Is My Ankle Sprained or Broken? How to Tell The Difference

Written by WebMD Editorial Contributors

Medically Reviewed by Jennifer Robinson, MD on April 24, 2023

• What’s an Ankle Sprain?
• What’s an Ankle Fracture?
• How Can I Tell the Difference?
• Treatment for a Sprain
• Treatment for a Fracture
• Recovery Times
• More

You’ve injured your ankle and can’t put your weight on it. It hurts and is tender to the touch, bruised, and swollen. It could be a sprain, or it might be broken.

The symptoms of an ankle sprain are a lot like a fracture, but you’ll need to know which injury you have so you can heal the right way.

This happens when you damage the ligaments in your ankle.

Ligaments are the tough, stretchy bands that hold your bones in place and help keep the joint stable. They’re meant to stretch and move, but only to a point. A sprain means that a ligament is torn or stretched beyond its limits.

This happens when at least one of three bones in your ankle breaks.

If just one bone is broken, you may not realize how bad the injury is. But if multiple bones break at once, you will lose stability in your ankle and may not be able to walk.

An ankle fracture can also lead to ligament damage.

To help figure out what the injury might be, ask yourself a few questions:

• Was there a noise when it happened? A sprain may occur silently, or in severe cases there may be a popping sound. With a fracture, you might hear a crack.
• Is your ankle misshapen? While swelling is a symptom of both injuries, if your ankle looks clearly “off,” it’s most likely because a bone is broken.
• Does your ankle feel numb? With a sprain, you feel pain. But if you have numbness or tingling, your ankle is most likely broken.
• Where is the pain? If your ankle hurts or is tender to the touch directly over your ankle bone, you probably have a fracture. If the pain is in the soft part of your ankle, it’s more likely a sprain.

If you’re still not sure, see your doctor. They can examine your ankle and give you a number of tests to figure out which injury you have.

It’s usually less involved when you are healing from a sprain. Most sprains will clear up on their own.

You may take anti-inflammatory drugs such as ibuprofen (Advil, Motrin) or naproxen (Aleve).

And your doctor may advise you to try the “RICE” method to ease your inflammation:

• Rest
• Ice
• Compression (with an elastic bandage)
• Elevation (ankle above the heart)

You may need physical therapy for a moderate sprain. You should start range of motion exercises once the pain and swelling subside. Surgery is usually for severe cases when other treatments have failed.

If you think your ankle is broken, you should get medical treatment right away. You need to have the ankle immobilized. This could involve crutches or a cast.

Your doctor may try to align the broken bones to help you heal. If the bones are unable to stay in place after your doctor has tried to stabilize the fracture, you might need surgery.

You can also apply ice, elevate your ankle, and take pain relievers. Talk to your doctor.

These can be vastly different for the two injuries as well.

A sprain may clear up within days, with worse sprains needing several weeks to heal.

Fractures usually take much longer. It could be 6 weeks to several months before you’re back to your regular routine. For most ankle fractures, you can do your rehab with a basic home exercise program of stretching, range of motion, strengthening, and balance exercises.

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Is My Ankle Sprained or Broken? How to Tell The Difference

Written by WebMD Editorial Contributors

Medically Reviewed by Jennifer Robinson, MD on April 24, 2023

• What’s an Ankle Sprain?
• What’s an Ankle Fracture?
• How Can I Tell the Difference?
• Treatment for a Sprain
• Treatment for a Fracture
• Recovery Times
• More

You’ve injured your ankle and can’t put your weight on it. It hurts and is tender to the touch, bruised, and swollen. It could be a sprain, or it might be broken.

The symptoms of an ankle sprain are a lot like a fracture, but you’ll need to know which injury you have so you can heal the right way.

This happens when you damage the ligaments in your ankle.

Ligaments are the tough, stretchy bands that hold your bones in place and help keep the joint stable. They’re meant to stretch and move, but only to a point. A sprain means that a ligament is torn or stretched beyond its limits.

This happens when at least one of three bones in your ankle breaks.

If just one bone is broken, you may not realize how bad the injury is. But if multiple bones break at once, you will lose stability in your ankle and may not be able to walk.

An ankle fracture can also lead to ligament damage.

To help figure out what the injury might be, ask yourself a few questions:

• Was there a noise when it happened? A sprain may occur silently, or in severe cases there may be a popping sound. With a fracture, you might hear a crack.
• Is your ankle misshapen? While swelling is a symptom of both injuries, if your ankle looks clearly “off,” it’s most likely because a bone is broken.
• Does your ankle feel numb? With a sprain, you feel pain. But if you have numbness or tingling, your ankle is most likely broken.
• Where is the pain? If your ankle hurts or is tender to the touch directly over your ankle bone, you probably have a fracture. If the pain is in the soft part of your ankle, it’s more likely a sprain.

If you’re still not sure, see your doctor. They can examine your ankle and give you a number of tests to figure out which injury you have.

It’s usually less involved when you are healing from a sprain. Most sprains will clear up on their own.

You may take anti-inflammatory drugs such as ibuprofen (Advil, Motrin) or naproxen (Aleve).

And your doctor may advise you to try the “RICE” method to ease your inflammation:

• Rest
• Ice
• Compression (with an elastic bandage)
• Elevation (ankle above the heart)

You may need physical therapy for a moderate sprain. You should start range of motion exercises once the pain and swelling subside. Surgery is usually for severe cases when other treatments have failed.

If you think your ankle is broken, you should get medical treatment right away. You need to have the ankle immobilized. This could involve crutches or a cast.

Your doctor may try to align the broken bones to help you heal. If the bones are unable to stay in place after your doctor has tried to stabilize the fracture, you might need surgery.

You can also apply ice, elevate your ankle, and take pain relievers. Talk to your doctor.

These can be vastly different for the two injuries as well.

A sprain may clear up within days, with worse sprains needing several weeks to heal.

Fractures usually take much longer. It could be 6 weeks to several months before you’re back to your regular routine. For most ankle fractures, you can do your rehab with a basic home exercise program of stretching, range of motion, strengthening, and balance exercises.

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Ankle fracture – how it happens, classification, treatment methods

The information provided on the page should not be used for self-treatment or self-diagnosis. If you suspect a disease, you should seek help from a qualified specialist. Only your doctor can diagnose and prescribe treatment.

Contents of the article:

• How fracture occurs
• Ankle fracture classification
• Symptoms
• Diagnostics
• First aid
• Treatment and clinical guidelines
• Surgical treatment
• Possible complications

What is an ankle fracture?

An ankle fracture is a partial or complete fracture of the leg bones. Ankle fractures can range in severity from less severe injuries involving small pieces of bone near the joint to severe fractures of the tibia and fibula, or both. Ankle fractures are common injuries, most often caused by the ankle twisting inward or outward. Many people mistake an ankle fracture for an ankle sprain, but the consequences are completely different and therefore require accurate and early diagnosis. Treatment and rehabilitation at home depends on this. Fortunately, both surgical and non-surgical treatments are being used today. All ankle fracture injuries should be evaluated by a physician to determine severity.

How a fracture occurs

Ankle fractures, more commonly known as ankle fractures, occur when one or more of the bones that make up the ankle joint is broken. Although an ankle fracture is an injury seen at almost any age, it is more common among older people and athletes who are physically active.

When the bones are damaged, the ankle becomes unstable. With the addition of ligament injuries, the injury can become a very serious problem, complications after an ankle fracture are possible.

An ankle fracture can be caused by sudden, inadvertent movement, such as twisting the ankle during sports or activity. Car accidents can also cause ankle fractures, especially after heavy impacts.

Also, a person can trip, fall, twist the ankle – this can cause an ankle fracture. Depending on age and previous health conditions, this problem can develop into much more serious damage if left untreated. Source:
Ankle injury analysis. Tailashev M.M., Salatin P.P., Sobolev V.V., Pozikov V.V., Kolesnikov A.S. Acta Biomedica Scientifica, 2008. p. 144-145.

Classification of ankle fractures

The ankle joint itself is formed by three bones – this is the largest tibia, then the fibula (shin bone) and the talus. It is located in the area between the calcaneus, as well as the greater and fibular bones. Ankle fractures are classified according to the area of ​​the broken bone:

• fracture in the area of ​​the medial malleolus is the inner surface of the tibia;
• posterior malleolus injury is the dorsum of the tibia;
• lateral malleolus fracture is an injury to the edge of the fibula.

The stability of the ankle joint is determined by the strength of the ligaments and bones. In case of fractures in the area of ​​the ankle joint, two joints are affected:

• ankle joint – formed by the lower leg, talus, fibula;
• joint syndesmosis is the area between the tibia and fibula held together by ligaments Source:
  Ankle joint fractures and treatments. Cherednik A.A., More Gautam Saherbao, Al-Fakih Abdulaziz. Bulletin of Medical Internet Conferences, 2014. p.432.

Symptoms

Since a sprain can sometimes feel like a broken ankle, it is always important to consult a doctor. Assessing the symptoms of an ankle fracture and post-injury pain helps in determining how serious the injury is.

An ankle fracture is accompanied by one or all of the following symptoms:

• pain at the fracture site, which in some cases may radiate from the foot to the knee;
• Significant swelling that may occur along the length of the leg or be more localized. How long the swelling lasts will depend on the severity of the injury and the amount of damaged tissue;
• a bruise that appears shortly after the injury;
• inability to walk, stepping on the whole leg. Therefore, the doctor will tell you how to walk correctly after an injury. However, a person can walk with less severe fractures, so never rely on walking as a test to see if a bone has been broken;
• changed the appearance of the ankle – it will be different from the other ankle;
• bone protrudes from under the skin in an open fracture. Fractures penetrating the skin require immediate intervention as they can lead to severe infection and prolonged recovery.

Diagnosis

The doctor will discuss with the patient the medical history (how long it hurts, before the injury) and symptoms. He will also ask how the injury happened and examine the affected area. If the traumatologist believes that you may have broken your ankle, they will order a series of examinations to more fully study the injury.

X-ray : X-rays can show if the ankle bone has been broken and how many fragments of the broken bone are there. They can also determine if there is a dislocation (tear between broken bones). The doctor may also take x-rays of other parts of the leg or foot to make sure nothing was damaged as a result of the injury.

Stress Test : A stress test is performed to determine if surgical procedures are needed to heal an injury. The doctor will put some pressure on the ankle and take a special x-ray to determine the severity of the lesion.

CT Scan (Computed Tomography): If the fracture extends beyond the ankle joint, a CT scan may be required to further investigate the injury. CT scanning allows you to get an image of a series of images in different planes, by which the doctor can determine the severity of the injury. Source:
Comprehensive diagnosis of ankle injuries. Kim L.I., Dyachkova G.V. Genius of Orthopedics, 2013. pp. 20-24.

MRI scan (Magnetic Resonance Imaging): If the doctor suspects a ligament injury has occurred, they may order an MRI scan to better view the affected area. MRI can look deeper into bones and soft tissues, such as ligaments, to create higher resolution images than most other tests.

Ankle fracture first aid

Ankle fracture treatment depends on the type and severity of the injury. First aid is needed to prevent further damage from a broken ankle and shorten the time for bone healing.

• Rest : relieve the injured ankle. Walking can lead to further injury, and only a doctor can determine when to step on your foot.
• Ice : apply an ice pack to the injured area by placing a thin towel between the ice and the skin. You need to use ice for 20 minutes and then wait at least 40 minutes before doing a cold compress again.
• Compression : An elastic bandage should be used to control swelling.
• Height : Ankle should be slightly elevated above heart level to reduce swelling.

Ankle fracture: treatment, clinical guidelines

If the traumatologist determines that the patient has a broken ankle, it is necessary to determine what type of fracture it is and how to treat it. Ankle fractures can be treated with non-surgical methods, as long as the injury is not too severe or unstable.

• Lateral fibula fracture . If the ankle is stable, non-surgical healing methods are available. These can range from wearing tall tennis shoes to short casts. The doctor may recommend rest and crutches to keep the foot light and to make sure that the fragments do not move during healing.
• Fracture of the tibia on the inside of the lower leg . If the fracture is all in place or if it is very minor, it can be cured if the ankle is not stressed for 6 weeks. A short leg bandage or a removable bandage, as well as a doctor’s recommendation when it is possible to walk, usually speeds up the healing process.
• Fracture of the back of the leg at the level of the ankle joint . In most cases, the fibula also breaks due to the fact that it shares ligaments with the posterior malleolus. If the ankle remains stable, it can be treated without surgery. Treatment may include a short leg bandage or a removable brace. It is important to determine the severity so that arthritis does not develop. As you heal, you will need to gradually develop an ankle fracture.
• Bimalleolar equivalent fracture (two of the three parts of the ankle broken) indicates that the ligaments on the inside of the ankle are also damaged. Because these injuries are usually unstable, surgery is usually recommended. In case of health problems that may interfere with the operation, a splint and a short bandage on the leg may be applied. You will need to see your doctor regularly to make sure your ankle remains stable.
• Trimalleolar fracture (all three parts of the ankle are broken). Since this is a very difficult situation, surgery is almost always recommended. Rare non-surgical treatment options include a short leg bandage, a splint, and regular doctor visits.

If the joint located between the tibia and fibula is damaged, and the ligaments are also affected, the damage can heal like an ankle sprain. The injury can be treated by removing weight from it without surgery.

However, in most cases sprains and one or more fractures occur. Recovery after an ankle fracture is rarely without surgical treatment. Source:
Treatment tactics for intra-articular fractures of the ankle joint (literature review). Zedgenidze I.V., Tishkov N.V. Acta Biomedica Scientifica, 2013. pp. 178-182.

Surgery

In the event that non-surgical treatments do not work or the ankle is too unstable, your doctor may recommend surgery for a broken ankle, followed by rehabilitation. After the operation, it is important to walk the leg, perform all the prescribed procedures in order to shorten the rehabilitation period.

Features of the operation: if the fragments are not in place, the bone fragments must be moved surgically. The fragments had to be returned to their normal position and fastened with special screws and metal plates attached to the outer surface of the bone. The surgery may involve bone grafting so that the new bone can actively heal. It is fixed with screws and a metal plate. This may reduce the risk of arthritis and speed up the return of movement.

Possible complications

After treatment, it is important to follow the surgeon’s instructions. Failure to follow this rule can lead to infection, deformity, arthritis, and chronic pain. Source:
Errors and complications in the treatment of complex ankle fractures. Salikhov R.Z., Pankov I.O., Plakseichuk Yu.A., Solovyov V.V. Practical medicine, 2014. p. 128-131.

• Mistakes and complications in the treatment of complex fractures of the ankle joint. Salikhov R.Z., Pankov I.O., Plakseichuk Yu. A., Solovyov V.V. Practical medicine, 2014. p. 128-131
• Ankle injury analysis. Tailashev M.M., Salatin P.P., Sobolev V.V., Pozikov V.V., Kolesnikov A.S. Acta Biomedica Scientifica, 2008. p. 144-145
• Comprehensive diagnosis of ankle joint injuries. Kim L.I., Dyachkova G.V. Genius of Orthopedics, 2013. p.20-24
• Fractures of the ankle joint and methods of treatment. Cherednik A.A., More Gautam Saherbao, Al-Fakih Abdulaziz. Bulletin of Medical Internet Conferences, 2014. p.432
• Therapeutic tactics for intra-articular fractures of the ankle joint (literature review). Zedgenidze I.V., Tishkov N.V. Acta Biomedica Scientifica, 2013. p.178-182

How to distinguish a fracture from a bruise: first aid for an ankle injury

Ankle and ankle injuries account for the lion’s share of all injuries of the musculoskeletal system. The proportion of ligament tears in the structure of sports injuries can reach up to 40%. Bruising, damage to the ligaments and bones of the joint can be caused by muscle imbalance, defects in shoes or coatings, changes in the nervous system, or banal inattention. Depending on the amount of damage, the recovery prognosis can vary dramatically. To understand the principles of helping with ankle injuries, it is worth understanding the types of injuries.

Content

• Bruise
• Torn and torn ligaments
• Fractures
• Ankle injury prevention
• First aid for ankle injury
• Modern solutions for treatment and rehabilitation

Injury

Banal bruise – a consequence of a kick on a hard object. In this case, as a rule, serious destruction of body tissues is not observed. Bruises on the lower leg and ankles are very painful, since the bones in this area are devoid of a protective fatty cover. Recovery from a minor injury is often quick. Extensive damage can cause massive edema, bruising, or even injury to blood vessels and nerves. However, most often a “normal” bruise is accompanied by only moderate pain and minor swelling.

Tears and ruptures of ligaments

Tears and ruptures of the ligaments of the ankle joint are the most extensive group of ankle injuries. In the typical direction of “tucking” the foot, 1, 2 or 3 lateral ligaments are injured. It should be noted that the ligaments are characterized by low elasticity. When overloaded, they do not stretch, but break completely or partially. The rupture is accompanied by pain, swelling, sometimes a crunch or crack. In the future, the ligaments may grow together or lose their tension. Small partial tears with the right approach have a very favorable prognosis. Complete ruptures of multiple ligaments often result in chronic instability and re-injury.

fractures

Even a small fracture is a potentially severe injury that requires a special approach. Among the fractures of the ankle joint, the following types are most common:

• isolated fracture of the lateral malleolus,
• bimalleolar fracture,
• bimalleolar fracture with fracture of the posterior edge of the tibia,
• fracture of the lower third of the bones of the leg.

To determine the prognosis and treatment tactics, the degree of displacement of fragments and the location of the zone of bone destruction are of great importance. Allocate fractures without displacement – “cracks” of the bone, and complex injuries with displacement of fragments. Severe fractures can be complicated by ruptures of blood vessels, nerves and ligaments. The outcome largely depends on the correctness of the provision of first and specialized care, adequate and complete rehabilitation.

Prevention of ankle injuries

Ankle injuries can be caused by:

• falls from a height,
• traffic accidents,
• industrial accidents
• simple negligence or negligence,
• muscle imbalance.

Despite a certain influence of factors beyond our control, the largest percentage of fractures and ruptures of the ankle ligaments is associated only with chronic overload and muscle imbalance. Most patients with fractures and severe ruptures recall that before that their foot had repeatedly “twisted” – the muscles seemed to be turned off. Timely restoration of the balance of the muscles of the lower leg and foot is the basis for the prevention of torn ligaments and ankle fractures. To strengthen the musculoskeletal apparatus of the legs, the so-called balance training has proven itself. The technique is actively used in sports medicine for training and rehabilitation of football players, gymnasts, and speed skaters. You can carry out balance training at home on a special balancing pillow.

Working with the right certified balance cushion after a few minutes gives a feeling of stability, pleasant working out and massage of the foot and lower leg. Regular exercise leads to strengthening the ankle and improving the balance of the whole body. Very often, various deformities of the foot lead to rupture of the ligaments. Excessive pronation or supination, valgus or varus of the heels are corrected with individual orthopedic insoles. These products directly correct musculoskeletal imbalance, improve blood circulation and perception of the foot and ankle area.

First aid for ankle injury

Seek immediate medical attention for any injury, who can accurately diagnose and recommend effective treatment. For bruises and small torn ligaments, the RICE protocol has proven itself:

R (rest – rest): stop stepping on your foot, provide it with complete rest.

I (ice – ice, cold): for the first few days, it is useful to apply an ice bottle or cold accumulator to the injury site. It is worth doing this for 10-20 minutes every 2-3 hours. A cold object should separate a small layer of tissue from the skin to avoid frostbite.

C (compression): to prevent swelling during the day, you can wrap the foot and lower leg with an elastic bandage (not tight!). Compression stockings are even better.

E (elevation): lie more for the first few days, put your foot on pillows to give it a slightly elevated position. So she will swell and hurt less. Serious ruptures, fractures require immediate fixation of the limb, sometimes surgery can be used.

Modern solutions for treatment and rehabilitation

Special orthoses can help with typical bruises and torn ligaments. Ankle braces tangibly reduce pain and swelling, speed up healing, and allow you to return to your active life earlier. Experienced consultants in ORTO SMART – Medtechnika, orthosalon stores will help you choose the best orthosis for your case. Depending on the indications, modern clamps of our network can perform:

• gentle compression for a noticeable reduction in pain and swelling,
• delicate support to stimulate your own muscles and receptors,
• moderate fixation for fast healing of ligaments and preservation of mobility,
• rigid fixation to stabilize severe damage.

In case postoperative fixation is required, convenient and comfortable splints are always available. Modern plastic splints are lighter than outdated plaster casts, they allow you to actively move and carry out hygienic treatment of the skin, change the angle and degree of fixation. It is important to understand that even after successful healing, the damaged area remains quite vulnerable.