Is my ankle broken?

Only in the UK, more than 1.5 million people attend A&E each year with ankle injuries. It is the most commonly injured body part during sport activities. Many people will ask themselves, how do I know if the ankle is broken (fractured) or just sprained? There is the saying that if you can move it, then it isn’t broken, but that is not always the case. 

Basic ankle anatomy

A broken ankle is an injury to the bones whereas a sprain is an injury to the ligaments (the connectors between bones).

The ankle joint owes its movement to a hinge created by the bones and its connecting ligaments. To be precise, the movement in the ankle is a combination of motion in two main joints. The true ankle joint or tibiotalar is responsible for the up and down motion, and the subtalar joint or talocalcaneal is responsible for the side-to-side motion. The true ankle joint is where the vast majority of fractures take place. This joint is formed by the tibia (shin bone) and the fibula (the other bone in the lower leg) which together articulate with the talus (ankle bone). 

The normal anatomy of these bones creates a tight assembly that resembles a mortise and allows for smooth movement. The main ligaments are localised in each side of the leg. On the inside they link the tibia to the talus, on the outside they link the fibula to the talus and the tibia to the fibula.

What are the signs of a fractured ankle?

Any of the three bones that make up the ankle joint can break but the most commonly broken ones are the tibia and the fibula at each side of the ankle. These two bones can be easily felt on everyone’s ankle as they create the bumps that jut out from the inside and outside of the ankle.

A broken ankle can happen as a result of a fall while walking, during sports or after a more severe trauma as in a car accident. 

Some of the signs and symptoms (complaints) of a broken ankle will include: Immediate pain (although pain can be masked in diabetic patients), swelling, bruising, tenderness to touch especially of the bony bumps, inability to bear weight (with pain when attempting to do so), and deformity (in the instance that the fracture creates a dislocation and moves the bones out of place).

Every ankle fracture is different just like every patient is different and no single ankle fracture will present in the same way. There are instances when an ankle fracture does not clearly show any of these signs or symptoms

What to do if an ankle fracture is suspected? 

Because of the variable presentation that accompanies ankle fractures, every injury to the ankle should be examined by a medical professional. There is a fine line that separates an ankle fracture from a sprain when it comes to symptoms. A severe sprain can often look like a fractured ankle and a minor fracture can present like a sprain. 

If you have sustained an injury to your ankle with swelling, pain and/or bruising you should see a doctor or orthopaedic surgeon who will rule out a fracture or any other major injuries. 

Until you have done so, the ankle can be splinted for comfort and if you have crutches you should use them to avoid putting weight on the injured leg. 

How is the fracture ruled out in clinic?

At your arrival to the clinic, your doctor will take a complete history of your injury. I am interested in knowing what happened for the ankle to break and whether previous injuries were sustained to this ankle. I will ask for your current symptoms or complaints to treat them in the best way possible but also to prevent any complications from the fracture. A radiograph (X-ray) is the ideal next step to rule out a fracture or find the location of the break. Occasionally advanced imaging like MRI or CT scan can be necessary. 

The type of treatment will depend highly on the result of the X-ray and there are some fractures that are treated with surgery whereas others can heal in a boot or ankle brace.