Should I get a scan for my sprained ankle?
June 29, 2020
Ankle sprains are one of the most common injuries we see as physiotherapists. It is common to have recurrent ankle sprains, and this often causes people to think “it’s no big deal, I do it all the time” and then don’t do anything about it. Unfortunately, a poorly treated ankle sprain can lead to long term consequences, such as recurrent ankle sprains and persistent pain. Bruising and swelling are not necessarily reliable indicators as to whether an x-ray is needed. You may have minimal swelling and bruising and still have a fracture, or vice versa.
The “Ottawa Ankle Rules” were created to give a quick, objective way of deciding whether an x-ray is indicated to check for a possible fracture. Fractures are not uncommon with ankle sprains, and they can involve small avulsion fractures (as the ligament stretches it pulls a small amount of bone off with it), or a more significant fracture of one of the bones of the ankle or foot.
It is important to detect these fractures early, so that they are managed appropriately to improve healing, reduce recovery times, and know if you should get a physio to help you with your broken ankle.
The Ottawa Ankle Rules:
If you experience any of the following, it is advised that you get an x-ray to check for a fracture.
- Unable to weight bear for 4 steps
- Tenderness at the posterior edge or tip of the lateral malleolus (A. in image below)
- Tenderness at the posterior edge or tip of the medial malleolus (B.)
- Tenderness on the base of the 5th metatarsal (C.) or navicular bone (D.)
Obviously the last three rules require some knowledge of ankle anatomy, but if you aren’t able to weight bear for 4 steps, get checked. Also, if in doubt, it’s always better to play it safe and get it checked out.
Whether you need an x-ray or not, you should follow standard RICE principles for the first 48 hours, to help to reduce swelling. RICE = Rest, Ice, Compression, Elevation. Try not to do too much walking and keep your foot elevated whenever possible. Ice a few times a day for about 20 minutes and if possible wear a compression bandage or tape the ankle to provide compression. You can gently move the ankle in different directions to maintain range of movement.
Whether you have suffered a fracture or not, your physio will be able to help with your rehabilitation and prevent the recurrent sprains. If indicated, your physio will also be able to refer you for an x-ray if you need to get one!
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