Something bad happened to your ankle, and now it’s painful, bruised, swollen, and tender to the touch. Bearing weight on the injured ankle is difficult, and walking on it feels awful, leaving you wondering whether you’re dealing with a sprain or an ankle fracture.
Does that sound familiar? If so, you’re not alone. 
Ankle fractures and ankle sprains are two of the most common lower extremity injuries, sending millions to the emergency room—or, better yet, a podiatrist. In fact, in the United States, doctors treat an estimated two million ankle sprains, and five million ankle fractures each year.
Unfortunately, these injuries aren’t just common; they have much in common. So much so that trying to determine if your ankle is sprained or broken can be more confusing than the plot of a poorly written mystery novel. With similar appearance and symptoms, but diverging recommendations for care, accurate diagnosis and treatment are vital to ensure a full recovery.
At Annapolis Foot & Ankle Center, our highly skilled Central Maryland podiatrist, Dr. Eric Harmelin, DPM, can help you crack the case and get the exceptional podiatric care you need to recover. Here’s what you should know.
Investigating Your Ankle’s Anatomy
While the ankle may not look particularly impressive from the outside, inside is a complex joint of numerous bones surrounded by various ligaments and tendons that work together to facilitate the movements required for daily activities, sports, and basic mobility. Keep reading for an overview of the ankle’s components.
- Tibia. Also known as the shinbone, the tibia is the larger of the two lower leg bones and forms the medial (inner) side of the ankle joint. The lower end of the tibia, called the medial malleolus, is the bony “bump” or protrusion on the inside of your ankle.
- Fibula. Located on the lateral (outer) side of the leg, the fibula is the smaller of the two leg bones. Its lower end, the lateral malleolus, forms the bony protrusion on the outside of your ankle.
- Talus. This is a bone located between the tibia and fibula. It sits on top of the calcaneus (heel bone), forming the lower part of the ankle joint and allowing for up-and-down motion.
- Ligaments. These strong bands of fibrous tissue that connect bones to other bones are responsible for providing stability to joints. There are several important ligaments in the ankle joint, including the deltoid ligament on the inside of the ankle, and the anterior talofibular ligament, calcaneofibular ligament, and posterior talofibular ligament on the ankle’s outer side.
- Tendons. Unlike ligaments, which connect bones to bones, tendons are fibrous tissues that connect muscles to bones. In the ankle joint, tendons play a role in transmitting the forces generated by the muscles to the bones, enabling movement and providing stability. Key tendons in the ankle include the Achilles tendon—which connects the calf muscles to the heel bone—and the peroneal tendons, which run along the outside of the ankle.
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The Usual Suspects: Causes, Risk Factors, and Symptoms of Ankle Sprains vs. Ankle Fractures
Explore the underlying causes of these prevalent ankle injuries, assess your risk factors, and familiarize yourself with the telltale signs and symptoms to uncover the source of your discomfort.
Ankle Sprains
Sprains occur when the ligaments responsible for stabilizing the ankle joint are forced beyond their normal range of motion, causing the fibrous bands of tissue to stretch, tear, or rupture.
These sprains are often caused by rolling, twisting, or turning the ankle in an awkward fashion due to falls, landing wrong after a jump or pivot, walking or exercising on uneven surfaces, or having someone step on your foot during athletic activities.
Risk Factors
You could potentially face an increased risk for ankle sprains if you:
- Participate in sports such as basketball, football, soccer, tennis, trail running, and other physical activities involving jumping, rolling, or twisting the foot.
- Wear shoes with high heels or those that fit poorly or are inappropriate for the sport or activity.
- Need to increase ankle strength or flexibility.
- Suffered a previous ankle injury.
Signs and Symptoms of an Ankle Sprain
Ankle sprain symptoms vary depending on how many ligaments are injured and whether the involved ligaments are stretched, partially torn, or completely torn. Common signs and symptoms associated with an ankle sprain can include:
- Popping sensation or sound at the time of injury
- Pain or discomfort that’s particularly noticeable when bearing weight on the affected foot
- Pain or tenderness when touching the ankle
- Swelling
- Bruising
- Instability when bearing weight or walking
- Reduced range of motion
Ankle Fractures
Fractures or breaks occur when the force exerted against a bone is stronger than the bone itself. These injuries range from non-displaced hairline cracks to complete breaks, where bone fragments are pushed out of alignment and may even penetrate the skin. Non-displaced hairline cracks, known as stress fractures, can be caused by overuse. More complex breaks, however, often result from twisting the ankle due to a misstep, fall, or sustaining a direct blow to the ankle in a car accident or similar incident.
Risk Factors
Though a fractured or broken ankle can happen to anyone, you’re more likely to suffer these types of injuries if you:
- Participate in football, basketball, soccer, tennis, gymnastics, or other high-impact sports and athletic activities that place significant stress on the ankle joint and require movements that can lead to twisting injuries.
- Wear shoes that fit poorly or lack support, increasing your risk of falling.
- Use improper training techniques or fail to warm up and stretch before exercising or engaging in other physical activities.
- Increase the intensity or duration of activity too quickly, increasing your risk of sustaining a stress fracture.
- Have a medical condition that decreases bone density, such as osteoporosis.
Signs and Symptoms of an Ankle Fracture
Like ankle sprains, ankle fracture symptoms vary by type and injury severity. Common indications include:
- A crack heard at the time of injury, followed by crunching or grinding sounds when moving the ankle joint
- Sudden, throbbing pain
- Discomfort, pain, or difficulty walking or bearing weight on the affected foot
- Severe swelling and bruising
- Tenderness
- Deformity
