Sprained ankle vs. broken ankle: Getting the right care for your injury

Joint Health

by Eitan Ingall, MD

Mar 29, 2024

Ankle injuries are one of the most common orthopedic-related reasons people visit the ER. And they can happen to almost anyone at any age—from a landing badly while playing a sport, to an accident at work, to a fall at home.

While some severe broken ankles are easy to recognize, you may not be able to tell if your injury is a sprained ankle or a fracture without a visit to the doctor. When in doubt, it’s best to get an X-ray. Having a clear picture of your ankle is important because the treatment for these two common injuries is different.

If there’s an obvious dislocation or deformity in your ankle, go to the emergency room for care. If you’re unsure, plan to see a doctor within 24 hours. You can visit an urgent care with X-ray imaging or look for an orthopedic clinic that offers a one-stop shop, where you can get an X-ray and see a specialist all in one place.

Sprained ankle treatment

Usually, a sprained ankle is caused by a low-energy injury where the foot inverts under the leg. When this happens, ligaments around the ankle can tear or stretch. The most common type of ankle sprain affects the ligaments on the outside of the ankle, but people can also injure the ligaments on the inside or a group of ligaments higher up on the ankle—known as a high ankle sprain.

Sometimes, we see people with X-rays that show a small piece of bone that pulled out along with their torn or stretched ligament. While this can appear like a broken ankle, it’s still only a sprain.

Most sprained ankles are treated by wearing a boot for about a week, followed by a brace. The goal with an ankle sprain is to promote early motion and activity and wean off the boot and brace as soon as possible. Wearing the boot too long can actually make your recovery harder and lead to other problems like hip pain, skin sensitivity or muscle atrophy.

What to expect with a broken ankle

Broken ankles can range from small fractures to major dislocations, and your symptoms and treatment will depend on how severe your broken ankle is. When it comes to ankle fractures, think of your ankle like a pretzel. A single break on the outside doesn’t typically affect the stability of the whole. But multiple breaks or a break in the middle will make the whole pretzel—or ankle—unstable.

Some small fractures that aren’t causing instability are treated without surgery. There’s good data that shows people with this type of injury do just fine with a brief period of immobilization in a boot, followed by a brace and then a regular shoe.

If you have a break in more than one place or there is instability, surgery is usually needed. The goal of surgery is to restore the rotation and alignment in the ankle and allow early motion. After a period of non-weight-bearing while the fracture is healing, most people are able to start walking with a boot and then a regular shoe.

Ankle health 101: How to fix ankle pain

Orthopedic care is highly specialized, so if you have a fracture or have multiple ankle sprains, consider visiting an orthopedic foot and ankle specialist sooner rather than later. By visiting a specialist early, you can often prevent future problems. For example, 80% or more of ankle arthritis is post-traumatic, meaning it’s a result of ankle fractures or multiple ankle sprains. So early, specialized care is important.

For people who have had more than one ankle sprain or start to have ongoing instability from multiple sprains, we have data-driven physical therapy protocols that if you follow them, can help your ankle stability get better.

If you have other medical conditions—such as osteoporosis or diabetes—or you’re a high-level athlete, visiting an orthopedic foot and ankle specialist is important, too. People at risk or with osteoporosis can choose high-impact activities that have been shown to increase bone density and decrease the risk of fractures.

Whether you have a sprained ankle, a broken ankle, or another foot or ankle condition, an orthopedic foot and ankle specialist can work with you to plan your next steps. Don’t wait to get the care you need. As your partner for everything from your knees to your toes, we want to see you quickly so you can get back to your active life.

Have questions about your ankle health? Find an orthopedic specialist near you.

About the Author

Eitan Ingall, MD, is an orthopedic foot and ankle surgeon on the medical staff at Baylor Scott & White Medical Center – McKinney.

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