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How to differentiate between severe ankle sprain and fracture?

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General & Family Physician
Practicing since : 2006
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I thought I asked a question about differentiating (without an ER visit) between a very severe ankle sprain and a fracture. I also thought I sent (is this possible) digital images of the affected limb?

It is now 3rd day since the trauma to the right ankle/foot. There is less swelling and pain (but obviously the bruising is changing color). Thanks!
Posted Fri, 27 Sep 2013 in Bones, Muscles and Joints
Answered by Dr. Jay Patel 1 hour later
Brief Answer:
Its sign for healing.

Detailed Answer:

The change in color is sign on healing process.

Bruises may change color due to the breakdown of hemoglobin from within escaped red blood cells in the extracellular space. The striking colors of a bruise are caused by the phagocytosis and sequential degradation of hemoglobin to biliverdin to bilirubin to hemosiderin, with hemoglobin itself producing a red-blue color, biliverdin producing a green color, bilirubin producing a yellow color, and hemosiderin producing a golden-brown color. As these products are cleared from the area, the bruise disappears. Often the underlying tissue damage has been repaired long before this process is complete.

So in short its just a process of healing and changing color and reduction in swelling is a great news.

ADVICE- Try to dip the injured foot in warm water for 10 minutes every 4 hours as it will help to heel faster. And I guess you would be prescribed pain medication to relive pain, if not you may use over the counter pain medication.

Thanks of the query. Please feel free to contact me in case of further concerns.
Above answer was peer-reviewed by
Follow-up: How to differentiate between severe ankle sprain and fracture? 1 hour later
comment: Thank you Dr. XXXXXXX So I take your response to mean I am not risking anything walking on it w/out cane or crutch as long as the pain continues to go down overall. I live in South XXXXXXX US and my swimming pool is 86 degrees F, is that warm enough for the regimen you suggest, or would a bathtub and warmer water (e.g., 95 degree F) be preferred? In the pool it is easier to elevate it and I can lie on a float. (Last Q, I promise)
Answered by Dr. Jay Patel 7 minutes later
Brief Answer:
POOL water is ok for afternoon.

Detailed Answer:

Welcome back, 86F pool water is ok if afternoon, but i would prefer about 95F once or twice a day, may be at mornings and evenings. Bath tub is more likely suitable for the 95F.

It very good that you are taking good care by not putting weight on injured foot. Keep on doing the same it will also help to get better soon.

Thanks again, as usual feel free to contact me.
Above answer was peer-reviewed by
Follow-up: How to differentiate between severe ankle sprain and fracture? 2 days later
Unforutunately, while pain (subjective) walking on the R foot gently yesterday. Pain & swelling were worse today.. I decided to get an x-ray. The radiologist, "I quote" remarked I don' know how you walked on my right foot for ANY amouny of time Today the xray, showed a clear, severe fracture of the lowest lateral aspect af the fibula (what lay people usually refer to as the "ankle"... Kindly review the discrepancies between the advice of your (on line) MD and the "live doctors and nurses" who examined my injury about 4X as thoroughly. If it turns out that in more than n=1 case (my own) that physicians' basic Hypocratic oath of "FIRST DO NO HARM" has been violated, then you are not only a bad APP, you are a XXXXXXX program that XXXXXXX should shut down immediately,
Answered by Dr. Jay Patel 1 hour later
Brief Answer:
The x-ray is needed to diagnosis fracture

Detailed Answer:

The fractures are diagnosed with the x-ray, and based on description and images it seems like a sprain.

More over the reduction in pain and swelling as you mentioned was in line with sprain, I am sorry I took your description without doubt since you were the best judge whats happing to you currently. I went by what you were saying, since being online its impossible to see exact details and no way to do physical examination, more over images only gives partial information. Their are limitation for an online consultation and its mostly taken as a secondary opinion/ advice purpose only as far as website rules are concerned.

But now you has fracture of fibula as per the x-ray report so please consult near by orthopedic doctor.

Thanks again.
Above answer was peer-reviewed by
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