Foot Fracture Or Ankle Sprain How Can You Tell?

By Daniel J. Cuttica, DO

The quick answer is, unless you are a specialist, you may not be able to tell. They both can have similar symptoms, so, in many cases, a board-certified orthopaedic foot and ankle doctor can best determine which it is.

Ankle Sprains

Sprained ankles commonly occur about 25,000 times every day. They can occur in sports, stepping on an uneven surface, or simply stepping down at an angle.

The ankle ligaments protect the ankle joint by holding the bones and joint in position. The ligament is elastic, and normally prevents the twisting, turning, and rolling of the foot. A sprain results when the ligament is forced to stretch beyond its normal range.

When a sprain is severe, the elastic fibers actually tear. Severe pain and instability may result if sprains are not properly treated.

Mechanism of Injury

With severe in- or out-turning of the foot, the ligaments stretch beyond their normal length, and can tear. You may even hear a “pop” if excessive force is applied to the ankle's soft tissue, resulting in pain and swelling.

Sprains are categorized in three grades, depending on the amount of force

Grade 1 is a mild sprain (slight stretching and some damage to ligament fibers)

Grade 2 is a moderate sprain (partial tearing of the ligament and abnormal ankle joint looseness)

Grade 3 is severe (complete ligament tear with gross instability)

Treatment Options

After diagnosed by X-ray or MRI, a sprain may require crutches, castboots, or air splints. Usually, swelling and pain last 2-3 days, but the whole healing process takes 4-6 weeks. You may be advised to incorporate motion during the healing process to prevent stiffness. Surgery is usually not required to treat even the most chronic tear, as long as the ankle is properly immobilized.

Grades 1 and 2 use the “RICE” guidelines Rest, Ice, Compression and Elevation, although grade 2 requires additional healing time. Grade 3 sprains rarely need surgery, but they are at risk for permanent instability, and may require a short leg cast or cast-brace for 2-3 weeks.

Ankle sprains recover in three phases

1. Rest and protection

2. Motion, strength and flexibility

3. A gradual return to safe activities

Medication

Non-steroidal anti-inflammatory drugs are effective for pain and inflammation.

Rehabilitation

Rehabilitation is used to help decrease pain and swelling and prevent chronic ankle problems.

It may involve ultrasound and electrical stimulation, active range of motion or controlled movements, water exercises, lower extremity exercises and endurance activities.

Proprioception training is important to increase strength, range of motion, and balance, to help avoid a repeat strain or unstable ankle.

Prevention of Sprains

Warming up, awareness of unstable surfaces, proper footwear, and attention to your body's pain or fatigue warning signs are the best ways to prevent sprains.