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How to know if you have broken your ankle

Updated: Jan 20, 2019


Ok, so you've sprained your ankle and you don’t fancy waiting in A&E for no good reason. You can use the Ottawa Ankle Rules to decide if you've broken your ankle or not.

How to know if you've broken your ankle? You can use the Ottawa rules to figure it out.

While broken bones sounds like the worst injury you can have, I would also go to A&E if the ankle significantly swells up within 15 to 30 minutes. This is usually indicative of an intra-articular injury (meaning inside the joint) and it is best to have it evaluated properly as these injuries can have a prolonged healing time compared to ligament or muscle tears.

The Ottawa Rules have been shown to have a very high sensitivity and a modest specificity to pick up ankle and foot fractures across various populations. This means that it is very unlikely that you've a broken your foot or ankle if the rules have a negative finding.

How to know if you have broken your ankle

The Ottawa Rules state that an x-ray of the ankle and/or foot is indicated if:

Pain is present in the Malleolar Areas (Zones A and B) or Midfoot (Zone C) combined with pain when you press on one or more of the following:

  • The bone in area 1

  • The bone in area 2

  • The navicular bone – area 3

  • The base of your 5th meta-tarsal bone – area 4

  • Or if you are unable to walk for at least 4 steps (even with a limp)

How to know if you have broken your ankle: Picture showing the areas of the foot and ankle that is palpated when trying to establish if you have fractured your ankle or foot.
Picture 1: Medial or inside view of the ankle and foot.

Picture showing bony areas you should palpate on the lateral ankle when using the Ottawa Rules
Picture 2: Lateral or outside view of the ankle and foot.

 I am pretty sure I don't have to go to A&E, so what now?

You should not underestimate the debilitating effect a torn ligament or muscle can have on your sport. It is important to establish whether you have injured any ligaments or muscles and then rehabilitate or strengthen them to prevent re-injuring your ankle.  Diagnosing exactly what you've injured is easy if you understand the body well.

A consultation with an experienced physiotherapist will be money well spent, as they can provide you with a diagnosis and tailored treatment plan that will speed up your recovery. This is something that I could easily help you with during an online physio consultation.

Read more about the online physio consultation process.


  • Go to A&E if the Ottawa Rules indicated that you may have fractured your ankle or foot or if your ankle swells up dramatically within 30 minutes of sustaining your injury.

  • Consult a physiotherapist to get an accurate diagnosis and tailored treatment plan. This will help to speed up your recovery.

Please let me know if you have any questions. Need more help with an injury? You can also consult me online using Skype video calls.

Best wishes


About the Author

Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Masters Degree in Sports Injury Management. Follow her on LinkedIn or ReasearchGate


  1. Kerkhoffs, G. M., van den Bekerom, M. et al. (2012). "Diagnosis, treatment and prevention of ankle sprains: an evidence-based clinical guideline." British Journal of Sports Medicine 46(12): 854-860.

  2. Tayeb, R. (2013). "DIAGNOSTIC VALUE OF OTTAWA ANKLE RULES: SIMPLE GUIDELINES WITH HIGH SENSITIVITY." British Journal of Sports Medicine 47(10): e3.

  3. Wang, X., Chang, S. et al. (2013). "Clinical Value of the Ottawa Ankle Rules for Diagnosis of Fractures in Acute " PLoS One