Foot fracture vs sprain: how to tell if your foot is broken

Broken foot or sprained foot: the key differences

Your foot has 26 bones, held together by ligaments, the tough bands of tissue that connect one bone to another. A fracture is a crack or break in one of those bones. A sprain is a stretched or torn ligament. Both usually cause pain, swelling and bruising, so the clues below matter more than how bad it looks:

If the pain is mostly around the bony bumps of your ankle, see our guide to a broken ankle vs a sprained ankle. This guide covers the foot itself: the toes, the long metatarsal bones, the midfoot and the heel.

Signs your foot may be broken

• sharp pain straight away, centered on one spot of bone
• swelling and bruising, sometimes spreading to the toes or the sole
• pain that gets worse when you stand, walk or push off
• trouble putting weight on the foot
• a toe or part of the foot that looks deformed
• a snap or crack at the time of the injury, although sprains can pop too

Not every fracture starts with a single injury. A stress fracture is a small crack from repeated impact. The pain builds over days or weeks of activity, eases with rest, and there’s usually one tender spot, often on the top of the foot.

Signs of a foot sprain

A sprained foot usually aches over a joint rather than on one bone. You may see swelling and bruising on the top or side of the foot, and it hurts to twist or bend the foot, but you can usually walk. Common foot sprains include:

• Midfoot sprain. The ligaments across the middle of the foot are stretched, often by twisting on a foot pointed downward or having your foot stepped on. Many involve the Lisfranc ligament, so they need a careful check (see below).
• Turf toe. A sprain of the big toe joint when the toe bends too far upward, common in football and soccer on artificial turf. The base of the big toe swells and hurts to bend.
• Toe sprain. From stubbing or jamming a toe. It can look and feel just like a broken toe.

Is my foot broken? When you need an X-ray

Doctors use a checklist called the Ottawa foot rules to decide who needs a foot X-ray after an injury. You need one if you have pain in the midfoot and any one of these:

1. The base of the fifth metatarsal hurts when pressed. That’s the bony bump halfway along the outer edge of your foot.
2. The navicular hurts when pressed. That’s the bony bump on the inner side of your foot, in front of and below the ankle bone.
3. You couldn’t take 4 steps (2 on each foot, limping is fine) right after the injury, and still can’t.

These rules don’t cover the toes or the heel. They haven’t been well tested in young children, and they’re less reliable in people with numb feet. A toe that looks crooked, heel pain after a fall, and any sign of a Lisfranc injury also need an X-ray.

Common foot fractures

Broken toes

Broken toes are the most common foot fracture, usually from stubbing a toe or dropping something on it. A broken small toe often heals in 4 to 6 weeks with buddy taping and a stiff-soled shoe, and you can usually walk on it. See walking on a broken pinky toe and how to tape a broken toe. A broken big toe carries more of your weight and more often needs a walking boot, or surgery if the break goes into the joint.

Metatarsal fractures

The metatarsals are the 5 long bones that run from your midfoot to your toes. They break from a direct blow, a twisting fall or repeated stress. Breaks of the middle three metatarsals that stay in line usually heal in a stiff-soled shoe or walking boot in about 6 to 8 weeks. If the bone has shifted, or several bones are broken, surgery may be needed.

Fifth metatarsal fractures: avulsion or Jones fracture

The fifth metatarsal is the long bone on the outer edge of your foot, behind the pinky toe. It often breaks when you roll your ankle, so many people think they’ve only sprained it. Where it breaks changes the treatment:

• Avulsion fracture. A tendon pulls off a small piece of bone at the very base. This is the most common type. It usually heals well in a walking boot or stiff-soled shoe in about 6 to 8 weeks, and you can often walk on it as comfort allows.
• Jones fracture. A break a little further along, about 2 cm (under an inch) from the base. This part of the bone has a poor blood supply, so it heals slowly and sometimes doesn’t heal at all. Treatment is often a cast or boot with no weight on the foot for 6 to 8 weeks, and athletes are often offered surgery with a screw to help it heal and lower the chance of it breaking again.

The two can feel the same, so any pain on the outer edge of the foot after an injury needs an X-ray.

Stress fractures

Stress fractures most often affect the second and third metatarsals, the navicular and the heel bone. They usually follow a jump in running, walking or training, and they’re more likely with low bone density or if you don’t eat enough for your activity level. An X-ray may look normal for the first 2 to 3 weeks, so an MRI is sometimes needed. Most heal in 6 to 8 weeks with rest from impact and a boot or stiff-soled shoe. Stress fractures of the navicular and the fifth metatarsal are higher risk and often need a stricter period without weight. Our guide for athletes with foot injuries covers getting back to running.

Heel bone fractures

A broken heel bone (calcaneus) usually comes from a fall from a height, such as off a ladder, or a car accident. It causes severe heel pain, swelling and trouble standing, and it needs emergency care. A fall hard enough to break a heel can also injure the spine, so mention any back pain. Heel pain without a big injury is more often a bone bruise or plantar fasciitis. See treating a bruised heel.

Lisfranc injuries: the midfoot sprain you shouldn’t ignore

The Lisfranc joint is where the long bones of the forefoot meet the small bones of the midfoot, across the top of your arch. An injury here can be a torn ligament, a fracture or both, and it’s one of the foot injuries most often mistaken for a simple sprain. It can happen when you twist on a foot pointed downward, miss a step, have someone land on your foot, or are in a car accident.

Warning signs of a Lisfranc injury:

• pain and swelling across the top of the midfoot
• bruising on the sole of the foot, in the arch area, which is a classic sign
• pain when you stand on tiptoe or push off
• trouble putting weight on the foot

Standard X-rays can look normal, especially when they’re taken without weight on the foot. Your podiatrist may take X-rays while you stand, compare both feet, or order a CT scan or MRI. If the bones haven’t shifted, treatment is usually a cast or boot with no weight on the foot for about 6 weeks. If they have shifted, surgery is usually needed. Recovery takes several months. A missed Lisfranc injury can lead to arthritis and a flattened arch, so get any midfoot injury with these signs checked promptly.

What to do right after a foot injury

For the first 2 to 3 days:

1. Rest. Stay off the foot if walking hurts, and use crutches if you have them.
2. Ice for 15 to 20 minutes every 2 to 3 hours, with a cloth between the ice and your skin.
3. Elevate your foot above the level of your heart.
4. Wrap it lightly with an elastic bandage. Loosen it if your toes tingle, go numb, or turn pale or blue.
5. Wear a stiff-soled shoe or a post-op shoe when you’re up. Avoid going barefoot and wearing flip-flops.
6. Take a pain reliever such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin), if it’s safe for you. Ask a doctor or pharmacist first if you have kidney, stomach or heart problems, take a blood thinner, or are pregnant.

Don’t try to straighten a crooked toe yourself.

If you have diabetes or neuropathy, don’t ice or wrap your foot before a podiatrist has seen it, because you may not feel damage to your skin. Also watch for a foot that turns red, warm and swollen after a minor twist, even if it doesn’t hurt much. That can be Charcot foot, a condition in which weakened bones break and the foot changes shape. Keep weight off it and see a podiatrist promptly. Our guide to diabetic foot care explains more.

How a podiatrist tells a fracture from a sprain

Your podiatrist will ask how the injury happened, press on the bones to find the exact sore spot, test the ligaments, check the circulation and feeling in your foot, and watch you stand or walk if you can. Evolve Health podiatrists have digital X-ray on site, so you can usually have an X-ray and get a diagnosis at the same visit. Standing X-rays help with Lisfranc injuries, and an MRI or CT scan may be ordered if a stress fracture or a subtle break is likely but the X-ray looks normal. Our guide to what to expect at a podiatrist appointment after a foot injury walks through the visit.

Treatment and healing times

These are typical times for the bone or ligament to heal. Getting back to running and sport usually takes a few more weeks, and physical therapy helps you get there safely. Learn how we treat sprains and fractures.

When to see a doctor for a foot injury

Go to the emergency room if:

• your foot looks deformed, or bone is showing through the skin
• your foot or toes are cold, pale, blue or numb
• you have severe heel pain after a fall from a height
• the pain is severe and keeps getting worse despite rest and elevation

Get seen the same day or the next day if:

• you can’t take 4 steps
• the outer edge of your foot, or the bump on the inner side of your midfoot, hurts to press
• you see bruising on the sole of your foot
• a toe looks crooked
• you have diabetes, neuropathy or poor circulation

Book a visit if:

• a sprain isn’t clearly better after a week
• pain builds with activity and one spot on a bone is tender
• swelling or pain is still there after 2 to 3 weeks

If you’re not sure whether your foot is broken, an X-ray settles it. You can find a podiatrist near you and book online.