A twisted ankle can be a sprain or a broken bone, and the two can look surprisingly alike. Pain, swelling and bruising show up in both. The difference matters because a fracture may need a cast, a boot or surgery, while a sprain usually does not.
What is an ankle fracture?
The ankle joint is formed by three bones: the shin bone (tibia), the thinner outer bone (fibula), and the talus that sits beneath them. A break in any of these bones is an ankle fracture. The bony bumps on each side of your ankle are the ends of the tibia and fibula, and they are common spots for breaks.
Ankle fractures happen when the foot twists, rolls or lands hard. Falls on ice, missed steps, sports, jumps and car accidents are common causes.
Common symptoms of an ankle fracture
These are the signs that most often point to a break:
- Sudden, often severe pain at the time of injury.
- Swelling that develops quickly and may reach the foot or lower leg.
- Bruising around the ankle, sometimes extending into the foot.
- Tenderness when you press directly on the bone.
- Trouble or inability to put weight on the foot.
- An ankle or foot that looks bent, twisted or out of place.
- A snap or crack heard or felt when the injury happened.
Ankle fracture or sprain?
A sprain is an injury to the ligaments that hold the ankle together. A fracture is a break in the bone. Both cause swelling and pain, and some people with a fracture can still walk a little.
Some clues lean toward a fracture: pain directly over the bone instead of the soft tissue, severe pain, inability to take more than a few steps, visible deformity, or numbness. Sprains tend to improve a bit each day, while a fracture stays very painful or gets worse. Still, you cannot always tell by feel. The only sure way is an exam and an X-ray.
What to do right after the injury
Stop activity and stay off the ankle. Raise the foot above heart level, apply ice wrapped in a cloth for short periods, and use a wrap or splint for support if you have one. Avoid walking on it to test whether it is broken, because that can make a break worse.
Do not try to push a crooked ankle back into place. If the foot looks deformed or feels numb, call 911 or go straight to the ER.
If you must move before you are seen, use crutches or lean on a person for support, and keep the injured foot off the ground. Do not drive on an injured right ankle. A simple splint made from a rolled magazine or pillow wrapped around the ankle can help limit movement on the way to your appointment.
How an ankle fracture is diagnosed and treated
Your doctor will examine the ankle, check circulation and feeling in the foot, and order X-rays. Our Forest Hills office has X-ray on site. The images show which bone is broken and whether the ankle joint is stable.
Treatment depends on the break. A stable fracture with the bones in good position may heal in a cast or walking boot, often with crutches to protect the ankle. If the bones have shifted or the joint is unstable, surgery may be needed to hold the pieces in place with plates and screws. Dr. Mehran Manouel is a board-certified orthopedic surgeon who treats fractures.
Recovery takes time, and your doctor will guide you on when to start putting weight on the foot and moving the ankle. Untreated ankle fractures can lead to ongoing pain, arthritis or a joint that gives way, so it is worth getting checked.
Recovery after an ankle fracture also depends on your age, general health and the type of break. Many patients need crutches for a period, and most benefit from gradual movement and strengthening once the bone is stable. Do not rush back to stairs, sports or long walks until your doctor clears you. Following the plan closely protects the ankle for the long term.
When to see an orthopedic doctor
Go to the ER or call 911 if your ankle looks deformed or out of place, bone has broken the skin, your foot is numb, pale, blue or cold, or the pain is severe. If you have a swollen, painful ankle after a twist or fall and cannot walk normally, see an orthopedic doctor within a day or two and keep weight off it until then. Able Orthopedic & Sports Medicine in Forest Hills offers in-office X-ray and fracture care for patients across Queens. Call (718) 897-2228 or book online.
Common questions
Can you walk on a broken ankle?
Sometimes, at least for a few steps. Being able to walk does not rule out a fracture, so get it checked if pain and swelling persist.
How long should I wait before getting an X-ray?
If you cannot bear weight, see obvious deformity or have severe pain, go right away. Otherwise, get it checked within a day or two.
Does every ankle fracture need surgery?
No. Stable fractures often heal with a cast or boot. Surgery is for breaks that are out of position or unstable.
This article is for general education and is not a substitute for a visit with a doctor. If you think you have a medical emergency, call 911.