Broken Ankle or Sprain? What a Broken Ankle Looks Like, and When You Need an X-Ray

A broken ankle and a bad sprain can look almost the same: swelling, bruising and pain around the ankle. A fracture is more likely if you can't take four steps on it, if pressing on the bony bumps at the ankle or the outer edge of the foot hurts, or if the ankle looks out of shape. Those are the signs clinicians use to decide whether you need an X-ray. A deformed ankle, bone through the skin, or a cold, numb foot needs the ER.

What a broken ankle looks like

• Swelling, often quickly
• Bruising that may spread down to the foot and toes over the next day or two
• Pain right over a bone, especially the bony bumps on either side of the ankle
• Trouble or inability to put weight on it
• Sometimes a visible bump or a bent, out-of-place look
• Sometimes a crack or pop at the moment of injury

Sprain or fracture?

A sprain is a stretched or torn ligament; a fracture is a broken bone. Pain from a sprain is usually in the soft area in front of and below the outer ankle bone. Pain from a fracture is more often right on the bone. But a severe sprain can hurt as much as a fracture, and you can have both. Our post on sprained ankles and wrists covers sprains in detail.

When you need an X-ray

Clinicians often use a set of checks called the Ottawa ankle rules. An X-ray is usually needed if there's pain around the ankle and any of these:

• Tenderness along the back edge or tip of either ankle bone
• Tenderness at the base of the fifth (little toe side) metatarsal, on the outer edge of the foot
• Tenderness over the navicular bone, on the inner side of the midfoot
• Unable to take four steps, both right after the injury and at the visit

What to do right after the injury

• Stop and get off it
• Ice for 15 to 20 minutes at a time, with a cloth between the ice and skin
• Raise it above the level of your heart
• Wrap it gently with an elastic bandage, not tight enough to cause numbness
• Take acetaminophen or ibuprofen for pain, if they're safe for you
• Use crutches or get help walking if it hurts to bear weight

Treatment

• Stable fractures are treated with a splint, boot or cast and crutches, and heal in about six to eight weeks
• Unstable fractures or those where the bone is out of place may need surgery, and you'll be referred to an orthopedic specialist

What urgent care can do

A clinician can examine your ankle, decide whether you need an X-ray, splint it, and arrange crutches and follow-up. X-ray staff aren't always on site at every hour, so call ahead if you need one. Our post on broken toes, fingers and when you need an X-ray covers other common fractures, and our ski and snowboard injuries post covers the slopes.

At an AfterOurs clinic, a standard self-pay visit is $175, a visit with one moderate service such as an X-ray is $250, and a self-pay in-clinic visit never costs more than $330. We contract with all major commercial and government plans, including Colorado Medicaid and Medicare. See our minor fractures page and the cost and insurance page.

Go to the ER or call 911 if the ankle or foot is badly deformed or bent, bone is poking through the skin, the foot is cold, pale, blue or numb, there's heavy bleeding, or the injury came from a serious fall or car crash.

Where to find us

Four clinics across metro Denver, all ages welcome, se habla español:

• Hampden (Southeast Denver): 8 AM–11 PM daily
• Littleton: 8 AM–11 PM daily
• Thornton: 8 AM–11 PM daily
• Highlands: Mon–Fri 5–11 PM, Sat–Sun 8 AM–11 PM

Walk in, or book online.