Broken Ankle Symptoms vs Sprain | How To Tell The Difference

Ankle sprains happen to about 1 out of 10,000 people per day, which makes it a common injury. (1) In contrast, a broken or fractured ankle is much rarer at only 179 per 100,000 people per year. (2) But, how can you tell the difference between broken ankle symptoms vs sprain?

Interestingly, both ankle injuries suffer a few of the same symptoms such as pain, swelling, and bruising. Their differences lie in the details, including the intensity of the pain, the amount of bruising, the range of motion, and others.

I’ll walk you through all of those but here are other related topics you’ll find here:

What’s the difference between a sprained or broken ankle?

Although they can both happen in your ankle joint, the main differences of these ankle injuries are:

  • The structures affected
  • How the injury happened
  • How the pain and swelling manifest themselves

Ankle sprains

An ankle sprain involves the ligaments. It affects the lateral ligaments about 85% of the time. (3

Ankle sprains usually happen after you roll your ankle awkwardly or land on someone’s foot.

This can lead to pain and ankle swelling that usually calms down after a few days.

Broken (fractured) ankle

A broken or fractured ankle describes bone damage.

Trauma or repetitive stress can result in either small cracks or full-on bone breakage. Among the bones of the ankle, it commonly affects the lateral malleolus – the bony bump on your outer ankle.

Those who had a broken bone can attest to the unbearable pain that happens immediately after the injury. 

Symptoms of sprained ankle vs broken ankle

Of course, there are other symptoms aside from pain and swelling that also play a huge role in defining both these injuries.

Sound

As the injury occurs, most ankle sprains have an audible popping sound. Meanwhile, a loud “crack” can often be heard for ankle fractures.

Pain intensity and tenderness

Pain from an ankle sprain is generally milder. You can even walk on your own with minor sprains.

But, with a broken ankle, the pain is much more severe to the point where full weight bearing can be impossible. Also, because of the broken bones surrounding the ankle joint, even the slightest touch can cause intense pain.

Deformity

Swelling is common for both sprained or broken ankles. But, for the latter, there can also be distortion on your affected joint, making your foot angled or unnaturally bent.

Bruising

There are more blood vessels involved in a broken ankle which can result in more noticeable skin discoloration. This also tends to take longer to fade in fractures whereas, in ankle sprains, it might only last for a day or two.

Range of motion

With a sprained ankle, pain is present at the extremes of range of motion.

In contrast, the severe pain from fractures can make it nearly impossible to move your foot and ankle.

When should I seek medical treatment for my ankle?

For severe cases of ankle sprains and any form of fracture, it’s important that you seek immediate medical attention to avoid making your injury worse. Also, because of the similarities between these injuries, getting an accurate diagnosis from your doctor is crucial for your treatment.

Treatment options for ankle sprains and ankle fractures

For ankle sprains

  • RICE therapy – This means rest, ice, compression, and elevation. It’s the treatment of choice for the first 4-5 days of getting your ankle sprained. (4
  • Medication – NSAIDs (nonsteroidal anti-inflammatory drugs) can help deal with inflammation which also results in pain relief. Examples include ibuprofen, aspirin, and naproxen.
  • Physical Therapy – A trip to your physical therapist can help shorten the recovery time. After a thorough assessment, they’ll provide exercises for foot strengthening, ankle strengthening, and balance. If necessary, your PT might also recommend an ankle brace.

For further reading: All about ankle braces and injuries

For ankle fracture

  • RICE therapy – Mild and non-displaced fractures might only need this to heal. However, this also means wearing a cast and staying off your foot.
  • Surgery – This is for more serious fractures and those that come with other soft tissue damage. This is done to reduce the risk of permanent deformity and other complications. You will also need to wear a protective boot and undergo physical therapy after your surgery.

FAQs:

Can a sprained ankle turn into a fracture?

Generally, no. They can have the same mechanism of injury but it can only either be one or the other. But, if you abuse your sprain and lose your balance, the consequent injury might be a broken bone.

What can happen if an ankle fracture is not treated right away?

Untreated fractures come with a higher risk for arthritis and other foot deformities.

What can happen if a sprained ankle is not treated right away?

An ankle injury that’s not taken care of results in higher chances of recurrent ankle sprain and possibly chronic ankle instability.

How long does it take for a fractured ankle to heal?

A fracture to the fibula can take six weeks to fully heal.

How long does it take for a sprained ankle to heal?

Minor ankle sprains only take a few days to recover. Severe ankle sprains can take around 2 months.

Conclusion

So to summarize,  an ankle sprain:

  • Usually affects your outer ankle ligaments
  • Less intense symptoms as compared to a broken bone
  • Can get better without surgery

While an ankle fracture:

  • Affects bones rather than soft tissue
  • More painful and traumatic than a sprained ankle
  • Higher chance for surgery and has a longer recovery time 

Resources

  1. Struijs, Peter, and Gino Kerkhoffs. “Ankle sprain.” BMJ clinical evidence vol. 2007 1115. 1 Sep. 2007 https://pubmed.ncbi.nlm.nih.gov/19450300/
  2. Juto, Hans et al. “Epidemiology of Adult Ankle Fractures: 1756 cases identified in Norrbotten County during 2009-2013 and classified according to AO/OTA.” BMC musculoskeletal disorders vol. 19,1 441. 13 Dec. 2018, doi: 10.1186/s12891-018-2326-x
  3. Ferran, Nicholas Antonio, and Nicola Maffulli. “Epidemiology of sprains of the lateral ankle ligament complex.” Foot and ankle clinics vol. 11,3 (2006): 659-62.  DOI: 10.1016/j.fcl.2006.07.002
  4. van den Bekerom, Michel P J et al. “What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults?.” Journal of athletic training vol. 47,4 (2012): 435-43. doi: 10.4085/1062-6050-47.4.14

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