The Ottawa Ankle Rules, which suggest signs of a broken leg or foot, only work for twists, or rolls, of the ankle and only if the injured person is fully alert. So if you twist your ankle and there’s lasting pain, suspect a broken leg bone (tibia or fibula) if you have any of these three findings:
1. There’s tenderness when you press on the tibia along any part of the six centimeters (about two-and-a-half inches) above where it ends.
Anatomy lesson: The end of your tibia is that knot on the inside of your ankle. The tibia is the larger of the two leg bones, and it supports your weight.
2. There’s tenderness when you press on the fibula along any part of the six centimeters above where it ends.
Anatomy lesson: The end of your fibula is that knot on the outside of your ankle. The fibula is smaller than the tibia. It’s just there for extra support and for muscles to attach to it.
3. You’re not able to bear any weight because of ankle pain. (Limping is OK.)
Suspect a break in the foot if you have any of these three findings:
1. There’s tenderness when you press near the ankle on the fifth metatarsal.
Anatomy lesson: The metatarsals are those long bones in your foot that the toes attach to. The fifth metatarsal is the one that goes with the little toe. If the ankle gets rolled inward too far, it’s not uncommon for that metatarsal to break off from the ligament that attaches it to an ankle bone. In essence, you have a broken foot bone.
Anatomy lesson: The navicular bone is near your tibia. On the inside of the ankle, it’s that highest foot bone you feel sticking out diagonally from the tibia.
3. You’re unable to bear weight due to foot pain.
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In either case—a broken leg bone or a broken foot bone—you’re gong to need crutches and a firm brace, as I describe in my video on how to make a splint.
Here’s a short video demonstrating the rules.
Having gone through all this, the bottom line to me is splint a twisted ankle as best you can until you can get to a doctor. Stay off of it if it hurts. If you suspect a break, stay off of it as much as you can. (If you walk too much too soon on a sprained ankle, it’s going to hurt and swell more and may take longer to heal.)
A woman came to see me after she’d sprained her ankle and had no other choice but to walk eleven miles back to get help. The ankle looked bad; it was very swollen, bruised, and painful. She probably still has problems from it, but she had to do what she had to do. If the ankle had been broken and she did all that walking she may very well have required surgery for it to heal.
What about you? Have you ever injured your ankle? Was it a break or a sprain? What did you do? How’s it doing now?
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Photo by Euskalanato on Flickr.