Ankle Pain: Is It Sprained or Broken?

Perhaps it was a roll on an uneven sidewalk, a fall from a curb, or a painful twist during a friendly soccer match — whatever the case, you’ve injured your ankle and now you’re in a lot of pain. As your ankle begins swelling and bruising, you’re probably wondering: is it broken or just sprained?

Sometimes, it’s nearly impossible to tell the difference on your own. Keep reading to learn more about ankle sprains vs. ankle fractures, signs and symptoms of each injury, and when you need medical attention.

Ankle Sprain Vs. Ankle Fracture

The ankle is a complex and highly mobile joint made up of an interconnected web of bones, muscles, ligaments, and tendons. The ankle is responsible for providing stability, support and body weight distribution during nearly every movement we make throughout the day. Because the ankle is a weight bearing joint, it’s vulnerable to injury. Rolling, twisting, or landing poorly on an ankle can cause injuries like sprains and fractures.

An ankle sprain occurs when the connective ligaments in the joint become overstretched or torn. Sprains are classified based on the severity of ligament damage.

Grade I sprain: A ligament is stretched, but not torn
Grade II sprain: A ligament is partially torn
Grade III sprain: A ligament is completely torn

A fractured ankle occurs when a bone in the joint chips, cracks or breaks. There are three bones that make up the ankle joint: the tibia (shinbone), fibula (lower leg bone), and the talus (ankle bone). Any of these bones can sustain a fracture from a twisting, falling, or direct impact accident.

Signs and Symptoms: How to Tell the Difference

It can be incredibly difficult to tell the difference between a sprained versus broken ankle. To further complicate matters, it’s entirely possible to have a fracture and ligament tearing at the same time. Sprains and fractures both cause pain, tenderness, swelling, bruising, and an inability to bear weight on the affected ankle. However, there are a few guidelines you can use to help you determine if your ankle is sprained or broken.

Pain level and location. Sprains and fractures are both painful, but fracture pain is usually immediate, sharper, and more intense than soft tissue pain. If you’re able, gently probe the injured ankle to determine the location of the pain. Sharp pain directly over a bone generally indicates a fracture, while pain in the soft part of the ankle indicates a sprain.
Weight bearing. If you’re able to bear weight or walk on the injured ankle, you most likely have a sprain. Keep in mind that’s not always the case — a severe Grade III sprain could leave you unable to stand on the foot. If you can’t bear weight on your foot, you need to see a doctor to receive an accurate diagnosis.
Swelling. Milder swelling that comes on gradually after the injury is more often a sign of a sprain than a break. Immediate and severe swelling is more often a sign of a fracture.
Deformity. A visible deformity or malalignment of the ankle is a surefire sign of a fracture. Bone that punctures the skin is another obvious sign of a break.
Numbness. Numbness, tingling or burning in the foot or toes is a sign of a fracture.

We recommend not making a final diagnosis yourself. If you’re in significant pain after an ankle injury or you think you’ve broken your ankle, seek medical attention right away.

When to See a Doctor

If you have significant ankle pain, swelling, bruising and inability to bear weight, you should see a doctor to have your ankle examined. Sprains and fractures are treated differently, which means having an accurate diagnosis is crucial to ensuring your ankle injury gets the care it needs. Your doctor will perform a physical exam and take imaging studies like an X-ray or MRI to determine the type of injury and the extent of the damage.

Treatment and Recovery

While ankle fractures and sprains may feel similar, they’re treated quite differently.

Sprains — while painful — usually heal on their own with rest and self-care measures at home. Your doctor might recommend the following to promote healing.

R.I.C.E. — rest, ice, compression, elevation
Over-the-counter medications like acetaminophen or ibuprofen
A brace or crutch to keep weight off the ankle
Physical therapy

Mild and moderate sprains typically heal within a few weeks, while more severe sprains could take up to 3-4 months to fully heal.

A fracture is a more severe injury that requires immediate treatment. Your treatment plan might include the following.

Closed reduction. If your fracture is stable, your surgeon will be able to manually manipulate the bones back into their aligned positions — a process called a closed reduction.
Open reduction and internal fixation (ORIF). If your fracture is displaced or unstable, it will require surgical repair. During an ORIF, your surgeon will place the broken bones in correct alignment and insert screws, rods, pins, or plates to hold the bones in place.
Immobilization. During the healing process, broken bones need to remain immobilized to grow back in correct alignment. Your foot and ankle will be placed in a boot or cast for several weeks.
Mobility aids. You’ll be given crutches or a wheelchair to help you get around without placing weight on the affected foot and ankle.
Pain medications. You can take over-the-counter medications like acetaminophen or ibuprofen to reduce pain and inflammation. The pain will steadily recede as the healing process continues.
Physical therapy. After your fracture is healed, you’ll need physical therapy to help you regain strength, flexibility, tolerance, and range of motion.

The fracture healing process can last for 3-4 months before you’re recovered and rehabilitated enough to return to normal activities.

Find the Best Foot and Ankle Care at BEST Surgery and Therapies

BEST is a single-stop healthcare solution for comprehensive orthopedic and spine care. Our state-of-the-art campus in Cincinnati, OH contains all the treatments and services you’ll need, including a physical therapy center, pain management suite, spine and orthopedic clinic, urgent orthopedic care center, ambulatory surgery center (ASC), and diagnostic imaging center.

If you sustain an ankle fracture, sprain, or dislocation, skip a visit to the emergency room and come straight to BEST’s urgent orthopedic care clinic. We provide same-day care and treatment for emergent injuries.

For more information and appointment scheduling, please call us to speak with a dedicated Patient Experience Coordinator.