If you’ve recently injured your ankle, you may be wondering whether it’s a minor sprain or a more serious broken ankle. Fortunately, there are some ways you can determine the severity of your injury before seeing a doctor. At Interventional Spine & Surgery Group, our team offers fast, patient-centered care for individuals with orthopedic and other types of injuries in central and northern New Jersey. Here, we explore how you can differentiate a broken ankle vs. a sprained ankle using the Ottawa Ankle Rules framework.
Key Takeaways
- Ankles are made up of bones, ligaments, and tendons. An injury to the bone is called a fracture or break, and an injury to the ligaments is called a sprain.
- An ankle fracture typically causes severe pain and swelling, an inability to bear weight, and visible deformity. It may be treated with immobilization or surgery.
- An ankle sprain causes localized pain and gradual swelling, and the patient can typically bear some weight. Treatments include pain medications, the R.I.C.E. method, physical therapy, and support devices.
- The Ottawa Ankle Rules are used to gauge the severity of an ankle injury and determine whether the patient needs an X-ray.
- Interventional Spine & Surgery Group provides a range of treatments for individuals with ankle injuries in central and northern New Jersey.
Ankle Anatomy: What Can Be Injured?
The ankle joint is a hinge joint that is made up of three bones: the tibia, fibula, and talus. It also contains ligaments, tough bands of fibrous tissue that connect bones that stabilize the joint, and tendons, thick tissues that connect the muscle to the bone that help enable movement.
The bones can break or fracture, while the ligaments can get sprained (stretched or torn). These injuries are typically caused by turning, twisting, rolling, or a sudden blow. The tendons can be strained due to repetitive overuse or sudden movements or twists. These injuries can range from mild to severe and can cause different symptoms. It’s important to determine which type of ankle injury you have to ensure you get the proper treatment.
Broken Ankle vs. Sprained Ankle: Key Differences
Both broken and sprained ankles can cause overlapping symptoms, but there are also a few key differences between the two injuries. Broken ankles (fractures) typically cause immediate, severe pain, visible deformity (crooked or twisted appearance), and an inability to bear weight. Fractures may be nondisplaced (remain in proper alignment) or displaced (shift out of position).
Sprains also cause immediate pain, although it may not be severe. They also often allow for some movement and cause gradual swelling. There isn’t typically a visible deformity, although the ankle may look puffy or swollen. Sprains are graded based on their severity. A mild sprain is when the ligament is stretched, but not torn; a moderate sprain is a partial tear of the ligament; and a severe sprain is a complete tear of the ligament.
Often, a patient will need an X-ray to determine which injury they have. However, physicians may also use clinical frameworks like the Ottawa Ankle Rules to gauge the severity of the injury without an immediate X-ray.
Symptom Comparison Table
| Symptom | Ankle Fracture | Ankle Sprain |
|---|---|---|
| Weight-bearing ability | No | Yes, can often limp or put some weight on the affected ankle |
| Immediate pain | Yes | Yes |
| Visible deformity | Yes, often looking crooked, twisted, or out of place | Often no, although there may be some puffiness |
| Swelling and bruising | Yes, dramatic, rapid, and widespread | Yes, gradual and localized |
| Movement ability | Severely impaired | Some |
| Injury sound | Yes, snapping or cracking sound | Yes, popping sound |
What Are the Ottawa Ankle Rules?
The Ottawa Ankle Rules are a clinical decision-making framework that was developed by Dr. Ian Stiell and the Ottawa Hospital Research Institute. These rules were designed to be used to determine whether a patient needs an X-ray after an ankle injury, helping to avoid unnecessary radiation and reduce healthcare costs. The criteria for ordering an ankle X-ray include pain in the malleolar (ankle) zone with any of the following:
- Bone tenderness at the lateral malleolus (posterior edge or tip of the outer ankle bone)
- Bone tenderness at the medial malleolus (posterior edge or tip of the inner ankle bone)
- Inability to bear weight (cannot take four steps immediately after the injury or in the emergency department)
If a patient meets these criteria, ankle imaging is necessary to further examine the injury. If a patient doesn’t meet the criteria, they typically don’t require an ankle X-ray.
What Are the Treatments for a Sprained Ankle?
A sprained ankle is a milder injury than a broken ankle, so it typically involves more conservative treatments. Options include:
- R.I.C.E. method: Rest, ice, compression, and elevation (R.I.C.E.) are commonly used within the first 48 to 72 hours of a sprain. They help to control swelling and pain.
- Pain medications: Taking over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or acetaminophen, is often recommended to reduce pain and inflammation.
- Support devices: For mild to moderate sprains, physicians may recommend wearing a support device, such as an elastic bandage, sports tape, or an ankle support brace, to help stabilize the ankle while it heals. For severe sprains, crutches or a walking boot may be used.
- Physical therapy: After the swelling has decreased, your physician will often prescribe physical therapy to help restore strength and flexibility. It involves targeted exercises to help prevent chronic ankle instability and reduce the risk of re-injury.
Most mild to moderate sprains will heal within a few weeks with conservative care. Patients with severe Grade 3 tears that won’t heal properly may require surgery, although it’s rare.
What Are the Treatments for a Broken Ankle?
When treating a broken ankle, the treatment will depend on how severe the break is and whether it is displaced or not. Doctors recommend the R.I.C.E. method to provide immediate first aid to a suspected fracture, although it’s important to seek medical attention promptly. After confirming an ankle fracture, the treatments may include:
Closed Reduction and Immobilization
If the ankle bones are out of alignment, a physician will numb the ankle and manually manipulate the bones back into place. Once the bones are aligned, the ankle will be immobilized to prevent movement during healing. This may be done by a plaster cast, splint, or pneumatic walking boot to prevent movement while it heals. These devices are typically worn for six to 12 weeks.
Surgery
If the ankle is unstable or cannot be properly aligned, surgery is required. The most common surgery is a two-part procedure called open reduction and internal fixation (ORIF). First, the surgeon makes an incision to realign the bone, and then they will insert metal plates and screws to stabilize it and hold it together while it heals. Full healing from ORIF can take anywhere from three to 12 months. Physical therapy is often prescribed to help the patient regain mobility, strength, and flexibility.
Find Fast Treatments for Ankle Sprains and Fractures Near You in New Jersey
If you have an ankle injury, fast diagnosis and treatment are available at Interventional Spine & Surgery Group. We provide patient-centered orthopedic care at nine locations throughout central and northern New Jersey, and we prioritize fast access to care to help you heal faster. We can see you now, we care, and we’ll help you get better. To request an appointment near you in New Jersey, contact us today.
Frequently Asked Questions About Ankle Injuries
How do I know if my ankle is broken or sprained?
To know if your ankle is broken or sprained, you can assess your symptoms. If you can’t bear weight, have severe pain, and have major bruising or swelling, you likely have a fracture. If you can bear some weight, have mild to moderate pain, and have localized swelling, it’s likely a sprain. Doctors can use the Ottawa Ankle Rules and X-rays to make the distinction.
Can you walk on a broken ankle?
Although it is possible to walk on a broken ankle, it is often extremely painful and can worsen the injury.
What are the Ottawa Ankle Rules?
The Ottawa Ankle Rules are a clinical framework used by physicians to determine the severity of an ankle injury and whether a patient needs X-rays.
Do I need an X-ray for a sprained ankle?
When doctors use the Ottawa Ankle Rules, they typically only order X-rays when the patient cannot bear weight to take four consecutive steps, or when they have tenderness directly on the bony edges of the ankle and midfoot. X-rays are often not necessary for sprains.
How long does a broken ankle take to heal?
A broken ankle typically takes six to eight weeks to initially heal, but full recovery can take three to six months. If surgery is required, recovery can take up to a year.
When does a broken ankle need surgery?
A broken ankle generally needs surgery when the bones are displaced, the joint is unstable, or the bone breaks through the skin.
What is the difference between a fracture and a break?
There is no difference. A fracture is the same thing as a break, and the terms are used interchangeably.
Can a broken ankle heal without surgery?
Yes, a broken ankle can heal without surgery, especially if it is nondisplaced and stable. Treatment usually involves a closed reduction and immobilization in a cast or splint.