Ankle injury - sprain or fracture?

Ankles – a “sprain” or something more?

Out walking, on the playing field or tennis court, you fall and hurt your ankle.

Annoying and painful, definitely. But now what? Feet up on the couch or off to A&E?

Fracture or Sprain?

These 4 quick tests, called the Ottawa Ankle Rules, are designed to eliminate people who do NOT have an ankle/foot fracture and thus, do not need an x-ray!!

  1. Can you take 4 steps (limping is allowed!)? NO – get an X-ray
  2. Do you have tenderness/pain around your medial or lateral malleoli (the little bone bumps on either side of your ankle)? YES – get an X-ray
  3. Do you have tenderness/pain around the base of the 5th metatarsal (bump on the outside edge of your foot below your little toe)? YES – get an X-ray
  4. Do you have tenderness/pain around your navicular bone? (bump on the inside of your foot, underneath your ankle crease)? YES – get an X-ray

There is an explanation and video via some awesome American specialists here. 


Just because you can’t take 4 steps or you are tender in these places does NOT mean you definitely have a fracture – just that it’s worthwhile checking.

Remember that it is hard to see strained ligaments so X-rays (and MRIs) are looking for something broken. If it’s not broken then RELAX! Go home, rest the foot for 24 hours and apply ICE and check it out with a physio tomorrow

What Next?

Get support – a physical support / brace can help keep you mobile and, most importantly, stop you limping (which causes all kinds of problems later on). Always make sure your support is chosen and fitted by a professional.

Get treatment – some physiotherapy will help to ease the pain and inflammation and Magnetic Resonance Therapy (MRT) can help to strengthen and regenerate the ligaments for more serious injuries.

Prevention – a review of your footwear and small adjustments to your training routine, including more balance work can prevent a recurrence.

It might be “just” a sprain but ankle injuries affect how you walk and recent studies are showing that they can have a profound influence on many other aches and pains as we get older. So getting some treatment straight away can prevent needing a whole lot more in a few years.

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