What happens if you twist your ankle so badly that you don’t know whether it’s sprained or broken? I get that question a lot on my post about clues to a possible fracture.
“I twisted my ankle in basketball. Is it broken?”
“It’s really swelled up. It hurts a lot. Is it broken or sprained?”
My answer? I don’t know. I can’t tell without a physical exam. And even then, my diagnosis would need to be confirmed with an X-ray because lots of times, breaks and sprains have the same symptoms. So, as you might imagine, in a survival situation without an X-ray, diagnosis and treatment will get tricky even for medical professionals.
Does It Matter?
Initially, most sprains and breaks actually require the same treatment: RICES—rest, ice, compression, elevation, splint. Like with most any acute injury, the old axiom “if it hurts don’t do it” is wise advice.
The tricky part will likely come in if you can’t get care for a week or two. At that point, you’ll need to make some best guesses about your injury to figure out how to proceed with treatment. Here are a few of the reasons:
- If the ankle is sprained, you’ll probably be able to start using it a lot faster. That’s good because keeping your ankle immobilized increases your risk for deep-vein thrombosis.
- If it’s broken, you’ll need to keep it immobilized longer so you don’t interrupt the bone’s healing process.
- If it’s broken, it may need special treatment, depending on things like where it’s broken and whether the bone has moved. For example, if the tibia (the largest bone in your lower leg; the bottom forms part of your ankle) is broken, you may need surgery as soon as such treatment (hopefully) becomes available again.
- If it’s badly sprained, you may need surgery. A minor sprain only stretches the ligaments and tendons. A worse sprain can partially tear them, and they take longer to heal. Sometimes a sprain tears ligaments or tendons completely. These never heal without surgery; however, many times people can live with the tears just fine. The pain eventually goes away. But sometimes it remains a problem without surgery. You really can’t diagnose this without an MRI.
These are also some of the reasons it’s best to seek professional medical help for an ankle injury early on if you can, unless it’s a minor sprain, to help you decide the treatment.
My previous post about sprains and breaks gives some clues that your ankle may be fractured after you’ve rolled it. And my new book, The Survival Doctor’s Complete Handbook, goes into more detail about treatment for specific types of ankle injuries. But for now, below are some of the signs and symptoms readers frequently mention and some of the things I believe you can and can’t tell from them.
“My Ankle Is Really Swollen. So it Must Be Broken.”
Doesn’t matter when it comes to diagnosis. You can have little or no swelling with a break or sprain. Or you can have a lot with either. And the more you’re up on the injured ankle, the more it tends to swell.
The point is, you can’t tell whether a bone is broken because of the amount of swelling. It’s not usual for ankle sprains to actually swell worse than breaks.
In my experience, if the ankle swells a lot within, say, the first 10 minutes or so, you’re dealing with a serious sprain … but not always.
“It’s Not Getting Better. So it Must Be Broken.”
OK, time to worry a bit.
I like patients to come back into the office for a follow-up about a week after the injury unless it’s a lot better.
The average sprain or break does take about four to eight weeks to heal. Over that time period, though, the pain and swelling should be getting progressively better.
If I’d diagnosed someone as having a sprain but it didn’t get better as it should have, a couple of the possibilities I’d consider are:
- The injury could be a tear, which, like a sprain, wouldn’t have shown up on X-ray. It may need a cast or even surgery. Until then, the ankle needs to be in a brace.
- Rarely, a fracture may show up that didn’t on the initial X-ray.
“It Popped. What Does That Mean?”
During an injury or afterwards, hearing or feeling a pop without pain means nothing. Experiencing a pop and pain, however, does definitely increase the odds that it’s either a bad sprain with a tendon or ligament tear or, yes, a break.
“The Leg Bone Is Crooked! So It Must Be Broken.”
You’re right on this one. Stay off of it completely, and go to the emergency room as soon as you can.
What about you? Have you ever had a broken ankle that you thought was a sprain or vice versa? How long did it take you to heal?