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How Do I Know If My Ankle Is Sprained or Broken?

November 07, 2023

Ah, the dreaded rolled ankle. It can come for anyone, whether you’re stepping off a curb or sprinting down the soccer field. Along with the physical ache, there’s the pain of uncertainty: Is your ankle sprained or broken?

For guidance, we talked to Thomas McDonald, MD, a foot and ankle surgeon at the Bone & Joint Institute at Hartford Hospital and Orthopedic Associates of Hartford. He sees patients in Enfield and Hartford.

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To find out if your ankle is sprained or broken, start with a physical exam.

Sprains and breaks can look awfully similar, with dramatic swelling and bruising for both.

To spare you the time and cost of an unnecessary X-ray, most health providers start with a physical exam, also known as pressing and asking where it hurts. (Yes, there is a method to this madness, known as the “Ottawa ankle rules.”)

“Not every ankle injury needs X-ray views,” says Dr. McDonald. “Is there bone tenderness or is it more soft tissue? A physical exam helps us decide whether a twisted ankle could possibly be broken.”

> Related: How to Avoid an Ankle Sprain: Do These Exercises

If you’re still hurting after a week or two, try an X-ray.

Say your physical exam at the urgent care center pointed toward a sprain, so you didn’t get an X-ray. You’ve been dutifully following all the classic advice: rest, ice, compression, elevation. But it’s been a few weeks, and you’re still limping.

You may have a fracture that was missed during the physical exam — and there’s only one way to know for sure.

“If you’re having a hard time walking on your ankle because of tenderness, have it evaluated again and get an X-ray,” says Dr. McDonald.

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After a month or two, talk to a foot and ankle specialist.

Maybe you already ruled out a bone break via X-ray, which means your ankle injury is probably a sprain — aka, a torn ligament. You’ve been following doctor’s orders, but six or eight weeks later, you still don’t feel 100%.

Your sprain may be particularly complicated or severe. Which means you may need a brace, physical therapy or, in extreme cases, even surgery. This is a unique area of expertise.

“If you’re stuck in the mud and don’t find yourself improving, see a foot and ankle specialist,” says Dr. McDonald. “We’ll do a careful physical exam and weightbearing X-rays in the office. Sometimes, we’ll also get an MRI, which can be helpful to look at all the soft tissue you can’t see in an X-ray.”

In fact, your ankle may not be sprained or broken.

What may seem like a straightforward ankle injury could be a sneakier problem, like a cartilage tear or a tiny fracture in one of the foot bones that sit around your ankle.

“It can be hard to know. There are subtle injuries that we worry about associated with the foot and ankle,” says Dr. McDonald.

When in question, see an orthopedics expert.

“We can reassure you, and get you back to feeling confident in your activities without worrying about doing more damage,” says Dr. McDonald.