tomorrow after school and is making me walk around during school because she thinks I’m babying it. What do I do about school tomorrow (by the way it’s an activity’s day and only a half day Below are pictures

  • Taylor Shipman

    Tonight I just got a call from a business saying I got a job and when I got off the phone I was excited and began to jump up and down and on lyrics left ankle I came down and I landed on it sideways and I heard a pop and ever since it has been hurting. I can walk on it but it’s sore and right below the ankle bone, where it kind of pops out a little, is swollen and when I mash on it it hurts…. I need some help….. idk what to do and I need to go to this job tomorrow.

  • Thres

    my ankle is brusied and really hurts. should i see a doctor to tell if it is broken

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

      Sounds like it to me.

  • Julie

    I tripped over a Chinese rug which I have had for 24 years and it has never happened before and to this day I still don’t know how I managed to to it, but hey, I have done it and I was sober. The pain was unbearable and if I hadn’t been lying down I would have passed out. It started to swell straight away and after staying on the floor for about five minutes I checked to see if I could move my foot and I could. I went to bed straight away and put a crepe bandage round it and raised the foot. The next day it looked like a barrage balloon. There was no shape to the foot at all apart from it looking like a huge sausage. For the following week I kept off it, putting it in cold water every two hours. It felt stiff but I could move my toes. It took nearly a week for the bruising to come out round the heel and along the ankle side of the foot which was purple and on top of the foot towards the toes was yellow. I haven’t had much pain but it was very sore and tender along the ankle side of the foot. I went to hospital after a week and had 3 x rays and was told that it wasn’t broken but I had sprained it badly. I was told to keep off it for a further two weeks and continue to do what I had been doing. They strapped it up tight like a drum forcing my foot towards my leg and I was told to keep the bandage on for three days and I did. It has now been four weeks and the bruising is still there but dramatically reduced and the swelling has gone way down. I haven’t put any weight on it yet although I slipped and landed on my foot and it felt like pins and needles and sore. I am now in a position where I don’t know what to do. Leave it before putting any weight on it until the bruising and swelling goes. At night sometimes I get a burning sensation in the heel of my foot while I am in bed and it is tender along the edge of my foot on the ankle side. I don’t want to do more damage than good by putting my weight on it prematurely, if it is best to let the last bit of swelling go. I can move my foot and I do rotating exercises twice a day and clench my toes which are less stiff now, but that is as far as I have gone. I have a whirlpool bath and everyday I put the jets on to give it some hydro therapy. What little swelling I have is round the ankle and it is puffy just before my toes. When I am upright my toes don’t swell anywhere near as bad as the first three weeks. My foot still doesn’t look like my foot so it has some way to go. Any advice would be greatly appreciated! Thank you Julie

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

      In general, you should be able to put weight on your foot after 4 weeks if it’s a simple sprain. Again, in general, sprains take 4-8 weeks to heal. But some sprains are worse than others and may cause complete tears in ligaments. It would seem time to have your ankle rechecked–by your regular doctor, an urgent care clinic, or an orthopedist–to see if they think it just needs more time (maybe with some physical therapy) or something like an MRI to rule out the tears or other damage that might not be seen on regular x-rays.

  • Nell

    I was running in the rain barefoot yesterday (stupid, right?) and then slipped and heard a crack and I screamed so bad. I couldn’t move it and i was carried inside and fell asleep. I woke up later and it was sore. My dad kept saying it was sprained but I just had this feeling it was broke. My foot looks exactly like the one in the picture above with that huge bump on the ankle area. I can’t even walk and i can’t move the foot upwards or sideways. I went asleep and woke up the next day (today) and I can see more veins and it’s turning purple. The only thing I can move are the toes. I am scared that if I go to the doctor, they will do surgery. I honestly would prefer a cast and crunches. I also have stairs which is going to be hard. If I go to the doctor, will they do surgery because I am only 12 and not like any bones are sticking out of my skin. Thanks.

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

      the person in the photo has a sprain. Not a break. Unless your ankle was broken really bad and probably involving both bones, it’s likely you’d get a cast for a break and not surgery.