Written by Zita Sham, Fairuuz Saleh and Shiv Mohan Banka, Principal Physiotherapists at Phoenix Rehab.Clinically reviewed by Louise Yow, Principal Physiotherapist & Director, AHPC A1300363H.Last reviewed 5 October 2026.
Is it a sprain or a fracture?
You cannot tell reliably from how much it hurts or how swollen it is. Both cause swelling and bruising. What separates them is where the bone is tender and whether you can walk. If you could not take four steps (limping still counts) both straight after the injury and when seen, or the bone is tender along the back edge or tip of the lower 6 cm of either ankle knob, at the base of the little toe’s long bone, or at the bony bump on the inner side of the midfoot, a doctor will usually want an X-ray.
Those checks are the Ottawa ankle rules, which doctors use to decide who needs an X-ray. A systematic review found they miss very few fractures when they are applied properly (Bachmann and colleagues, BMJ, 2003). They are a decision aid for a doctor, not a home test, but they explain what the doctor is pressing on.
| More like a sprain | More like a fracture | |
|---|---|---|
| How it happened | Rolled the ankle inward, often on a step, a curb or in sport | The same roll with more force, a fall from height, or a direct blow |
| Walking | Painful, but you can take a few steps | You cannot take four steps, then or at the clinic |
| Where it is tender | The soft area in front of and below the outer ankle knob | On the bone itself: the back edge or tip of either ankle knob, the base of the little toe’s long bone, or the bony bump on the inner midfoot |
| Shape | Swollen but normal shape | The ankle looks out of line or deformed |
Call 995 if the ankle looks deformed or out of place, or the foot is cold, pale or numb. Go to the emergency department now if the skin is broken over the injury or stretched tight and white over a bone. See a doctor the same day if you cannot take four steps or the bone itself is tender. A doctor or emergency department arranges the X-ray. Physiotherapists do not order imaging in Singapore, and if we find these signs at your appointment we refer you to a doctor, who decides on imaging, before treating.
If it is a sprain
Most ankle sprains are treated without a cast, with early protected walking and a staged return to load. The common trap is stopping when the pain stops, before balance and calf strength are back, and it is one reason so many people sprain the same ankle again. See ankle sprain physiotherapy and your ankle stopped hurting, that is not the same as healed.
One injury is easy to mistake for a sprain: a midfoot (Lisfranc) injury, with pain across the top of the foot and bruising on the sole. See Lisfranc injury. See a doctor the same day if that matches. It needs imaging.
If it is a fracture
An ankle fracture usually involves the bony knob on the outside (the end of the fibula), the inside (the end of the tibia), or both. What happens next depends on whether the joint is stable.
- Stable, with the bones in line. Usually a boot or cast, often with weight allowed early as your doctor directs, for about six weeks.
- Unstable or out of line. Usually surgery to fix the bones with a plate and screws, then a boot, with weight limited for two to six weeks, depending on your surgeon, before it is built back up.
Either way, the bone heals on its own timeline. The calf wastes and the ankle stiffens while it does, and that is what decides how you walk afterwards. Physiotherapy works on those two things, at each stage your doctor allows.
After surgery, the Ankle Fracture Surgery Recovery Program sets out the stages week by week, what is usually normal and what is not, and the measures used to move up. Fractures treated in a boot follow the same four stages, usually on a shorter timeline.
How long does an ankle fracture take to recover?
The bone typically heals in six to eight weeks. Walking normally on the flat often takes three months, and stairs, slopes and running take longer, commonly four to six months or more after surgery. Swelling by the end of the day can last six months or longer. A painful, swollen or hot calf is different. See a doctor the same day. These are typical ranges. Your surgeon’s instructions on weight bearing take precedence.
The two numbers that track recovery are how far your knee travels over your foot in a lunge, and how many single-leg heel raises you can do on each side. Both are measured in a couple of minutes, and both respond to loading rather than to time.
What our patients say
Google reviews from our clinics in Singapore.
Where are you with this right now?
1. It is settling on its own
You are out of the boot, walking a little further each week, and stairs are getting easier month on month. That is the expected shape. Keep the exercises you were given, and judge progress over a month, not a day. You do not need us for this, and we would rather say so.
2. It has stopped improving
You walk fine on the flat, then a curb catches you out. You go down stairs one at a time. The ankle aches by evening, and the calf on that side is still thinner.
Walking on the flat does not rebuild the calf or the ankle bend that stairs and slopes need. Count your single-leg heel raises on each side. If the injured side is well short, that is the finding.
The Stalled Recovery Review is three appointments over three weeks with the same therapist, because what an ankle does under graded loading cannot be read in one visit. $690, nett, no GST.
3. You have had surgery, or you have a date
Recovery after an ankle fixation has a shape, and knowing which stage you are in tells you whether you are on it. See the Ankle Fracture Surgery Recovery Program.
All of it runs on the same four stages. The Phoenix Recovery Protocol explains what each stage works on and what you have to meet to move up. No referral needed to start.
Next step
Find out which stage you are in
Pain is the first thing to leave. Movement and strength are the last things trained back, and most people stop before that part is done. One Assessment and Treatment is a single 45-minute appointment at $230, nett, no GST. Your therapist finds what is actually limiting you, treats it in the same appointment, and you leave with your current stage and a written plan.
Prefer to phone? Each of our five clinics has its own number on the clinics page. No referral needed to book.
Related reading
- physiotherapy after surgery
- ankle physiotherapy
- What Is Ankle Inversion and How Can Physiotherapy Help?
- What Is Plantar Fasciitis and How Does Physiotherapy Help?
- Achilles Tendon Rupture: What You Need To Know
- The Phoenix Recovery Protocol, and the four stages
- All recovery programs, hand and physio
- How to Treat Arthritis Ankle
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