When Is an Ankle Fracture Not Really an Ankle Fracture?
Let’s talk about the “ankle fracture” that’s really just a fancy sprain. There’s a common ankle injury that shows up on X-rays as a fracture but behaves more like an ankle sprain. The culprit? A fibular avulsion fracture. What exactly is it? How does it happen? And how should it be treated? It’s a familiar story in the orthopedic clinic: a patient is referred from the emergency room or their family doctor after twisting their ankle. An X-ray was taken, and they’re told they have an “ankle fracture.” Naturally, they’re worried. Or maybe they’re being seen for a chronic ankle issue, and an “old fracture” is spotted on X-ray. But here’s the good news: while fibular avulsion fractures aren’t completely harmless, they’re usually far less serious than typical ankle fractures that affect joint stability. In fact, they’re better thought of as a bad ankle sprain with a little extra drama. Let’s break it down: A classic ankle sprain happens when your foot rolls inward, stretching or tearing the ligaments on the outside of your ankle. Ligaments don’t show up on X-rays, so most sprains appear normal on imaging. But in some cases, when the ligament tears, it pulls off a tiny piece of bone from the lower part of the fibula (the smaller bone on the outside of the leg). This is called an avulsion fracture. Think of it like ripping off a piece of tape from a painted wall—you don’t just get tape, you also peel off a bit of paint. That little piece of bone does show up on an X-ray (Figure 1), which is why it gets labeled a “fracture.” Technically, that’s correct. But functionally, it’s behaving like a sprain. So how is a fibular avulsion fracture treated? Just like an ankle sprain! Even though the X-ray shows a bit of bone has been pulled off, that fragment is usually small and only slightly displaced—it doesn’t affect the motion of the ankle joint. That means no surgery is needed. Instead, the treatment is the same as for a traditional ankle sprain: rest, ice, compression, elevation (RICE), and physical therapy. Most people recover fully over time. Still, like any moderate to severe ankle sprain, it may take longer to heal than you’d like, and some people can experience lingering symptoms if additional structures were injured. So the next time you hear “ankle fracture,” don’t panic. It might just be the ankle fracture that’s not really a fracture. To learn more about distal fibular avulsion fractures, check out our full article:👉 https://footeducation.com/fibular-avulsion-fracture/ Stephen Pinney MD
