Does an Ankle Sprain Need an X-Ray? - DOC

Does an Ankle Sprain Need an X-Ray?

Ankle sprain diagnosis picture San Francisco Podiatrist

How to Tell if you need an ankle Xray after you sprain your ankle- by San Francisco House Call Podiatrist

Whether you roll your ankle stepping of a curb wrong or trip over a root while trail running in Golden Gate Park, your first question is likely “do I need an x-ray?”  In this article we will explain exactly how it is that we ankle doctors evaluate a patient with an ankle sprain and determine whether or not ankle X-rays are needed.  

One secret is that there is a standard set of rules that all doctors who might treat an ankle sprain will follow when decided whether or not to take xrays of a sprained ankle.

 This includes, ER doctors, orthopedic surgeons and podiatrists.  By following these rules, we can determine if it is likely (or unlikely) that there is a broken bone lurking in that aching ankle that might cause problems down the road. 

Many people think that the amount of ankle swelling, ankle pain, or bruising of the ankle can be used as a guide to whether or not the foot is broken and needs an x-ray.  But this is false!  Fractures and severe ankle sprains look very similar.  They all have pain, bruising and swelling.  But there is a way to tell if it is “probably broken.”

Simply put, there are 5 reasons to get an ankle x-ray.

1. You can’t walk on the ankle.

2. You have tenderness at the outside ankle bone (fibula).

3. You have tenderness at the inside ankle bone (tibia).

4. You have tenderness at the outside of the foot (at the “styloid”).

5. You have tenderness at the bone over the arch (the navicular bone).


If you can’t walk on the foot/ankle, you need an xray.  Many times a broken foot or ankle hurts so much, that you just can’t walk on it.  But just because you can walk on it, doesn’t mean you don’t need x-rays.

As a foot and ankle surgeon, I have actually seen people with broken ankles, metatarsal bone fractures, cuneiform bone fractures, navicular bone fracture, and heel bone fractures all walk right into my podiatry office.  Some of them had to be taken to surgery the very same day. 

To decide whether or not we should take xrays of the ankle, we (as ankle surgeons) first “palpate” (medical terminology for poke around) on the end of the tibia and the end of the fibula.  The fibula is the hard knot of bone you feel as the ankle bone on the outside of your ankle.  For example, if you sprain your left ankle and press on the left fibula, you would be pressing on the left side of your left ankle.  If you press on the left tibia, you would be pressing on the right side of your left ankle.

Ankle sprain diagnosis picture San Francisco Podiatrist  Inside ankle pain diagnosis by San Francisco Podiatrist

If you have pain or tenderness when you “palpate” or push on either the fibula or tibia (as illustrated in the pictures), you definitely should have x-rays of the ankle to make sure it isn’t broken. 

To decide whether or not we should take xrays of the foot after you sprain your ankle, we (as foot doctors) would also “palpate” (poke around) on the navicular bone and the bump on the end of of the fifth metatarsal called the “styloid process.” 

The styloid process is that bump of bone protruding on the outside of the foot half way between the little toe and the heel.  The navicular is a knot of bone just above the arch. 

If you have pain or tenderness when you “palpate” (or push on) either the navicular bone or styloid process, (as illustrated in the pictures), you definitely should have x-rays of the foot to make sure you didn’t break your foot when you rolled the ankle.

Ankle sprains are the most common of all musculoskeletal sports injuries.  But not all injured ankles are treated the same.  Mild ankle sprains get better with rest, ice, compression and elevation. Severe ankle sprains need t be protected and immobilized as well.  But fractures (broken ankle bones) need strict immobilization or surgery.  

If you have any tenderness at the fibula, tibia, navicular or styloid process, then you definitely need to get xrays.  At Doc On The Run, we treat ankle injuries as emergencies.  Not only can we arrange same day x-rays, we can even see you with a house call today anywhere in the Bay Area. 

By seeing an ankle expert who will see you the same day or even make house calls, you can make sure you will get the best treatment.  The good news is that most ankle sprains can fully recovery with the correct treatment. If you sprained your ankle, see an ankle expert today!

Dr. Christopher Segler is a sports medicine podiatrist who specializes in immediate treatment and rapid recovery.  He won an award from the American College of Foot and Ankle Surgeons for his research on ankle fractures that are frequently misdiagnosed as ankle sprains.  As an athlete himself, he believes that non-surgical treatment is best whenever possible.  If you have a question about an ankle sprain, you can call and speak with him directly at 415-308-0833.  And yes, he actually will speak with you!