Do I Need an X-Ray After an Ankle Injury?
A sudden twist, fall, or awkward landing can leave you with a swollen, painful ankle—and an important question: should you get an X-ray?
Not every ankle injury requires imaging. In fact, most sprains can be managed without it. However, certain signs can help determine whether your injury might be more serious and needs further evaluation.
When Imaging May Be Necessary
X-rays are typically used to rule out fractures. You may need one if:
You can’t walk four steps, either right after the injury or during an exam.
You have bone tenderness—especially on the bony points at the back of your ankle or along the outside of your foot.
The injury involved significant force, like a fall from a height or hard impact.
There’s visible deformity, excessive bruising, or swelling.
Pain and function don’t improve after several days of care.
These are the types of signs healthcare providers assess using tools like the Ottawa Ankle Rules, a widely used guideline for determining whether an X-ray is needed after ankle or foot trauma. It helps reduce unnecessary imaging while ensuring serious injuries aren’t missed.
What If You Don’t Need an X-Ray?
If you’re able to walk, don’t have pinpoint bone pain, and your symptoms are mild to moderate, it’s likely a sprain. In such cases, focus on early protection, elevation, gentle movement, and a gradual return to activity. Listen to your body and avoid overloading the ankle in the early phase.
Most soft tissue injuries improve with time and proper care. However, if your symptoms worsen or persist longer than expected, a reassessment—including possible imaging—may still be needed.
Bottom Line
You don’t always need an X-ray after twisting your ankle—but you shouldn’t ignore serious signs either. Pain over the bones, inability to walk, and high-impact injuries are all red flags. Use common sense, monitor your recovery, and when in doubt, seek medical advice. It’s better to be cautious than miss a fracture.
References
Stiell, I. G., Greenberg, G. H., McKnight, R. D., Nair, R. C., McDowell, I., & Reardon, M. (1992). Decision rules for the use of radiography in acute ankle injuries: Refinement and prospective validation. JAMA, 269(9), 1127–1132.
Dubois, B., Esculier, J. F., & Gojanovic, B. (2019). PEACE and LOVE: A new paradigm for soft-tissue injury management. British Journal of Sports Medicine, 54(2), 72–73.
National Institute for Health and Care Excellence (NICE). (2020). Fractures (non-complex): Assessment and management. NICE Guideline NG38.
