Is Your Ankle Sprained, Strained or Fractured?

Learn the different types of ankle injuries and treatments

A man sits after turning his ankle while running. Could it be a sprain, a strain or a fracture?

Learn the different types of ankle injuries and treatments

Whether they happen while playing a sport or simply from misjudging a curb, ankle injuries are a common complaint.

The first sign is usually a sudden sharp pain in the joint, but how do you know if it is an ankle sprain, ankle strain or fractured ankle? Understanding the differences between the three types of injuries is the first step to getting the right treatment for each.

Ankle sprain

An ankle sprain occurs when the ligaments that connect the bones in the ankle joint are overstretched or torn, typically from twisting or rolling the ankle. Ankle sprain symptoms can include pain, swelling and bruising, and it may be difficult to move your ankle freely. 

The appropriate treatment for a sprained ankle depends on the severity of the injury. There are three grades of ankle sprains.

Mild sprain (Grade I)

In a mild ankle sprain, damage to the ligaments is minimal. Pain and swelling tend to be mild, and you can usually stand and bear weight on the ankle although it may be uncomfortable. Most mild ankle sprains require rest, ice, compression, and elevation (RICE) therapy for a few days until the pain and swelling subsides. Gentle stretching and massage also can help with healing.

Moderate sprain (Grade II)

With a moderate ankle sprain, the ligaments are partially torn. Pain and swelling may be moderate to severe. You may have limited range of motion when you try to move your ankle, and standing on it will likely be very painful.

Severe sprain (Grade III)

A severe ankle sprain happens when the ligament is completely torn. Pain and swelling are severe and bearing weight is likely impossible; you may need to use crutches or a scooter to keep weight off of your ankle. Your doctor may order an imaging exam, such as an MRI to help evaluate the damage.

“If your pain is significant and bearing weight is not really tolerable, have it checked out by a doctor,” says Bahram (Troy) Moghadam, DPM, a podiatrist and foot and ankle surgeon at Scripps Clinic. “Most likely we will immobilize the ankle with a walking brace or splint to allow it to heal, but in some cases, surgery may be necessary to repair the torn tissue. Once it heals, physical therapy can help restore strength and range of motion.” 

Ankle strain

An ankle strain is similar to a sprain, except the damage involves the muscles and tendons instead of the ligaments; tendons are heavy bands of fibrous tissue that connect bones to muscles.

Ankle strains often result from abrupt movements, such as suddenly changing direction in soccer or pickleball. Like ankle sprains, ankle strain symptoms include varying degrees of pain and swelling. Your ankle may feel tender to the touch and be difficult to move. Bruising isn’t likely with a strain, but you may have muscle spasms.

The grades of severity and appropriate treatments for a strained ankle are similar to those for ankle sprains.

Ankle fracture

A fractured ankle has a break or crack in one or more of the three bones that make up the ankle: the tibia, fibula and talus. Broken ankles typically occur from a fall or excessive force to the joint, such as landing incorrectly from a jump or having a high-impact collision.

Ankle fracture symptoms include severe pain and swelling, and bearing weight is impossible. You may hear the bone break or be able to see or feel it through the skin. A fractured ankle requires immediate medical attention.

If you suspect you may have broken it, go to an urgent care or emergency room. The doctor will order X-rays or other imaging tests to determine the severity of the fracture and whether the bone is displaced, meaning it has been knocked out of alignment. If the bone is still in place, you may just need a cast or brace until it heals. Surgery may be needed to realign a displaced bone or stabilize the break with screws or pins.

“In some cases, it’s actually better to break an ankle than to sprain or strain it,” says Dr. Moghadam. “When an ankle fracture occurs, the bone snaps but the ligaments and tendons generally aren’t badly damaged. Bones heal in six to eight weeks, but severely stretched or torn ligaments or tendons can take much longer.”

Regardless of which type of ankle injury you experience, it’s a good idea to seek medical attention for anything more than mild pain and swelling. The sooner you get the appropriate treatment, the sooner your ankle can heal properly.

Preventing ankle injuries

Preventing ankle injuries during exercise or playing a sport involves several key strategies. First and foremost, ensure proper warm-up and stretching routines before engaging in any physical activity to improve flexibility and reduce the risk of injury.

Wearing appropriate footwear with good ankle support is important, especially for activities involving running or jumping.

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