5 Signs your Ankle Sprain Might be a Fracture

If you have ever played basketball, tennis, volleyball or even walked on an uneven sidewalk, you may have been a victim of an ankle sprain.  With almost every sprain there is an ominous “pop” or significant bruising. For the 25,000 people who suffer from an ankle sprain each day in the United States alone, it is possible that the popping sound or bruise that covers the entire outside of the foot may be a fracture instead.  Unfortunately, the things we subconsciously hold synonymous with a sprain can also happen with a fracture.

Although there are many variations of a fracture, the definition is quite simple.  It is a break or interruption in bone continuity.  But what exactly is a sprain?  An ankle sprain isn’t as straight forward as a fracture.  It involves some level of damage to a ligament, whose role is to support the interaction between two bones.  The damage can be a partial tear, complete tear or stretching of the ligament.  This results in pain and instability of the joint.

Sprained Ankle or Ankle Fracture, University Foot and Ankle Institute.In both fractures and sprains, you can have pain, swelling, bruising and it may be difficult to walk.  For those of us with an x-ray machine or an MRI handy, it can be fairly easy to discern between the two.  But how do you know the difference without advanced imaging or x-ray vision?

Here are 5 signs that your ankle sprain may be a fracture:

1) Inability to place weight on your foot

The main function of a ligament is the stability of the ankle, they are mostly stressed in side-to-side movement.  Most people with an ankle sprain can walk or, at least, place weight on their foot without significant pain.  There are always outliers to this generalization, but the pain level with a fracture is going to be much higher, especially when placing weight on that area.

2) Pain directly to the bone

The ankle is made up of the fibula (outside bone), tibia (inside bone) and the talus, which is the part of the foot connected to the ankle.  Although ligament injuries can cause pain at the edges of those bones because it is where they attach, a fracture will have pain in a much larger area.  Pressing upwards along the ankle bone is not going to commonly produce pain in the setting of a sprain.  Be sure to also check the 5th metatarsal bone, which is located on the outside of the foot.  This is commonly fractured during an ankle sprain, but also easily missed.

3) Visible protrusion of the bone

Swelling is common in both a fracture and a sprain, but a fracture results in a piece of bone becoming unstable from the rest of the bone.  In most cases the surrounding soft tissue provides enough support to keep the bone in place.  In some instances, the fractured piece of bone is moved out of position.  This results in a protrusion of bone which can be visually evident on examination.

4) Bruising extending higher up the leg

Similar to swelling, bruising accompanies almost every ankle sprain and fracture.  Ligaments tend to be located at the tips of the bones in the ankle.  Because of this, any bruising will be located around the tips of those bones.  Bones are very vascular, meaning they have a lot of blood flow, which results in more bruising.  A fracture that occurs at the tip of the bone can have similar bruising patterns, but many fractures occur higher up the leg.  The resulting bruising can be seen extending higher up the ankle.

5) Persistent pain

Pain is likely to accompany both and ankle sprain and fracture.  With appropriate treatment of rest, ice and compression most ankle sprains have significant decrease in pain after the first week.   If your pain continues beyond that point, there is a higher likelihood that a more extensive injuries is present.

ankle-fracture-mainNot all ankle sprains or fractures will apply to these general rules.  Certain ankle sprains can require extensive treatment and longer recovery time.  Because of this, it is always critical to have prompt evaluation by a physician, which can result in early proper treatment, quicker recovery and better long- term results.

The team of experts at UFAI are nationally recognized experts in the field of foot and ankle care. They have decades of combined experience and pride themselves in offering the best and most advanced care. If you have suffered an ankle injury or have any questions regarding foot and ankle care, we encourage you to call us at (877) 989-9110 or visit us at www.footankleinstitute.com.

The UFAI Education Team

The UFAI Education Team

For almost fifteen years, University Foot and Ankle Institute and their nationally recognized physicians have been providing the most technologically advanced medical care for the foot and ankle with the highest success rates in the country.

As a teaching institution, University Foot and Ankle Institute’s Fellowship Program is among the most advanced in the nation.

We at UFAI are driven to get our patients back to their normal activities with the highest level of function, in the least amount of time, using the least invasive treatments possible. From start to finish, we are with you every step of the way.

The UFAI Education Team works to help empower our patients and website visitors with the most up-to-date information about foot and ankle conditions, treatment options, recovery and injury prevention. Our goal is to pass on truly useful information to our readers.

We hope you enjoy our work and find it of value. Please let us know!
The UFAI Education Team


  1. I like how you mentioned that being unable to put weight on your foot can indicate that it’s a fracture, not a sprain. My daughter injured herself while playing soccer, and we thought it was just a sprain. She hasn’t been able to put weight on it for a while now though. You have convinced me it would be best to visit a professional and see if it’s a fracture. Thanks!

  2. With my ankle fracture I could not walk and the ankle ligaments hurt a lot. Thanks for the post.

  3. My cousin moved-in with us while he attends school this semester, which has not started yet. Last week he sprained his ankle playing basketball. It hasn’t healed yet and he has bruising higher up the leg that seems to be extending up the ankle like you described. We better have him see a doctor to check if he fractured his ankle and not wait for school to start to see a doctor there. Thanks for the advise, very helpful.

  4. I still can’t put weight on my foot and it hurts,yet my doctor said it’s a MILD sprain. I’ve had a severe sprain before, and this hurts just as bad, if not worse.

  5. Help me please … so I can stop worrying..

    My Son (23) was beaten down, socked, kicked and stomped on 1 month ago.. by 3 large older men.
    His (R) outer ankle bone was very painful and severe swelling…… 36 days the swelling is much less, but the mobility – range of motion is not at all like his left ankle.

    As his mother nothing had been done… We have medical insurance and I have now begged for my son to have MRI and X-Ray….. he is in jail for using “pepper spray” in self defense…. has many disabilities…… What to do?? The Fresno County Jail is ignoring this injury.

    • Audrey,

      I am so very sorry to hear the condition of your son, that is terrible. We are not lawyers so we cannot be of help in getting his physical paid attention to. A good lawyer seems like job one, you need a good and strong legal advocate for him.

      In regard to his physical condition, stick to your “Mama Bear instincts” in getting his condition looked at. You need to find a local foot and ankle doctor for him to be cared for once he is out. I do not know if any of our doctors know anyone up in your area, but if you want me to ask, I most certainly will. Please let me know.

      In the mean time, please stay strong and do not stop fighting for your son.

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