Reviewed by Dr Andre Budihardjo, MM, Simon Shen, D.C. and Physician Brandon Yew

Sprained Ankle? How to Distinguish It from a Fracture

Published April 14, 2023| 7 min read

An ankle sprain isn’t the same as a fracture and they require different treatments. Learn how TCM can speed up the recovery for both conditions.

Two women sitting on stairs while one looks at the other’s ankle.

A fractured or sprained ankle are two common injuries people experience. However, distinguishing between them may be tricky. Here’s how to tell whether you have a sprained or fractured ankle and how to treat it using clinical and Traditional Chinese Medicine (TCM) remedies.

Sprains vs Fractures

A sprain is a ligament injury, while a fracture is a bone injury, says Dr Emily Harold, Professor of Orthopedics at University of Utah Health Care. An ankle sprain is an injury to a ligament that connects the two bones.

A guideline called the Ottawa Ankle Rules, is used by medical practitioners to determine if patients who have ankle injuries require an x-ray. “One of the rules is if you can walk on your ankle right after the injury, that’s a good sign it’s a sprain,” explains Dr Harold.

If there is tenderness on either side of the ankle on the bony parts, both on the inside and the outside of the ankle, you should get an x-ray to ensure you don’t have a fracture. This includes tenderness on the outside or the lateral part of the foot.

The TCM View On Ankle Sprains and Fractures

According to Doctor of chiropractic Simon Shen, first-time sprains, especially if they’re severe, can look like a fracture. There will be severe, intense pain and significant bruising and swelling around the ankle, so it’s best to get an x-ray to distinguish it from a fracture.

Fractures caused by the inversion of the ankle tend to occur at the distal fibular bone, which is just above the lateral malleolus (the outer ankle bone) and not exactly at the ankle.

If you notice bruising and severe pain at the site, it’s more likely to be a fracture. There is also a possibility of an avulsion fracture, where the ligaments’ insertion points onto the bones break off. This kind of fracture has a mixed presentation of both ligament sprain and fracture and can be diagnosed with an x-ray.

Signs of a sprained ankle

Look out for these signs of a sprained ankle according to Dr Shen and Real Health Medical Senior TCM Physician Brandon Yew:

Localised swelling and bruising
Pain when bearing weight during standing and walking, resulting in limping

Pain and stiffness when doing ankle joint rotations
A limited range of ankle joint motion
Moderate to severe pain when trying to move the ankle but the pain may not be felt or not as severe when putting weight onto it.

Common Causes of Sprains and Fractures

Two men playing badminton. — An ankle sprain can occur during physical activities where you need to change directions frequently, such as badminton.

The most common cause of a sprained ankle are exercises and sports where you need to change direction frequently or move over uneven ground, notes Dr Shen. A sudden loss of footing while walking or climbing stairs, and chronic and repeated stress and strain on the ankle due to the nature of certain jobs can also cause ankle injuries.

Treatment for a Sprained Ankle

If you don’t seek treatment and rehabilitation after an ankle injury, it’s very likely for recurring sprains from misaligned ankle joints to occur.

“Ankle adjustments are vital to realign the joint and ultimately reduce the likelihood of sprains. For rehab, it is important to strengthen the muscles controlling the movement of the ankle to compensate for the lax injured ligaments.”

Real Medical Senior TCM Physician Brandon Yew.

Rest and relax

The main treatment is to rest and avoid activities that cause pain, discomfort or swelling. Avoid stressing the affected area.

“We usually start with some gentle stretching and physical therapy. Avoid any kind of activity that really stresses it until it slowly heals with time, and that can take up to a month,” says Dr Harold.

“A nonsteroidal drug can help with inflammation. However, it’s worth noting that it doesn’t help the injury to heal faster. It’s more of a pain reliever,” she adds.

RICE method

The Harvard Medical School (HMS) recommends the classic RICE regimen — rest, ice, compression, and elevation.

If there is severe pain and swelling, rest your ankle as much as possible in the initial 24 to 48 hours. During that time, submerge your foot and ankle in cold water, or use an ice pack for 15 to 20 minutes three times a day, or until the swelling reduces. Be sure to cover your ankle with a towel to protect the skin when applying ice packs.

Elevate and wrap

To further reduce swelling, you can compress your ankle with an elasticised wrap, such as an ACE bandage or elastic ankle sleeve. When sitting, lift your ankle as high as you comfortably can, if possible, to the height of your hip. In the first 24 hours, avoid anything that might worsen the swelling such as hot showers, hot packs or heat rubs.

How TCM Helps with Fractures and Sprains

A woman sitting in a chair with her feet elevated. — If your ankle is painful or swollen, try to lift it to the height of your hip when sitting down.

TCM can help quicken the healing of a fractured ankle by reducing inflammation and restoring proper blood circulation through treatments such as acupuncture, blood-letting, cupping, tuina, and herbal medication.

These are formulated carefully by a TCM physician to address each patient’s unique body constitution. Hence, it’s best to always consult a TCM physician for a proper assessment.

Herbs that help

Physician Yew suggests some herbs that help with healing an ankle fracture:

Eucommia bark (du zhong, 杜仲)
Chinese Taxillus twig (sang ji sheng, 桑寄生)
Twotooth Achyranthes root (niu xi, 牛膝)

Slenderstyle Acanthopanax bark (wu jia pi, 五加皮)
East Asian tree fern rhizome (gou ji, 狗脊)

For a sprained ankle, he recommends these herbal formulas:

Tao Hong Si Wu Tang (桃红四物汤)
Jin Gu Die Shang Pian (筋骨跌伤片)
Zheng Gu Zi Jin Dan (正骨紫金丹)
Xiao Zhong Huo Xue Pian (消肿活血片)

Physician Yew advises to avoid self-medicating as these herbs should be prescribed by a TCM professional in combination with other herbs to address underlying root causes. This provides a more holistic treatment rather than just treating symptoms.

Acupressure

Acupressure is an easy self-help remedy. Place your fingers or blunt object like a massage stick on certain acupoints and massage in clockwise and anticlockwise circular motions, 20 times each. Repeat for at least three minutes per acupoint.

The acupoints that might help relieve ankle pain are:

He gu (LI4, 合谷)
Da zhu (BL11, 大杼)
Zu san li (ST36, 足三里)
Tai chong (LR3, 太冲)
San yin jiao (SP6, 三阴交)

3D illustrations of the feng chi, he gu, ying xiang, yin tang, zu san li acupoints — Located on the back of the hand, between the 1st and 2nd metacarpal bones.

.5 finger-breadths lateral to the lower border of the spinous process of the first thoracic vertebra (T1).

Stimulation of the Zu San Li acupoint can help manage the symptoms of social anxiety.

Located on top of the foot, in the depression closest to the first metatarsal space. It revitalises the Liver.

An illustration of san yin jiao acupressure point for teeth health in pregnant women. — Located four fingers above the inner ankle.

For a sprained ankle, these acupoints will help:

He gu (LI4, 合谷)
Yang xi (LI5, 阳溪)
Yang chi (SJ4, 阳池)
Yang lao (SI6, 养老)

Da ling (PC7, 大陵)

Located On the radial side of the wrist in a depression between extensor pollicis longus and brevis tendons, found when the thumb is tilted upward.

On the dorsal ulnar aspect of the forearm, in the depression on the radial side of the styloid process of the ulna.

In the middle of the transverse crease of the wrist, between the 2 tendons of the front of the forearm.

Acupressure only offers mild relief for ankle sprains and fractures. It’s best to obtain treatment from an acupuncturist together with clinical treatment.

At the end of the day, if the pain from your ankle injury is severe and the swelling doesn’t subside, visit a medical professional for a consultation and an x-ray to ensure you get proper treatment. Don’t take a sprained or fractured ankle lightly to prevent it from worsening.

Ever experienced an ankle sprain or fracture? Tell us what worked for you in the comments below.