| Symptoms of a Sprained Ankle | Symptoms of a Broken Ankle | |
| Pain | The pain is felt especially when putting weight on the foot. The pain is focused on the soft part of the ankle. | The pain is immediate and severe. It can become throbbing or pulsing, affecting the ankle joint. |
| Swelling | Yes | Yes |
| Bruising | Red or purple skin | Severe discoloration; black, red, or purple skin |
| Tenderness | Yes, or soreness | Yes, or numbness or coolness in the foot |
| Changes in the ankle | Ankle instability, feeling like the ankle will give out on you | Changes in the shape of the ankle, bumps, protruding bones (in severe cases) |
| Effects on walking | Difficulty and pain with walking | Complete inability to put weight on the ankle |
Because these injuries affect different parts of the ankle, there are several key differences in how the injuries are diagnosed and treated and how long they take to heal.
Which Part of the Ankle Is Affected
Sprained ankle: Ankle sprains occur when one or more ligaments—the bands of tough connective tissue that run alongside and on top of the ankle joint—stretch and tear. Ligament tears happen when the foot turns too far inward or outward, also known as inversion (inward) or eversion (outward) injuries. About 90% of sprains are inversion injuries, affecting the three lateral ligaments on the outside of the ankle. An eversion injury causes the remaining 10% of injuries, affecting the deltoid ligament on the inside of the ankle.
Broken ankle: When you have a broken ankle, it affects one or more of the three bones of the ankle joint: The distal tibia (inner shinbone) and distal fibula (smaller outer bone) of the lower leg and talus (large bone of the foot). About 70% of ankle fractures affect one bone, 20% affect two bones, and 10% affect all three.
How Common They Are
Sprained ankle: Ankle sprains are more common. They’re especially common among athletes, making up 15% of all sports injuries. Sprained ankles lead to over two million emergency room visits in the United States per year. The highest rates of ankle sprains occur in girls aged 10-14 and boys 15-19.
Broken ankle: Ankle fractures are less common. They affect about 187 out of 100,000 people. For people born female, ankle fractures are most common among those 75-84 years old. Among people born male, the injury is most common for 15-24 year olds.
Recovery Time
Recovery times from ankle injuries vary significantly and depend on how severe the case is. However, recovery from sprained ankles can be quicker.
Sprained ankle: You can expect full recovery from mild sprains within one to two weeks and should be able to apply weight within days. Recovery can take three to six weeks for moderate cases and up to several months for more severe injuries.
Broken ankle: Recovery times can be longer with ankle fractures. You’ll need to wear a cast or supportive boot for at least four to eight weeks, and it takes at least six to 10 weeks before the ankle heals. Most people can resume normal activities at three or four months, with complete recovery taking up to two years.
While they are different injuries, sprained and broken ankles have a lot in common in terms of diagnosis, treatment, and management.
How They’re Diagnosed
Doctors will use the same types of tests to diagnose either injury. A physical exam is enough to detect most cases of an ankle sprain. But if you have chronic or severe symptoms or your doctor suspects a bone fracture, they may take images or scans of your ankle.
Tests that healthcare providers may use to diagnose both conditions include:
- Palpation: The doctor will gently squeeze and press the affected areas.
- Range of motion test: The doctor will assess how much your ankle is able to move.
- Stability test: The doctor will push and pull on the foot to test its ability to provide support.
- Neurovascular assessment: The doctor feels and looks for signs of blood vessel or nerve damage or abnormalities like skin tenting, which is when the skin is tight around a broken bone, making it appear in a tent shape.
- Imaging: This could be X-rays, magnetic resonance imaging (MRI), or computed tomography (CT) scans used to screen for signs of a bone fracture or assess the extent of damage to the ankle.
The Need for Support
Treatment for both injuries always focuses on immobilization, which involves supporting the ankle as it heals.
For a mild sprain, taping the ankle can help. For more serious cases, you may need a walking boot or cast. You may wear a cast or brace for up to 10-14 days with a severe sprain.
For a broken ankle, you’ll need a cast or walking boot for at least four to eight weeks.
Symptom Management
Strategies to manage symptoms of ankle sprains and broken ankles overlap. In both cases, you should keep weight off, regularly apply ice, and elevate the ankle to help manage swelling. Over-the-counter pain medications, such as Motrin (ibuprofen) or Tylenol (acetaminophen), may help.
Your doctor may prescribe opioids or other medications for severe pain in the early stages of recovery.
Physical Therapy
Physical therapy involves working with a physical therapist to learn and perform exercises to restore ankle strength and stability. For ankle sprains, once the swelling and initial symptoms subside, treatment programs support rehabilitation and can speed recovery.
Physical therapy can also play a role in recovery from ankle fractures. The therapy starts once the cast or boot is removed and your doctor is sure your ankle can safely bear weight.
Since ankle sprains and broken ankles are both caused by accidents or falls, it’s possible to experience both at the same time. In fact, it’s pretty common. It’s estimated that one in five people with sprains also had bone fractures.
One type of injury that can cause a sprain and break is a syndesmosis injury. The syndesmosis is a group of ligaments just above the ankle joint. When it’s sprained, it’s known as a high ankle sprain. One or more bones may break, too.
If you have an ankle injury, any symptoms of a broken ankle or a severely sprained ankle need medical attention. In more severe cases, you may be referred to a podiatrist, a doctor specialized in foot and ankle conditions, or an orthopedic surgeon, a doctor specialized in diagnosing and treating bone, joint, and muscle injuries.
If you have any of the following signs, contact your doctor:
- You’re unable to walk or feel severe pain while walking
- Pain or swelling gets worse despite rest, icing, and pain medication use
- Symptoms last five to seven days
- Your ankle feels unstable or weak
- Your ankle is discolored, like red, black, or blue
- You have numbness, prickling, stinging, coldness, or a change in sensation
Although both can cause symptoms like swelling and pain, there are significant differences between ankle sprains and broken ankles. Sprains affect the ligaments that support the bones of the ankle joint, while fractures affect the bones. In general, recovery from ankle sprains is quicker, as little as seven to 14 days, with broken ankles taking months to years to heal fully.
Your doctor will use similar tests to diagnose broken and sprained ankles, and the non-surgical treatment approaches will overlap. If you think you have either condition, reach out to a doctor for guidance.
