Broken or Sprained Ankle?

The ankle has an ant-like ability to sustain huge loads during day-to-day life. In fact, it can handle up to three times a person’s body mass. But when things go wrong, the results can be painful and difficult to diagnose. How do you know if you have a broken or sprained ankle?

Understanding the difference between a broken or sprained ankle starts with understanding the anatomy of the ankle. The joint is made up of three bones, the inside and back part of the tibia (or shinbone), the end of the fibula (a smaller, lower-leg bone), and the talus (a small bone that sits between the heel, and the tibia and fibula).  

The inside portion of the tibia is known as the medial malleolus. The back of the tibia is the posterior malleolus, and the end of the fibula is called the lateral malleolus. Doctors classify fractures based on these official titles. For example, a break at the end of the fibula is called a lateral malleolus fracture.

“The anatomy of the ankle is very complex, and the pain from a broken or sprained ankle can be quite similar,” says sports medicine specialist Dr. Joseph L. Finstein. “I’ve diagnosed patients with a break and sprains following identical mishaps - A trip or fall, twisting or rolling an ankle, or an impact in sports.”

The diagnosis process begins with a careful examination of your ankle, foot and lower leg with a focus on pain levels, how the injury happened, and your medical history. If an ankle fracture is indicated, additional tests like X-rays, CT (computed tomography) or MRI (magnetic resonance imaging) scans, or stress tests may be ordered to provide more information.

Broken ankles are caused by stressing the ankle joint beyond the strength of its elements. When a fracture occurs, the bone is chipped, cracked, or completely broken in two or more places.

Symptoms most associated with a broken or sprained ankle may include:

Breaks should always be checked by a healthcare professional to ensure proper healing. As Dr. Finstein discussed in his blog post "Broken Bone - Why See an Orthopedist", an untreated break can lead to serious complications. The fibula, for instance, can be fractured at different levels, each requiring different treatment options.

A sprained ankle is actually a tear or disruption of the ligaments, which is fibrous tissue that holds bone to bone in a joint. Sprains occur when too much pressure is put on the joints, overstretching the ligament to the point where they can rupture completely. 

Spains are generally broken down into two types: a common ankle sprain and a high ankle sprain. The common variety involves an injury to the AFTL (anterior talofibular) ligament on the outside of the ankle. A high ankle sprain, which is quite common in sports, involves a different group of ligaments above the join and between the tibia and fibula, known as syndesmosis.

New Orleans Saints running back Alvin Kamara suffered a high-ankle sprain during practice after a Week 6 game against the Jacksonville Jaguars. University of Alabama quarter Tua Tagovailoa endured a similar injury earlier this season.

As with broken or sprained wrists, most ankle sprains are treated using the “RICE” method of rest, icing, compression and elevation. Patients are encouraged to keep weight off the affected joint, to ice for about 15 minutes every few hours during the first days after injury, to wrap the leg, and to sit or lie with the foot above the level of your heart. This helps reduce swelling and alleviate some pain. The period of rest for a high ankle sprain can be as much as twice as long – six weeks or more. 

In the case of severe high ankle sprains, if the ankle is unstable, a fracture is out of place or the ligament is completely torn, surgery may be required. The latest surgical treatment to stabilize a high ankle sprain is the TightRope anchor system. The TightRope system anchors the ends of the tibia and fibula together with a braided polyethylene cord, rather than with a rigid surgical screw, to restore the original position of the bones and to allow for proper healing.

Healing after these injuries involves a similarly broad range of time. Pain from some sprains is gone within a matter of weeks; it takes longer for broken bones and torn soft tissue to heal. The doctor may recommend a walking boot, as you transition back to every-day activities.

Because a broken and sprained ankle can be so similar, you need to have an ankle injury evaluated by a specialist. If the injury happens on the weekend, you can see an orthopedic specialist, without an appointment, at our Saturday clinic. We see patients on both sides of the river at our Metairie clinic and our Boutte clinic.