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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  • Shawna

    I was playing hide and go seek in the dark and i went to run to the safe and i steped on something but i didnt hear any noise it hurt last night but its feeling a little better.

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

      I’m glad it’s feeling better. Perhaps you should have an adult check it just in case.

  • corey

    Yesterday I jumped off my friends porch and on the way down seen his sons little pic nic table so I moved my foot not to break it and landed on my ankle.. Idk if its broke or sprain and I don’t wanna go to the E.r for them to tell me its sprain… But it is turning black and swollen almost all the way around idk wut to do.. It happen Sunday…but I have rolled and sprained my other ankle a lot but it has never been this bad… I also can’t afford to miss work… Wut should I do

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

      Corey, try an urgent care clinic. It’s cheaper than the ER and many have extended hours.

  • Jason

    I have this contusion on my ankle for a year now and it has an indent in my ankle. When I move it I can hear a loud crack I think it is broken

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

      Sounds like you should have a doctor check it out.

  • Lilah

    Today I was skateboarding and I fell off and I don’t know if my ankle is broken or not it is swollen a little less then that picture and it’s not black and blue but It hurts to move it and I CAN NOT walk on it at all or I’ll start to cry. I know I should go to the doctors to make sure but it costs a lot and we can’t be spending all that money if it’s just sprained.

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

      The only way you’re going to be able to tell is to get an exam and x-ray. Going to your regular doctor or an urgent care center will probably be your cheapest route. You can call around and ask for prices. Also you could check around and see if there are any clinics that charge a sliding scale fee based on income.

  • l

    My 2 yr old daughter fell on her ankle and Cries with any little move you does especially if ahe test to put wieght could it be broken or sprained cause its not swollen

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

      At that age, you can’t tell. Sound like she needs to be checked out and probably get an Xray. You could call her doctor or go to an Urgent Care Clinic.

  • Sam

    Last night I rolled my ankle while playing basketball. It doesn’t hurt much when you touch it but if I twist it or put bend my knee while standing it hurts. What do you think it could be?

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

      If you have doubts, have someone check it. Here’s a post on what to do, in general, for the initial treatment of sprains. http://www.thesurvivaldoctor.com/2013/02/28/rice-for-injuries/

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

      From what you describe, sounds like a sprained ankle.

  • Jenna

    I hurt my ankle last night on a trampoline and now it’s very swollen and unbearable to walk on. Do you think I should take it to a doctor if it persists to hurt?

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

      Yes, definitely.

  • http://www.kaffeezeitbakery.com/ Mara

    I’ve currently been trying to get a diagnosis for for chronic pain I’m having in multiple joints ( fingers, knuckles, pelvic area, back area) but my MRI and X-rays came back normal (No x-rays were done on my feet at this time). I woke up one morning about 2 weeks ago with both of my ankles in pain, later that day they both swelled up ( The left one was swollen on the outside of the foot, and the right one was swelling in the inner part of the foot.). I could still kind of walk on them, it just hurt. My doctor was stumped and put me on a diuretic for 5 days to reduce the swelling, but the swelling continued. About 3 nights ago, I tried rolling over in my sleep and suddenly felt a sharp pain in one of the ankles. I couldn’t put pressure on it or anything, I couldn’t even lay it on my mattress without it hurting intensely. I went to the doctor again, he game me steroid pills this time and is trying to set me up with a rheumatologist. The morning are the worst, it’s completely stiff and painful to even put any pressure on it. I wear an ankle wrap and brace during the day to try to help but it doesn’t do much as far as reducing the pain. Limping on it throughout the day seems to help me get around but I can feel it compromising my other ankle which is also swelling and in pain. Any opinion on what it can be? I’m 26 years old and have had stress fractures in both my feet before but the pain feels different.

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

      Mara, there are multiple disease that cause polyarthritis. I’m glad you’re getting it checked out by a rheumatologist. Do anti-inflammatories help?

      • http://www.kaffeezeitbakery.com/ Mara

        Not really, but the steroids seem to be helping with the pain.

  • mike

    So I just rolled my ankle playing basketball and I thought I heard it crack, I broke my other ankle 7 years ago or so hiking and had to walk two miles for help so it had swollen up to the size of a softball, but it didn’t really swell much this time, but I did ice it. Theonly part that hurts is the back of the knot of my ankle. I can put some pressure on it but I’m trying not to as it really hurts.

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

      Minimal swelling can’t tell you, for sure, how bad a sprain is, or if something’s broken.

  • Yvonne

    I was playing basketball today so i jumped and i twisted my right ankle and i heard and felt a snap. We went to the doctor right away to get it checked but they said i just sprained it so i didnt have to get an xray. I can put pressure on it except when i try to like roll or move it side to side, it really hurts. The doctor told me to elevate it and put ice on it but it still hurts. It’s not swollen or anything. And now, im really not sure if its broken or i just sprained it.

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

      Many times, it’s hard to tell. I always think it’s good to get a followup exam, about a week after the injury, if an injury is not getting a lot better.