Sprained Ankle vs. Broken Ankle: What Are the Differences?

A sprained ankle and a broken ankle can result from twisting and rolling the ankle. While both conditions cause ankle pain and instability, a broken ankle is a more serious injury that requires different treatment compared to a sprained ankle. This article will discuss the differences between a sprained ankle and a broken ankle, how they are diagnosed, and treatment options.

Symptoms

Symptoms of a sprained ankle and a broken ankle can overlap, with pain and swelling being the most common symptoms among the two types of injuries. Symptoms between the two vary in intensity, however, and can present differently.

Symptoms that overlap between a sprained ankle and broken ankle include:

• Swelling
• Bruising
• Tenderness to the touch
• Limited range of motion

Causes

Sprained and broken ankles can result from similar causes. The extent of impact and injury to your ankle, however, will differ. Injuries caused by higher impacts typically cause more severe injuries, like a broken ankle, while milder injuries are more likely to result in a sprained ankle.

Sprained Ankle Causes

A sprained ankle most often results from twisting or rolling the ankle inward. This type of injury can occur with:

• Wearing unstable or unsupportive shoes such as flip flops or high heels
• Walking or running on uneven ground
• Jumping and landing incorrectly
• Losing your balance
• Slipping off a curb or step 

Broken Ankle Causes

A broken ankle is typically a more traumatic injury that results from a greater amount of force with injury. While a broken ankle can result from the same causes as a sprained ankle, it is also more likely to occur with:

• High-impact sports injuries, such as twisting a planted foot or falling and landing on top of your foot 
• Traumatic falls
• Motor vehicle accidents

Diagnosis

Diagnosis for an ankle injury begins with a visit to your healthcare provider after the injury to your ankle. Your healthcare provider will ask how the injury occurred and will observe how you can walk or if you can bear weight on your foot. Your healthcare provider will examine the physical appearance of your ankle, check for bruising and swelling, and try to move your ankle in different directions. 

Depending on your symptoms, your healthcare provider may take an X-ray. When screening for ankle injuries, healthcare providers typically follow the Ottawa Ankle Rules. These guidelines provide recommendations for when an ankle x-ray should be performed to determine if a broken ankle has occurred.

An ankle x-ray should be performed if you:

• Have pain or tenderness over the inner bone of the ankle (medial malleolus of the tibia)
• Have pain or tenderness over the outer bone of the ankle (lateral malleolus of the fibula)
• Cannot bear weight on your foot immediately after injury
• Cannot bear weight for four steps on the affected ankle in the emergency department

Because X-rays produce images of bone, they can be used to determine if you have a broken ankle. Your healthcare provider will be able to see if there is a fracture in one or more of the bones that make up your ankle joint.

If your X-ray is normal, but you have ankle pain, swelling, and/or bruising after an injury to your ankle, you will likely be diagnosed with an ankle sprain. Oftentimes no further tests are needed to diagnose an ankle sprain. Your healthcare provider will typically make a diagnosis based on your symptoms and negative X-ray result.

If you continue to have pain and swelling for several weeks or months after an ankle injury, your healthcare provider may have an MRI of your ankle performed. MRIs examine soft tissues of the body and can be used to determine if a tendon or ligament is torn. 

Treatment

A proper diagnosis of your ankle injury is needed to determine the appropriate treatment. Certain methods can be used for ankle injuries to reduce pain, improve range of motion, and increase strength, while more involved medical procedures and precautions are often needed for broken ankles. 

Sprained Ankle Treatment

Treatment for a sprained ankle first involves resting your ankle from prolonged standing and walking. An ankle sprain overstretches the ligaments of your ankle, causing damage that weakens its ability to stabilize your ankle joint. When this occurs, resting your ankle from the pressure of weight bearing is needed to reduce pain and irritation.

During this time, applying ice to your ankle can help reduce pain and swelling. If needed, over-the-counter pain medication like Tylenol or non-steroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) or Aleve (naproxen sodium) can also be used to help alleviate pain.

Wearing an ankle brace can also be beneficial to support your ankle joint if it feels unstable. Ankle braces and supportive sleeves can be purchased at most drug stores. If you went to the emergency room following your ankle injury, you might be provided with an ankle brace from the hospital and/or crutches to help you walk if you have a lot of pain.

Pain and swelling from an ankle sprain can limit your ankle movement, so ankle stretches and range of motion exercises are important to restore your ankle mobility. Because your ankle ligaments are sprained and weakened, you will also want to perform exercises to strengthen the muscles surrounding your ankle to provide stability.

Depending on the extent of your ankle sprain, your healthcare provider may refer you to a physical therapist to work on exercises that improve your range of motion, strength, balance, and gait (walking) pattern. 

Broken Ankle Treatment

Treatment for a broken ankle typically begins with a period of immobilization. When a bone breaks, it needs to be immobilized, or prevented from moving, for it to heal properly. Immobilization for a broken ankle will include a cast or boot to stabilize your ankle in place.

Depending on the severity of your broken ankle and how many bones were affected, you may require surgery to realign your ankle joint and hold your bones in place with metal pins and screws for it to heal.

Immobilizing your ankle will also require a period of non-weight bearing for four to eight weeks to reduce pressure on your broken ankle, which can interfere with the healing process. During this time, you will have to use crutches, a walker, scooter, or wheelchair to get around to avoid putting weight on your broken ankle.

Throughout your recovery from a broken ankle, you may use ice and pain-relieving medication to help decrease your pain and swelling.

After your initial immobilization and non-weight-bearing period, your healthcare provider will clear you to begin physical therapy. You will also be cleared to begin weight-bearing on your foot. This typically begins with a protective boot and crutches or a walker for support. As you gain more strength and stability in your ankle, the boot and assistive device will gradually be discontinued under guidance by your physical therapist to help get you back to walking normally again.

Physical therapy visits will involve several months of recovery involving stretching, strengthening, and balance exercises to return you to your prior level of functioning. 

Prevention

Preventing ankle injuries starts with wearing supportive footwear to avoid twisting or rolling your ankle. Avoid running on uneven ground and walking on slick surfaces when possible, and take your time walking downstairs. Strengthening your ankle muscles, particularly your peroneals that move your ankle outward, can also help support and stabilize your ankle joint to reduce the risk of injury.

Summary

A sprained ankle and a broken ankle can both result from twisting, rolling, or trauma to the ankle, although broken ankles result from more traumatic and higher impact injuries. Both types of injuries can result in ankle pain, difficulty or inability with bearing weight on the affected ankle, inability or difficulty walking, swelling, bruising, and reduced range of motion, with more severe symptoms and limitations with a broken ankle. 

An X-ray will diagnose whether you have a broken or sprained ankle, and treatment for both injuries will involve rest, ice, exercise, and possibly physical therapy. Severely broken ankles often need surgery to realign the broken bones and involve more limitations in the early stages of recovery, including immobilization with a cast or walking boot and non-weight bearing for four to eight weeks with the use of an assistive device like crutches, a walker, scooter, or wheelchair.