Sprained Ankle vs Broken Ankle: How to Tell the Difference

What Happens When You Sprain Your Ankle?

A sprained ankle occurs when the ligaments that support your ankle stretch beyond their normal range or tear. Think of ligaments as strong rubber bands that connect your bones and keep your joints stable. When you roll, twist, or turn your ankle in an awkward way, these ligaments can become overstretched or damaged.

Ankle sprains are incredibly common, accounting for about 16%-40% of all sports-related injuries. The most frequent type affects the ligaments on the outside of your ankle, which happens when your foot rolls inward while your leg moves in the opposite direction.

There are three grades of ankle sprains:

• Grade 1 (Mild): Ligaments are stretched but not torn
• Grade 2 (Moderate): Partial tearing of the ligament
• Grade 3 (Severe): Complete tear of the ligament

What Happens When You Break Your Ankle?

An ankle fracture, commonly called a broken ankle, involves one or more breaks in the bones that make up your ankle joint. Your ankle is actually more complex than you might think. It’s formed by three bones: the tibia (shin bone), fibula (smaller bone next to your shin), and talus (foot bone that sits on top of your heel bone).

Ankle fractures can range from small cracks in the bone to complete breaks where the bone separates into multiple pieces. The severity often depends on the force of the injury and the direction of the trauma.

Sprained Ankle vs Broken Ankle: Key Symptoms to Watch For

While both injuries can cause pain and swelling, there are some telltale signs that can help you differentiate between a sprain and a fracture:

Sprained Ankle Symptoms

• Pain that’s often manageable and may improve with rest
• Swelling that develops gradually
• Bruising around the ankle area
• Difficulty bearing weight, but usually still possible
• Ankle feels unstable or “gives way”
• Pain increases with movement or pressure on the ligament

Broken Ankle Symptoms:

• Severe, immediate pain that may be excruciating
• Rapid, significant swelling
• Visible deformity or ankle appears “out of place”
• Inability to bear any weight on the affected foot
• Numbness or tingling in the foot
• Bone protruding through the skin (in severe cases)

Pain Levels: Sprained Ankle vs Broken Ankle

One of the most common questions we hear is, “How much pain is normal?” The answer isn’t black and white, but here’s what typically distinguishes the two:

Sprained ankles usually cause moderate pain that you can somewhat tolerate. You might limp, but you can often still walk short distances. The pain tends to be achy and throbbing, and it may actually feel better when you’re not moving.

Broken ankles typically cause severe, sharp pain that’s difficult to ignore. The pain is often described as intense and constant, regardless of whether you’re moving or at rest. Most people with a broken ankle cannot put any weight on their foot without experiencing excruciating pain.

The Weight-bearing Test

The ability to bear weight on your injured ankle is one of the most reliable indicators of injury severity, though it’s not foolproof.

With a mild to moderate sprain, you might be able to walk, albeit with discomfort and a limp. However, walking isn’t recommended as it can worsen the injury.

With a severe sprain or broken ankle, walking is usually impossible due to pain and instability. If you cannot take four steps without severe pain, it’s likely more than a minor sprain.

Remember: just because you can walk doesn’t mean you should. Even if it’s “just” a sprain, continuing to walk on an injured ankle can delay healing and potentially cause long-term problems.

Sprained Ankle vs Broken Ankle: Comparison Chart

Immediate First Aid: What to Do Right After Injury

Whether you’re dealing with a sprain or fracture, proper immediate care can make a significant difference in your recovery:

For suspected sprains: Follow the RICE protocol:

• Rest: Stop activity immediately
• Ice: Apply for 15-20 minutes every 2-3 hours for the first 48 hours
• Compression: Use an elastic bandage (not too tight)
• Elevation: Keep your ankle raised above heart level when possible

For suspected fractures:

• Don’t put any weight on the ankle
• Keep the ankle as still as possible
• Apply ice wrapped in a towel
• Seek emergency medical care immediately

When to See a Doctor: Red Flags You Shouldn’t Ignore

While minor sprains can often be managed at home initially, certain symptoms warrant immediate medical attention:

• Severe pain that doesn’t improve with rest and over-the-counter pain medication
• Complete inability to bear weight
• Visible deformity of the ankle
• Numbness or tingling in your foot
• Signs of infection (if there’s an open wound)
• No improvement after 2-3 days of home treatment
• Your ankle feels completely unstable

At Motion Orthopaedics, we always recommend the “better safe than sorry” approach. If you’re unsure about the severity of your ankle injury, it’s worth having it evaluated by an orthopedic specialist.

Sprained Ankle vs Broken Ankle: Diagnostic Tests

When you visit an orthopedic clinic, several diagnostic tools help determine whether you have a sprain or fracture:

• Physical examination involves testing your ankle’s range of motion, checking for points of tenderness, and assessing stability.
• X-rays are the gold standard for identifying fractures. They can show breaks in bones but won’t reveal ligament damage.
• MRI or ultrasound might be ordered if a severe ligament injury is suspected, as these tests can show soft tissue damage that X-rays miss.
• CT scans are sometimes used for complex fractures to get detailed images of bone damage.

Treatment Approaches

Sprained Ankle Treatment

• Mild sprains: RICE therapy, over-the-counter pain relievers, gradual return to activity
• Moderate sprains: May require a brace or boot, physical therapy
• Severe sprains: Sometimes need immobilization similar to fractures, extensive physical therapy

Broken Ankle Treatment

• Non-displaced fractures: Cast or boot for 6-8 weeks
• Displaced fractures: May require surgery to realign bones
• Complex fractures: Often need surgical repair with plates, screws, or rods

Recovery Timeline: What to Expect

Sprained ankles typically heal in 1-6 weeks, depending on severity. Grade 1 sprains might feel better in a few days, while Grade 3 sprains can take several months to fully heal.

Broken ankles generally require 6-12 weeks for the bone to heal, followed by physical therapy to restore strength and mobility. Complete recovery can take several months.

Preventing Future Ankle Injuries

Both sprains and fractures often happen due to similar mechanisms, so prevention strategies overlap:

• Strengthen your ankle and calf muscles
• Improve your balance and proprioception
• Wear appropriate footwear for your activities
• Be cautious on uneven surfaces
• Warm up properly before exercise
• Consider ankle bracing if you have a history of injuries

When in Doubt, Get It Checked Out

The difference between a sprained ankle and a broken ankle isn’t always obvious, even to healthcare professionals without proper examination and imaging. While this guide can help you understand the typical differences, there’s no substitute for professional medical evaluation.

At Motion Orthopaedics, our experienced team specializes in diagnosing and treating all types of ankle injuries. We use state-of-the-art diagnostic equipment and evidence-based treatment approaches to get you back on your feet as quickly and safely as possible.

Meet Our Ankle Specialists:

• David J. King, MD
• Mitchell Tarka, MD
• Scott W. Zehnder, MD
• Nathan Mall, MD, CIME

Remember, proper treatment of ankle injuries, whether sprains or fractures, is crucial for preventing long-term complications like chronic pain, instability, or arthritis. 

If you’re dealing with an ankle injury and aren’t sure whether it’s sprained or broken, request an appointment at Motion Orthopaedics today. 

Your ankles carry you through life;  they deserve expert care when things go wrong.