Ankle injuries are incredibly common in athletes and non-athletes, alike. That is because the ankle joints play an important function in every step you take and are responsible for keeping you stable and maintaining balance as you move through sports, work, and everyday life. And while the ankle joint is technically a hinge joint with a somewhat limited range of motion up, down, left, and right, it’s also a synovial joint with the most freedom to move (compared to other types of joints).
This freedom of movement is a blessing and a curse, as the joint is prone to both ankle sprains and fractures.
Broken Ankle vs Sprained Ankle
Also called an ankle fracture, a broken ankle occurs when one or more of the bones that make up the ankle joint – the tibia, fibula, and talus – suffer a break. The severity of a broken ankle can vary widely from a hairline fracture (or tiny crack in the bone) to complex ankle fractures that involve severe damage to the soft tissue around the bone, the bone breaking into multiple bits and pieces, and other complicating injuries that compound the ankle injury.
In general, ankle fractures are classified as nondisplaced fractures (the bone fragments are not out of place), displaced fractures (the broken bone fragments are out of place), and open fractures (the broken bone breaks through the skin).
There are four main types of ankle fractures:
- Lateral malleolus fracture – a fracture of the lower end of the fibula
- Posterior malleolus fracture – a fracture of the back of the tibia
- Bimalleolar fracture – a fracture to both the medial malleolus and lateral malleolus
- Trimalleolar ankle fracture – a bimalleolar fracture with the posterior malleolus also broken
Broken Ankle Causes
Ankle fractures are commonly associated with accidents, sports injuries, or traumatic events. Broken ankles are typically caused by rotational injuries (i.e. twisting forces that exceed the bone’s strength) but they can result from a severe impact, such as a fall or car accident, direct trauma to the ankle, or even from repetitive stress.
An ankle sprain occurs when the ligaments surrounding the ankle joint are stretched or torn. The ligaments of the ankle joint hold all of the ankle bones and joint in position, protecting and stabilizing the ankle. When these ligaments are stretched beyond their capacity or torn, the result is a sprained ankle.
There are two types of ankle sprains: eversion ankle sprains and inversion ankle sprains. Eversion sprains occur when the ankle rolls outwards and injures the deltoid ligaments in the ankle. An inversion sprain occurs when the foot is twisted upward and the ankle rolls inward.
There are three grades (or levels) of ankle sprains:
- Grade 1 (mild) – the ankle ligament(s) are only slightly stretched or there is a very small tear in the ligament(s).
- Grade 2 (moderate) – the ligament(s) are torn but it’s not a complete (all the way through) tear.
- Grade 3 (severe) – the ligament(s) are completely torn or severed.
Sprained Ankle Causes
This injury is commonly caused by sudden twisting or rolling movements of the foot, such as landing awkwardly from a jump or stepping on an uneven surface. Sports and similar activities, especially those involving rapid changes in direction or high impact, increase the risk of ankle sprains. Ankle sprains can also be caused by lower-impact occurrences, such as falling or tripping, losing your balance, or even stepping wrong in a high-heeled shoe.
Sprained vs Broken Ankle Symptoms
The symptoms of a sprained ankle and broken ankle can be similar depending on the severity of the sprain or break. A grade 3 ankle sprain could feel like a broken ankle and a simple hairline ankle fracture could present as a severe sprain. Because it can be difficult to tell the difference between an ankle sprain and a broken ankle, it’s important to see a foot and ankle specialist to properly diagnose your injury.
Sprained Ankle Symptoms
Common symptoms of an ankle sprain include:
- Difficulty bearing weight on the affected foot
Again, the severity of the sprain can range from mild (stretching of the ligaments) to severe (complete tear of the ligaments), with accompanying instability.
Broken Ankle Symptoms
Ankle fractures present symptoms similar to ankle sprains, including:
- Immediate, throbbing pain
- Difficulty walking
However, in cases of fractures, the pain is usually more intense, and there may be:
- A visible deformity
- An audible crack at the time of injury
- An inability to move the ankle joint
Risk Factors for Ankle Injuries
Both ankle sprains and ankle fractures can occur in anyone, but certain factors increase the likelihood of sustaining an ankle injury. Factors such as participation in sports, inadequate warm-up, previous ankle injuries, improper footwear, weak muscles or ligaments, and uneven surfaces can increase the risk of both ankle sprains and fractures.
Non-Surgical Treatments for Ankle Sprains and Ankle Fractures
Treatment for ankle sprains usually involves the R.I.C.E. protocol: Rest, Ice, Compression, and Elevation. Resting the affected ankle, applying ice packs, compressing the area with a bandage or ankle brace for sprains, and elevating the foot can help reduce pain, swelling, and inflammation. Your foot and ankle specialist may also prescribe physical therapy to strengthen the ankle and improve stability.
Non-displaced or stable ankle fractures may be treated with immobilization techniques, such as casting or splinting, to allow the bones to heal on their own. Weight-bearing restrictions and the use of crutches are often necessary in conjunction with casting and splinting. However, severe fractures or those with significant displacement may require ankle surgery.
In most cases, ankle sprains do not require surgical intervention. However, if conservative treatments fail to alleviate symptoms or severe instability persists, surgery may be considered to repair the torn ligaments or reconstruct the ankle joint.
Surgery is often required to realign and stabilize ankle fractures. Various surgical techniques, including open reduction and internal fixation (ORIF), may be used to secure the fractured bones using screws, plates, or rods. These surgical interventions allow for proper healing and restoration of ankle function.
As ankle sprains and ankle fractures share similar symptoms, it is important to see a foot and ankle specialist for proper diagnosis and treatment. Non-surgical treatments such as rest, ice, and physical therapy are common for both injuries; however, surgery may be necessary for severe fractures. Thankfully, preventative measures such as wearing appropriate footwear, warming up, and strengthening the ankle can reduce the risk of ankle sprains and fractures and help you maintain healthy, functional ankles.