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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  • king

    i slid into second base and i heard a pop but it was swollen like an egg was in my ankle and was black and blue could it be sprained or broke

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

      Yes, either.

  • Marshall

    Last night while playing basketball I rolled my ankle heard and felt a pop followed by a burning/throbbing pain figured I sprained my ankle but when I took my shoe off expecting swelling but my ankle didn’t swell the only swelling and discoloration is below the ankle on my foot looks like a small ball on the side of my foot i can put a lil weight on it but not full weight I limp very badly my question ankle sprain or metatarsal fracture or something else

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

      Have someone check it.

  • Tallie

    I had a bad sprain and some tore ligaments about 4 month’s ago. It has healed after a lot of nursiring and still get a bit soar from time to time however on Sunday we were walking outside when I miss stepped and twisted it again. It is very badly swollen “worse than the last time” it is alos swollen right around not just on the side. I don’t want to go to the doc if he is just going to give me pain killers and anti inflammatory (not that its helping) cause those I can take myself, any ideas if it sounds if it may be broken?

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

      Your guess is as good as mine without someone checking it.

  • Anonymous

    my ankle down has been hurting but i dont know when it started i woke up one morning and started getting ready for school a few minutes later it started hurting and today 2 weeks later i could barely walk on it does any1 know what is wrong with my foot

  • Libby Lemon


    I broke my ankle two weeks ago, and had to have a titanium plate and 7 screws surgically placed to help it heal. I’ve accidentally stepped down on it twice since then, but otherwise I think it’s healing okay because I have virtually no pain anymore – even without the pain killers. Is this normal for it to no longer hurt? I’m kinda afraid (i.e., paranoid) that it’s numb or something because I damaged it worse when I accidentally put weight on it.

    • Libby Lemon

      I feel like it’s too good to be true that it’s already not hurting anymore LOL

  • Ashley

    Hi I tripped on some stairs and my foot hurt alittle but I went jogging anyway now I can’t put any weight on my foot but it’s not swollen could it be sprained?

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


  • Georgia

    Yesterday a hit my foot off a matal plate whilst running and the impact was very hard that it knocked me over. My foot is extremely swollen around the forefoot and im in alot of pain ive left it over night and all that has changed i a bruise had apperead a lot more than yesterday what should i do?

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

      RICE and have someone check it.

  • Julia Pasquale

    I woke up in the middle of the night because I slept on my leg wrong and it went numb. I got up to walk around a bit and I had no control over how I was walking and the next thing I know my ankle is in pain and I am unable to walk or move my ankle or foot. I cant exactly remember if I rolled it or not since I was half asleep and my leg was numb and I had no control of how I was walking but I think I rolled and sprained it. The area of my ankle is a little bruised and red and hurts when I put pressure on it. Also, whenever I try to move it around I hear a popping sound. I don’t know if this is serious enough to get checked out or if I should just use the R.I.C.E method.

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

      If it’s still hurting, have it checked out.

  • Zoe

    11 days ago in pe, we were playing badminton, and when it was the end of class, we had to put our rackets on the ground. But accidentally, my friend threw her racket, and it hit my ankle. I fell in the right side of it, like the end of the tibia bone. It was purple, and it hurt extremely bad. A week later I went to the doctor, and they said its not broken. But, it’s still so painful and it’s still purple. What confuses me is that one time in health class, my teacher said that when you sprain your ankle, you twist it or stretch it, which I didn’t do. The doctor said if it still hurts in a few days to go back, should I?

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

      Yes, I’d follow the doctor’s orders but bone bruises can also hurt for quite a while.