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The Difference between a Broken and Sprained Ankle

Every year in the U.S., more than one million people visit the emergency room with ankle injuries. Of these, the majority are sprains and fractures, and in many cases, it can be hard to tell the two apart at first.

While a fracture refers to a break in one or more of the ankle bones (tibia, fibula, talus or calcaneus), a sprained ankle refers to damage to the ligaments of the ankle due to overstretching beyond their normal range of motion. However, both of these conditions can be very painful and occur as a result of similar injuries. Some of the most common causes of ankle pain include sports injuries, walking on uneven surfaces and car accidents.

Ankle Sprains

Ankle sprains can range from mild to severe in nature and are commonly observed in athletes. The most common symptoms are sudden pain, swelling, bruising and an inability to walk. If the sprain is mild, you may only experience some tenderness when touching and may not have any, or only very little, swelling. On the other hand, in severe cases, the swelling may be substantial and the pain intolerable with weight-bearing on the foot being next to impossible.

If you suspect that you have sprained your ankle, adhere to the so-called RICE protocol – Rest, Icing the ankle, using Compression bandages to wrap the ankle and Elevating the foot to reduce the swelling and pain. For severe cases, you may need to wear a boot or splint to stabilize the ankle and take over-the-counter pain medications. If you are an athlete, you may even require physiotherapy before going back to your normal sports activities.

Ankle Fractures

Similarly to ankle sprains, ankle fractures are a common type of sports injury. However, unlike ankle sprains, a broken ankle always requires medical attention. If the swelling and pain do not resolve within a day or two of following the RICE protocol, and if you are unable to walk on the foot, you should see a doctor. If the ankle appears deformed or if you experience numbness, weakness or reduced circulation of the affected leg, you should see a sports medicine physician immediately.

How To Tell the Difference

So, with the symptoms being so similar, how can you tell a broken or sprained ankle apart? Well, there are a few distinguishing signs to keep in mind. First, try to recall if there was a sound when you were injured. A “cracking” noise may be a sign that the ankle is broken while sprains may be associated with a “popping” sound.

Second, check if the ankle appears deformed or crooked in addition to being swollen as this may be a sign of a fracture. Third, the presence of numbness is indicative of a fracture. Moreover, if you cannot move the ankle joint at all, are in extreme pain, and cannot put any weight at all on the ankle, it is likely that it is broken. To be sure, it is important that you are examined by your GP or by a sports injury doctor, which may include having an X-ray.

How To Reduce the Risk of Ankle Injuries

While there is no way to fully avoid contracting a sports injury, there are certain things you can do to reduce the risk. These include avoiding playing sports when you are in pain or are very tired, eating a well-balanced diet in order to maintain a healthy weight and to nourish your muscles, always warming up before exercising and cooling down afterward, building muscle strength, wearing good shoes and other protective equipment as needed, and trying to always run on flat surfaces.

Frank Collier, MD

Physical Medicine & Rehabilitation
Pain Management Specialist

Dr. Frank Collier is a board-certified Physical Medicine and Rehabilitation physician and Pain Management Specialist who specializes in the treatment of injuries and illnesses that affect how people move and function while living with pain.

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