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When it comes to broken ankles, people have a lot of questions. Ankle fractures aren’t exactly rare — they happen to about 4 out of every 10,000 people, according to research in the journal BMC Musculoskeletal Disorders.

We asked Jorge Bustillo, MD, an orthopaedic foot and ankle surgeon, our most common questions about ankle fractures.

How can I tell if I’ve sprained or broken my ankle?

If you injure your ankle, you may wonder if it’s sprained or broken. Ankle fractures are not as common as ankle sprains. Still, the difference between the two confuses people every day.

Swelling and bruising happen with both sprains and breaks. But if you can put some weight on the injured ankle, it’s usually a good sign and your ankle may just be sprained. This isn’t always the case, but it’s a rough measure to go on.

What are the most common symptoms of a broken ankle?

One of the biggest signs of whether your ankle is broken is if you are able to bear weight on it, within reason. But pain, swelling, and bruising are also common symptoms of a broken ankle.

Are there different types of ankle fractures?

Yes, ankle fractures are on a continuum of how serious they are, depending on the energy needed to produce a fracture. Think of energy as the amount of force on the bone and/or joint. The higher the energy, the more damage.

A lower-energy ankle fracture usually breaks the fibula bone. The fibula is the small bone on the outer aspect of your lower leg. So, if you’re walking and twist your ankle, it’s probably the fibula.

These lower-energy breaks often don’t need surgery.

If you start increasing the energy, like a fall, a car accident, or a severe twist, you do more damage. These injuries might also break the larger shin bone in your lower leg (the tibia) and damage the ligaments as well. Those are more serious and usually need surgery.

Can I move my toes with a broken ankle?

Some people come in worried that they can’t move their toes. They automatically think they broke their ankle. But the ability to move your toes, or lack thereof, is not a sign of a break.

What does a broken ankle feel like?

I can only say what people have described to me: It hurts. A lot!

You touch your bone, and it hurts. You try to walk, and it hurts. It hurts even when you’re sitting there.

Can a broken ankle heal on its own?

A broken ankle may heal on its own. But will it heal the right way and with the correct alignment? This depends on the type of fracture or injury.

One of the big problems with bad ankle breaks is that they can damage the cartilage. When you damage the cartilage, it leads to arthritis. Operative treatment lets us see what other damage the break caused and try to fix and align everything correctly.

Is it true that it’s better to break your ankle than sprain it?

There is some truth to this. Fractures involve the bone, whereas sprains affect the ligaments. Bone has a good blood supply and heals quickly, compared to ligaments.

So, certain ankle fractures have an excellent prognosis and there is enough bone healing in 6 weeks. But a really bad sprain can take longer than that to heal.

Still, it’s a little like comparing apples and oranges. Many variables are at play for how long any sprain or break takes to heal.

What are my treatment options for a broken ankle?

There are a range of options to treat ankle fractures. The best option will depend on how many bones and ligaments the injury affected. Many fractures don’t need surgery. If you break your fibula but the joint looks normal, you may just need a cast or boot.

Then, there are certain fractures where your ankle is unstable. Depending on the injury or fracture, you may have an option to opt for surgery or for a cast to stabilize the joint or fracture. In these specific situations, both can do equally well.

And then there are unstable breaks that, even with a cast, it won’t heal the right way. These need surgery.

What does ankle surgery usually involve?

Ankle surgery is often an outpatient procedure. We’re usually putting a plate with screws on the fibula. Some fractures might also need a few screws on the tibia.

After surgery, patients will usually go home in a splint and switch to a boot two weeks after surgery. At two weeks, we usually remove the sutures. Patients can start moving the ankle at that point. Around the sixth week, patients can often advance their weight bearing.

By about 12 weeks out, one is usually getting around pretty well. Around six months after the surgery, they’ll be able to do more high-impact activities.

It takes about a year or more to fully heal and get back to where you were.

What happens if a broken ankle goes untreated?

If you’re lucky and it’s not a bad fracture, then nothing bad would necessarily happen if you let a broken ankle go untreated. But if an unstable ankle heals in a bad position, this is called a malunion. In addition to not looking right from being misaligned, you’ll end up with arthritis from the cartilage that was damaged.

Will I need physical therapy after surgery?

The need for physical therapy varies from person to person. If someone is doing really well after surgery, they may not need physical therapy (PT). Someone with a more complex injury that is struggling with pain and mobility may greatly benefit.

I always say PT gets you better quicker. Physical therapists know how to get you walking better, get your swelling down, increase your range of motion, and help you get back on track faster.

Why should you choose UPMC?

At UPMC, we’re always trying to think about how to best help people and improve the treatment process. If you come here, you are getting an experienced team seasoned in treating these types of injuries. Our fellowship-trained orthopaedic surgeons are experts in their field, who are well-equipped to care for you every step of the way.

Learn more about ankle injuries, and how UPMC Orthopaedic Care can help get you back on your feet.