Updated: Jul 3
Many people who have sprained their ankle playing sport may wonder whether it is necessary to go to A&E to have the injury diagnosed and treated, or whether it will be sufficient to rest it up at home. The short answer is: If you think you need to go to A&E, you probably should. A slightly longer answer is: It depends to a large extent on whether your ankle is broken or you have ruptured a tendon. This article will help you to figure out whether you should go to the emergency room or not.
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When you should NOT go to A&E with an ankle injury
Just to clarify, this article is about an injury that may have only just happened, with a sudden onset of pain because your foot was either forced sideways or upwards or downwards through trauma, like twisting it or being tackled. We're not talking about pain that's come on over a period of time, even though it can be really sore, because that is more likely to be an overuse injury. It still needs to be checked by a health professional as soon as possible so that you can get on the right track to recovery, but it's less likely to be broken and to require a trip to the emergency room. So, in this article, we're talking about something that's just happened through a traumatic mechanism of injury.
How to test your sprained ankle for a fracture like they do at A&E
At most accident-and-emergency departments they will apply what are called the Ottawa Ankle Rules. These are a set of rules to determine whether or not you need an X-ray of your sprained ankle.
You can watch this video if you want to see Steph demonstrate this.
Below are two pictures – one showing the inside of the ankle and foot and one showing the outside. These highlight the various places they will examine to determine whether they are painful or tender to the touch, which will indicate whether you need X-rays.
They will be looking to see whether you've got tenderness at the tip of your lateral malleolus, which is the bottom of your fibula bone (Area 1 in the pictures), along the back edge of it for six centimetres. So, if you feel along the bone there and it's sore, then you will probably need to have your ankle X-rayed.
The same goes for the bottom of the tibia (Area 2). You would probably need to go to hospital for your sprained ankle if you've got pain along the six centimetres at the bottom of the tibia, at the back edge of it, when you touch it.
If you've had a trauma injury but actually have pain in your midfoot instead of your ankle, they will be looking to see whether you've got pain on your navicular (Area 3) or the base of your fifth metatarsal (Area 4). If either of these are painful to the touch, you may well need to go to A&E for X-rays of your foot and ankle.
Lastly, you should check whether you can walk four weight-bearing steps. If you can walk four steps while carrying weight on the sprained ankle or foot, it is probably not necessary to go to A&E for your injury.
If you do have tenderness in those bony areas or you have real difficulty weight-bearing and you do decide you need to go for an X-ray, it doesn't necessarily mean that your foot or ankle is broken. It is one of those things that some severe sprains can behave just like a fracture, and that's why you need an X-ray to decide whether or not it is broken, because actually the symptoms can be the same. Without an X-ray, it is very difficult to tell.
Another reason to go to A&E even if you can stand on your foot
If you think you've ruptured your Achilles tendon, you heard a pop, or it felt like someone kicked you in the back of your leg, or like you've been shot in the back of your Achilles, you also need to go to A&E. You probably won't have an X-ray, but the injury definitely needs to be seen the same day as you will need immediate treatment if you have torn your tendon.
What to do for your sprained ankle if you do not have to go to A&E
If you don't have any pain in those bony areas and you're able to weight-bear completely fine, then the good news is that there is less than a one percent chance that you've broken a bone in your ankle. So, you may well be able to save yourself a trip to A&E and having to sit there for hours, only to be sent home eventually with a bit of advice to rest the injured ankle.
However, we would still advise you to see a health professional in the next couple of days, just so that they can give you some good advice on early management of the injury and to look at things properly. This will enable you to do the right things and to avoid the risk of getting persistent problems after it's healed or recurrent problems where it happens again and again, because this can happen in up to 70 percent of people after a lateral ankle sprain. So, you might want to look at the second article in this series of three, which tells you what you should be doing those first few days after an acute ankle sprain. The third article is focused on how to avoid the risk of spraining your ankle over and over again.
Need more help?
Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan.
We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.