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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  • lexy holiday

    My ankle has been hurting for a while. Its not very easy to use it by walking or running and do gymnastics so I think thats apart of the problem hut I have never had anything broken and this is the worse pain yet I just dont know if it is or not.

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

      You should have it checked to see if you need an x-ray. Tiny cracks do happen.

  • lexy holiday

    My ankle has been hurting for a while. Its not very easy to use it by walking or running and do gymnastics so I think thats apart of the problem hut I have never had anything broken and this is the worse pain yet I just dont know if it is or not.

  • lexy holiday

    My ankle has been hurting for a while. Its not very easy to use it by walking or running and do gymnastics so I think thats apart of the problem hut I have never had anything broken and this is the worse pain yet I just dont know if it is or not.

  • Jarrad

    Hi I’m a 28 year old male who has a very sore ankle from a trailer running over my ankle quite a few years ago and really sore.

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

      Could be post traumatic arthritis. Sounds like you should have it rechecked. If it’s arthritis, ibuprofen might help.

  • Hailey

    So i have injured my ankle before and its peremantly messed up because of the injury, I just thought it was a sprain, so of course i did what i knew to do, but it never got better so i went to see speacilist and it turned out i cracked my growth plate and they casted me.Months after i got the cast off my ankle still wasnt healed they did an MRI which showed nothing was wrong. till this day i have had pain, but a few days ago i tripped over a metal chain and within minutes my ankle was huge and badly bruised with a lot of popped veins. I can barley bare weight on it, what should I do!

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

      i err on the safe side and see a doctor.

  • joehimes

    I went to the dr an it was all swelled up an they said it didn’t look broken but been a week an still can’t use it

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

      I’d check back them. Sometimes tiny fractures don’t show up initially but will a week later. On the other hand, it does usually take a good week for most sprains to heal

      • joehimes

        Ok thanks

  • Madi

    well I play soccer and I was playing goalie during practice because I team took turns so it was my turn and I thought my coach said no hands so I used my feet I kicked the ball at the same time as the girl I missed and she did to and she kicked my at full power into the ankle and its blue and purple and black and has a yellow dot in the middle I would send a picture but its hard to when your laptop cant take one. lol hope its not broken soccer season is about to start.

  • Cjuan

    10 days ago I fell off a horse and my ankle swelled up, I didn’t think anything of it and carried on riding and limping around with the help of friends through the pain and relying on painkillers which didn’t have much effect. It’s very painful to touch just around the ankle bone but the swelling has now almost gone. However, for the last 3-4 days I have had a tingling or numbness in my toes on the affected foot. As the swelling has gone I didn’t think it can be broken but it’s still very sore and the numb toes are a concern. Is it worth going to the doctor to have it checked? Any advice welcome. Thanks!

    • Cjuan

      I should also add that I was on vacation in Bosnia at the time of injury and due to the distance from the hospital and what I considered to be a non serious injury, my hosts took me to see a local woman who pulled my foot so as to realign my ankle. She bandaged it with a mixture of egg whites and alcohol. It sounds crazy I know but she advised it would take around 16 days to heal fully… Just thought this may also be relevant!

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

        Worries would be, if it still hurts to bear weight, if the circulation is not good (mottled, cold, or darker colored toes compared to the other foot), definite numbness compared to the other foot when scratched with something like a pin, or getting worse. Even without those, if you have concerns, or the symptoms are not getting progressively better, you should see a doctor.

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  • madison

    i’m big into horse riding and today i fell and a few hours later i have this SHARP PAIN and now my ankle has been hurting for 6 hours and i can’t walk

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

      If you can’t walk, you should have it checked out.