A broken ankle involves a break in one or more of the three bones that form the ankle joint: the tibia, the fibula, or the talus. The tibia and fibula are the two long bones of the lower leg, while the talus connects the leg to the foot. A fracture can range from a small, hairline crack to a severe break involving multiple bones and ligaments. Medical advice for any suspected fracture is to avoid placing weight on the injured limb until a professional diagnosis is made. Attempting to walk risks converting a relatively stable injury into a much more complex one.
The Direct Answer: Walking After Injury
It is a common misconception that if a person can walk on an injured ankle, it cannot be broken; however, this is not accurate. A person may be able to bear weight on a fractured ankle, especially with simple, non-displaced fractures where the bone fragments remain correctly aligned. Similarly, a hairline fracture, also known as a stress fracture, might not cause enough immediate pain to completely prevent walking.
The ability to walk does not indicate the ankle is safe to use and should not be relied upon to rule out a fracture. Continuing to walk on an unstable fracture can lead to serious complications by increasing the separation, or displacement, between the bone fragments. This displacement can severely damage the surrounding joint cartilage and delicate soft tissues, including ligaments, tendons, and nerves.
The stability of the fracture is the most important factor determining the risk, regardless of a person’s pain tolerance. If a fracture is made unstable by walking, it can shift from a condition treatable with a cast or boot to one that requires invasive surgery to realign the bones. Ignoring the injury increases the likelihood of long-term problems, such as chronic ankle instability and post-traumatic arthritis.
Distinguishing a Fracture from a Severe Sprain
Differentiating a fracture from a severe ankle sprain is challenging because both injuries cause pain, swelling, and bruising. A fracture often presents with specific sensory and physical markers that help distinguish it from a ligament sprain. A key sign that points toward a fracture is pain that is highly localized and intense directly over the bone itself.
A person who has sustained an ankle fracture may have heard a distinct cracking sound at the moment of injury, signaling a break in the bone. In contrast, a severe sprain is more likely to be accompanied by a popping or snapping sound as the ligaments tear or stretch.
Another significant indicator of a fracture is a visible misalignment or deformity of the ankle joint, where the foot appears to be resting at an unnatural angle. While both injuries impair walking, a severe sprain may still permit some limping or slight weight-bearing. A displaced fracture typically causes severe, immediate pain that makes it nearly impossible to place any weight on the foot. If there is numbness or tingling in the foot, this suggests potential nerve involvement, which is associated with a severe fracture or dislocation.
Immediate Care and When to Seek Medical Attention
Following an acute ankle injury, the immediate priority is to stop any activity and apply the RICE protocol: Rest, Ice, Compression, and Elevation. Rest involves avoiding any weight-bearing activity on the injured foot. Ice should be applied to the area for 15 to 20 minutes every few hours to reduce swelling and pain.
Compression, using an elastic bandage, helps control swelling, but it must be wrapped snugly without cutting off circulation. Elevation of the ankle above the level of the heart assists in allowing excess fluid to drain away from the injury site. Applying these measures helps stabilize the injury and manage symptoms until professional medical help is available.
A person should go to an emergency room immediately if they experience severe symptoms, regardless of the initial pain level. These signs include a visible deformity of the ankle, an open fracture where bone fragments have broken through the skin, or any loss of sensation or inability to move the toes. These conditions suggest a highly unstable injury that may involve neurovascular compromise and requires urgent intervention.
Medical Diagnosis and Treatment Overview
Once at a medical facility, the diagnostic process begins with a physical examination to assess the injury, including checking for nerve or blood vessel damage. The primary method for confirming a fracture is through X-rays, which provide clear images of the bone structure and show the exact location and degree of bone displacement. For more complex breaks or to evaluate surrounding soft tissue damage, a computed tomography (CT) scan or magnetic resonance imaging (MRI) may be used to gain a detailed, three-dimensional view.
Treatment for an ankle fracture is determined by the stability of the joint and the alignment of the bone fragments. Stable, non-displaced fractures are managed with non-surgical immobilization, typically involving a cast, splint, or walking boot for several weeks. This keeps the bone fragments still so they can heal.
For unstable or displaced fractures, surgery is usually necessary to restore the joint’s alignment. This procedure, Open Reduction and Internal Fixation (ORIF), involves the surgeon realigning the bone fragments and securing them in place using plates, screws, or rods. Following either non-surgical or surgical treatment, rehabilitation and physical therapy are necessary to restore the ankle’s strength, range of motion, and function.