Ankle Sprain vs. Ankle Fracture: How to Tell the Difference

Ankle injuries are incredibly common—but how do you know if it’s just a sprain or something more serious, like a fracture? Unfortunately, the symptoms can look similar. Here’s how to tell the difference and when to seek help.

What’s a Sprain?An ankle sprain involves stretching or tearing of the ligaments that stabilize the joint. Most often, this affects the lateral ligaments on the outer side of the ankle.

What’s a Fracture?A fracture means there’s a break in the bone—this can include the tibia, fibula, or talus near the ankle joint. Fractures may occur with or without visible deformity.

Key Signs It May Be a Fracture:

• Inability to bear weight at all

• Pain directly over the bony areas, not just soft tissue

• Noticeable deformity or misalignment

• Severe swelling and bruising shortly after injury

• Hearing or feeling a “crack” at the time of trauma

Ottawa Ankle Rules:Doctors often use these guidelines to determine whether an X-ray is needed:

• Pain in the malleolar zone (ankle bones)

• Bone tenderness at the back edge of the fibula or tibia

• Inability to take four steps

Treatment Differences:

• Sprains: RICE (rest, ice, compression, elevation), rehab, and a gradual return to activity

• Fractures: May require immobilization, casting, or surgical fixation depending on severity

Bottom line: If you can’t walk, don’t wait—get your ankle evaluated. Early diagnosis makes all the difference in recovery.