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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  • Amanda

    I have fallen twice and both times my ankle right ankle rolled and it was exactly a year apart from each other I could not walk on it at all after it happened both times had x-rays both times and they said just really bad sprain could they possibly have misdiagnosed it for a break???? Went through PT for three months and it seemed ok but I still have discomfort at times and ankle bone still huge from rolling it twice

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

      More likely you tore some ligaments. Depending on how bad they’re torn, some may not heal completely making it easier to re-sprain your ankle. In general. other than continued strengthening exercises, sometimes surgery may be needed. If it’s giving you a lot of trouble considered getting it checked again.

  • Talia

    I play soccer and for the past week I’ve been playing it almost everyday and the outside of my left ankle where the big ball part is on my ankle it hurts. When ever I walk on it or put lots of pressure on it will hurt. the pain will go away and just come back and will start hurting. I would just like to know if your think it’s a sprain or a broken ankle

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

      Talia, there’s no way I could tell without an exam and possible x-ray. It’s more than likely irritated or bruise but it’s possible it could be broken. You can try one of two things. Either stay off of it for few days. If it hurts to put weight on it, use crutches. Or you could have someone check and see if it needs an x-ray (preferred choice).

  • Alex

    I jumped off my bed last night and landed on my ankle, I didn’t hear a popping sound so I think it is just sprained. There was only a little swelling though and no discoloration.

  • maluna

    A few years back I stepped off a curb and twisted my ankle. I didn’t have insurance, so I figured I only sprained it for falling off the curb.
    The next day it was swollen and slightly bruised on the sides. I could not stand on it as it was really painful. I ended up putting a light brace on it and using crutches for 1-3 months. It fully gained it’s strength back after 6 months. Does that sound like a sprain or a fragment?

    Now my ankle is hurting again. Could this be from my ankle not healing correctly? I started running again and that might have aggravated it

  • Porter

    No swelling or anything like that, just a little pain.

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

      Have one of the coaches or trainers check it or one of your parents to help you decide.

  • Porter

    I was just playing basketball about an hour and thirty minutes ago and I went up for a layup and landed on someone’s foot, once I landed I felt a bit of a crack. The feeling I felt was a bit of a sting and one of the coaches said to do the RICE system when I got home. That is what I am doing now but I feel a little pain. // Once I got up after I landed I was able to walk on it a little and I went back in but had to sit down because my ankle couldn’t handle it. Then about 15 mins left to go in practice I was up on it shooting a little bit and stuff, BUT I am not sure if I need to see a doctor?.

  • Jack Woodfield

    today i was playing football/soccer and my leg was in the air and a over weight person landed on it and flattened it it is hurting more and more as time goes on and there is no swelling or bruising yet what should i do

  • Lexi Parlier

    What bone is the hardest to break or sprain?

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

      Any can be broken. I suppose the pelvis or the heel of the foot but then again, with enough force, those are broken all of the time. How about the 3 bones in the middle ear?:)
      Technically bones are not sprained. The joint tendons, ligaments, or muscles that are attached to the bones are sprained. Any joints you use more–back, neck, any in the arms or legs, or more likely to cause sprains. Pelvis and ribs are less likely but not that uncommon. Yes, there are joints in the ribs and bones of the pelvis. And they do move, but very little. So for sprains, I’d say the skull and the bones in the ear.

  • Lexi

    I was at diving lessons on July 1st and I was doing tuck jumps and now my foot hurts and it has been hurting for a few days and I don’t know what to do because I don’t want to go too the doctors office because I don’t think It’s a fun place because it is scary sometimes

  • Lexi

    I have always wanted to twist my ankle.but I don’t know how:D