Foot Pain: Is My Ankle Sprained or Broken?

Ankle injuries, which can include ligament overstretching or tearing and bone fractures, are common orthopedic injuries that affect athletes and individuals of all kinds. When ankle pain occurs, it’s easy to confuse sprains and fractures because the symptoms can feel similar.

In this blog, we speak to Laura Luick, M.D., a board-certified orthopedic surgeon with INTEGRIS Health Medical Group Orthopedics Central, to learn more. 

“Often, ankle sprains and fractures can be difficult to differentiate on symptoms alone,” Luick explains. “It is important to consult with a medical professional for both sprains and breaks." 

Key differences between a sprained ankle and broken ankle

A sprained ankle involves ligament damage, whereas a broken ankle involves one or more of the bones breaking. Although the symptoms can be similar, fractures usually take longer to heal and the treatment is usually more involved.

Ankle sprain

Your foot has several ligaments that connect bones in your feet to bones in your leg. During activities, these ligaments can stretch or tear, which is known as a sprain.

The ankle has three ligament complexes that are involved with sprains – medial ligaments (inner ankle), lateral ligaments (outer ankle) and syndesmotic ligaments (high ankle).

• Medial ligaments: Also called deltoid ligaments, these are four bands that connect the tibia to the lower part of the ankle (talus), heel bone (calcaneus) and a wedge-shaped bone in the midfoot (navicular).
• Lateral ligaments: These ligaments consist of three bands that are located on the outside of the ankle and connect the fibula to the talus and calcaneus.
• Syndesmotic ligaments: Located at the top of the ankle, these bands consist of the anterior inferior tibiofibular ligament (in front of the tibia and fibula) and the posterior inferior tibiofibular ligament (in back of the tibia and fibula).

When it comes to sports injuries, ankle sprains are either classified as low ankle sprains or high ankle sprains. 

Most low ankle sprains occur when the ankle inverts (rolls inward) – lateral ligaments are weaker than other foot ligaments and more prone to injury. Deltoid ligament involvement is less common but can happen in severe sprains or in fractures. Of the three lateral bands, the anterior talofibular ligament at the front of the ankle and the calcaneofibular ligament at the middle of the ankle are usually most affected.

High ankle sprains, also called syndesmosis sprains, are more severe because the bones the ligaments support – the tibia and fibula – carry a greater load. High ankle sprains occur when the foot is flexed upward and then turns inward or outward. They are most common when a forceful blow is involved, such as athletes who play contact sports.

Despite the severity and prolonged healing time, high ankle sprains don’t tend to produce much swelling or bruising.

An ankle sprain, regardless of type, falls under three categories – grade 1 (mild), grade 2 (moderate) or grade 3 (severe).

• Grade 1: A mild ankle sprain occurs when ligaments stretch but aren’t torn. Pain and swelling are the most common symptoms.
• Grade 2: A moderate ankle sprain occurs when ligaments partially tear. In addition to pain and swelling, the foot may also bruise and be difficult to walk on.
• Grade 3: A severe ankle sprain occurs when ligaments completely tear or rupture. Grade 3 sprains produce significant pain, swelling, bruising and instability. Walking usually isn’t possible with a severe sprain.

Broken ankle

Ultimately, a broken ankle is categorized by the location in which the fracture occurs. You will hear doctors use the word malleolus (the bony knob on each side of the ankle) to describe the fractures – medial malleolus is on the inner side of the ankle, lateral malleolus is on the outer side of the ankle and posterior malleolus is on the back of the tibia.

• Lateral malleolus fracture: This fracture occurs when the bone on the outside of the ankle breaks, specifically the fibula. It’s the most common ankle fracture.
• Medial malleolus fracture: This fracture occurs when the bone on the inside of the ankle breaks, specifically the tibia.
• Bimalleolar ankle fracture: This fracture occurs when both the lateral and medial malleolus break. This usually happens when severe twisting is involved.
• Bimalleolar equivalent fracture: This fracture involves both a break and damage to ligaments, typically the deltoid ligament.
• Posterior malleolus fracture: This fracture occurs when the back of the tibia breaks.
• Trimalleolar fracture: This injury occurs when a break occurs to the lateral malleolus, medial malleolus and posterior malleolus.
• Pilon fracture: This rare type of fracture, also called a tibial plafond fracture, occurs when the end of the tibia near the ankle breaks. Extreme force is typically to blame – trauma drives the talus up into the base of the tibia.
• Maisonneuve fracture: This fracture occurs when you both damage ligaments in your ankle and fracture the top part of the fibula near the knee.

What to look for

• Pain: A broken ankle typically produces severe pain compared to mild or moderate pain associated with an ankle sprain.
• Swelling/bruising: Swelling and bruising tend to be more prominent when a fracture occurs.
• Instability: A broken ankle makes it difficult to bear weight, while you may still be able to walk on a sprain.
• Deformity: Ankle misalignment when the bone moves out of place is a key sign of a fracture.
• Range of motion: Movement is usually harder with a break than a sprain, particularly if the break is extensive.

Diagnosing ankle injuries

When an ankle injury occurs, your doctor can conduct various exams to determine the severity or type of injury.

How do the treatments differ?

Surgery for ankle fractures include a procedure called an open reduction internal fixation (ORIF). The surgery realigns the broken bones and secures them with screws, plates or metal rods so they can heal properly.

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