Is your ankle sprain a fracture?

First of all welcome to my fourth blog post! My name is Joe and I am a licensed Doctor of Physical Therapy and USA Track & Field running coach. I am also an avid runner, triathlete, and somebody who loves simplifying research to provide advice for endurance and strength athletes! I am excited to start writing new content for all my peeps trying to better themselves. Let's get straight into the topic of today which is " how to tell if your ankle sprain is a fracture".

I recently just posed on this on my personal Facebook page. So if you aren’t following me on there, send over a friend request because I put these videos out every single week. But the emphasis of the video was on figuring out if you have an ankle fracture or not. Since it has been snowing a lot in Philadelphia, conditions have been icy and slippery. Because of this, I have seen a large increase in people who are suffering ankle sprains and falls. I also know that some runners have still been running in the snow! If you fit into any of the categories above or just want to learn more about ankle injuries, this one is for you. I am sure you will find this blog post helpful.



An ankle fracture occurs when you have serious bone damage to a specific structure in your body. The fracture most often occurs because of something traumatic (think falling down the stairs or being involved in a car accident). Whenever a fracture is suspected, the absolute best thing you can do is to get an x-ray or radiograph to confirm that is has occurred. This is essential because initially bones must heal and be in a protected environment such as a boot to regrow before they can be loaded.

If you experienced a traumatic fall, are unable to put any weight through your leg, you should seek out immediate medical attention. It is better to be overly cautious in these situations to ensure you can recover and get the care you deserve.


The 4 areas of foot tenderness and Ankle Rules

The areas highlighted above are the 4 areas you would want to press on to see if you have any tenderness to palpation. We call this the Ottawa Ankle Rules. These rules help guide what we want to isolate and look at, instead of just pressing on any of the 26 bones of the feet. These rules were developed through research and are clinically proven to help decide if you need an x-ray or not. These highlighted bones are also the most commonly fractured in a fall and if these four areas are not tender, you can be VERY confident that you DO NOT have an ankle fracture. The first recommendation when performing this test, is that it is best to have somebody else do it for you. Why? Because palpating your own bones for tenderness is like trying to tickle yourself. It is very hard to do. So make sure you have a friend who you trust do it for you. Also keep in mind that if you have Diabetes, this may change your ability to sense when someone is touching you. This obviously can impact the results of the test. The last consideration is that if you have a lot of swelling going on, it can make it even harder to get a feel for any bone sensitivity.

Click the YouTube video for further clarification:


Bearing Weight

So now you know the four areas to press on but we still have one last important topic to touch on. You have to be able to bear weight on the leg, or to put it simply "put some weight on it." If you can limp, then you can put weight on it. But if you are unable to stand up and even doing a slight weight shift in standing causes excruciating pain, you should go get an x-ray. This is another helpful tip to keep in mind because bones LOVE weight bearing activity. This is why things like running ( as mentioned in the previous post) can have a protective effect on your body. But if you are unable to put any weight on that leg, you should go see a doctor ASAP and get some imaging.

Alright we accomplished a lot in a short amount of time! The big takeaways are:

  1. Ankle fractures can happen and you now know the 4 common areas where they occur

  2. Radiographs are only necessary when you have tenderness in the 4 areas

  3. Being unable to bear weight is an indication that a fracture is a strong possibility

  4. When in doubt, refer out and seek help from a medical professional.

Let me know what you think about this topic or if you have any questions you can comment below. Please share this blog post with a friend or fellow runner! We want to help out as many active individuals as possible. Like, comment, share, and happy running.


Keep Moving Forward!

Dr. Joseph Daigneau, PT, DPT, USATF-1

Lead Physical Therapist, Persevere Physical Therapy LLC