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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  • Dani

    i was playing soccer and i got kicked, i landed on my ankle and couldn’t walk a few days have passed and it still hurts.
    i also had a game today and i got kicked it hurts more and i don’t know what to do

  • Aleksy Andrzej Milkowski

    2 days ago, I was playing and soccer and I tried to block a shot, and unfortunately my ankle got twisted and I heard a loud noise, there was pain, it went away after 15-20 minutes while I was laying on the field. I could put any weight on the ankle. It didn’t get swollen, maybe just a little but the swelling went away quickly. I dont have any bruise. Do you think this could be a sprain or a broken ankle?

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

      If I’m understanding correctly, you’re really not having any problems with it at present. If that’s the case, I’m not sure why you think something is wrong. If, however, you meant to write you couldn’t put any weight on it, and weight is still bothering it, you should have it checked out.

      • Aleksy Andrzej Milkowski

        I meant to say that I couldn’t any weight, now I can just a little, I can stand but I can’t walk. Also Sinus tarsi feels tender and it hurts upon pressing on it. When I try to walk the inside of my foot under the ankle hurts.

  • veronica de leon

    I rolled my ankle 7 weeks ago and till now I’m not sure what’s wrong with it. I can slowly feel getting better but it still hurts. 3 days after my injury I went to the ER because it hurt so bad and it was severely swollen and purple :(. They took x-ray s but they saw no significant fracture but they said I might still have a fracture because they see something on the inside of my ankle, to follow up with my doc. I did and she said firmly I had a fracture but she referred me to the foot doc. Went to see him 2 weeks later, he did x rays but he saw no fracture or at least any that he could see :(.. order a bone scan but now I’m playing the waiting game because 4 weeks have passed and still no call from him ughh this is so frustrating. Any feed back?

  • Manny

    I rolled my ankle in a football game last night and had to come out and couldn’t return to the game. I cannot put pressure on it and the doctor said it is just soft tissue damage he sent me to get an x-ray and I am waiting for the results if it isn’t fractured or broken what could it be? I cant walk on it at all and I can only hop on my other foot

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

      If it’s not fractured, it’s probably a bad sprain.

  • Drew

    Last night I was playin backyard football and stepped off in a whole with my right foot and the left side is swollen real bad and the left side slightly the right side doesn’t hurt when I touch it but the left one does slightly is it broken?

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

      Drew, there’s no way I could tell without an exam and possibly and x-ray. You should have checked out. Meantime, remember RICE

  • Esther

    Today, my foot and ankle started to hurt very badly. I could barley walk. It hurts if I put any pressure on it, and even if I don’t. Im not sure if it’s broken or just a sprain. And I don’t know how it happened. PL help me Dr. James Hubbbard

  • Bella

    I hurt my ankle and it REALLY hurts everytime i move it there is cracking James do you think it is Broken or Sprained? It really hurts when i walk on it. I cant move it or it will start hurting!!! I was doing a Cartwheel and i kept falling

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

      Sounds like you should have it checked to see if it needs an Xray. Meantime, stay off of it.

      • Bella

        How long do i stay off it till my mom can get me to the Doctor? It still hurts a day later it still hurts. When i need to do something like walk what do i use ?

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

          For any injury, if you’re concerned there could be a break but don’t know, you don’t put weight on it if it hurts to do so. For walking, you’d need crutches or at least a cane. Putting weight on it may not harm anything, but there’s a risk it could make it worse, move the break, retwist it, etc. After it’s checked out, the instructions may change. The best thing for you is to tell your parents, have them check it, and see what they think.

          • Bella

            So far my mom thinks it is just a sprain. But, I have sprained the same ankle like 9 times this is my 10th time spraining the same ankle. So… I keep saying to myself if i did not break it this time I will break it next time. Because, I love doing cartwheels. Do stores sell x-ray things so you don’t have to go to the Doctor? I am letting my mom read the letters from you and me so I don’t have to tell her because…. When I eat I get alittle sick. I don’t know why I am only 10 years old,

          • Bella

            So far my mom thinks it is just a sprain. But, I have sprained the same ankle like 9 times this is my 10th time spraining/breaking the same ankle. So… I keep saying to myself if i did not break it this time I will break it next time. Because, I love doing cartwheels. Do stores sell x-ray things so you don’t have to go to the Doctor? I am letting my mom read the letters from you and me so I don’t have to tell her because…. When I eat I get alittle sick. I don’t know why I am only 10 years old,

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

            You can only get X-rays at an medical facility with doctor’s, nurse practitioner’s, or physician’s assistant’s orders. Stores do sell braces.

          • Bella

            Okay. Well, I really don’t want to go to the Doctor. Is there anything else I can do then do to the Doctor?

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

            Check out my RICE post

          • Bella

            Thank you for you’re help. My ankle is feeling SO much better. It turn’s out it was just a sprain. Because my mom told me when you have an broken ankle or foot or knee you can not walk. So, I know it was just a sprain. Thank you again for you help. Hope you can answer other peoples questions. Have a wonderful day.

          • Bella

            Can you give me the link?

          • Bella

            Doctor James you have been a good good help. Thank you for all your help. I just don’t want to go to the Doctor. I hate using Crutches better yet I hate even more using a cane. But, if you want me to use crutches till it is better i will try too.

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

            I give out general information for general problems. I never try to specifically diagnose or specifically treat an individual unless I’ve done an exam. In your case, you should talk everything over and come up with a plan. Sorry, but i can’t tell you what you should do or not do or what’s best for you , specifically.

          • Bella

            Thank you so much for you’re help. My ankle is now feel SO

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

            You’re welcome. Glad to hear it.

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