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Ankle Sprain

A friend with limping daughter just appeared at my door with the age-old question: “Do we need an X-ray?” She’d twisted her ankle.

Red Flags:

• Bone broke through skin
• Obvious deformity (shortened, twisted, bent)
• Poor blood flow (cool, pale, pulseless)
• Nerve damage (can’t move, can’t feel)
• Wound infection (fever, pus, redness)
• Pain can’t be controlled with splint, sling and analgesics


Happy Words

• Feels better with acetaminophen/ibuprofen, ice, elevation, air splint, crutches
• Back to laughing and fighting with siblings.



If all happy and no red, it’s often OK to watch and wait 24-72 hours despite a limp.

Regarding X-rays, consider these questions:

  1. If something is broken will management be different? (cast, surgery, release from sports, etc.)
  2. Is it worth the radiation, time and expense?

In many ERs, despite “Ottawa ankle rules“, very often injury = X-ray. If after a few days watching and waiting you’d like to chase an X-ray, I’m happy to sign the Selma Carlson X-ray request. They’re great folks with quite reasonable self-pay prices.

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