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Broken Ankle vs. Sprained Ankle: What’s the Difference?

Summit Orthopedics foot and ankle surgeon Tracy Rupke, M.D., explains the difference between a broken ankle and a sprained ankle and tells you what to do about it.

The ankle joint is complex, with many ligaments, tendons, bones, and muscles all coming together in a small space. It’s also prone to injuries, including breaks and sprains. But how do you know the difference between a broken ankle and a sprained one? Summit Orthopedics foot and ankle surgeon Tracy Rupke, M.D., “breaks” down broken ankles vs. sprained ankles and explains when to seek treatment.

Broken ankle vs. sprained ankle: what’s the difference?

“When you have a broken (or fractured) ankle, that means a bone in your ankle has broken,” Dr. Rupke said. “When you have an ankle sprain, that means you’ve damaged one or more ankle ligaments, the tough strips of tissue that connect bones to other bones.”

Both ankle breaks and sprains are most often the result of slipping and falling, whether on the snow and ice or inside on the stairs. A broken or sprained ankle can also happen in car accidents, during sports, or in a variety of other situations. Symptoms of broken and sprained ankles are often quite similar, with pain, bruising, and swelling common in both.

When should you seek treatment for a broken or sprained ankle?

Many people think no treatment is needed when “it’s just a sprain.” But according to Dr. Rupke, that’s a dangerous attitude to take. “Even a bad sprain needs treatment, and it’s impossible to know the extent of the injury without an X-ray,” Dr. Rupke said. “If you hurt your ankle, and it’s sore, swollen, or bruised, you need an X-ray.”

Some people use the “can I put weight on it?” test to determine whether they come in for treatment, but Dr. Rupke does not recommend that rule of thumb. “Even people with fractures can put weight on their injured ankle sometimes. It’s not a good test, and you could be doing even more damage by trying to walk on it,” Dr. Rupke said.

What are treatments for broken ankles vs. sprained ankles?

Treatment varies according to the injury’s severity. “For a minor sprain, you might have a splint or ankle brace,” Dr. Rupke said. “For anything more major, we may recommend a walking boot.”

Most nondisplaced ankle fractures, where the bone ends have not shifted out of their natural position, can be treated in a boot. If the bone ends have moved (called a displaced fracture), surgery may be needed to make sure the ankle heals properly. No matter whether it’s a broken ankle or a sprained ankle, getting treatment is key.

“For some ankle injuries, if they are not treated, there is a 90 percent chance of developing arthritis within just six months of the injury,” Dr. Rupke said. “Even less severe conditions can have devastating long-term results. In sum, even if it turns out to be just a mild sprain, it pays to get an X-ray to be sure.”

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