How Accurate Are X-Rays for a Twisted Ankle?

I twisted my ankle when I missed the last step of our staircase. The doctor took X-rays and said there was no fracture. How accurate are X-rays for this type of injury?

X-rays are a common and reliable tool for diagnosing bone fractures, and they are highly accurate when it comes to detecting breaks in the bones of the ankle. However, because the ankle is a complex joint, several different X-ray views are often needed to ensure a thorough examination.

While X-rays are excellent at identifying fractures, they aren’t as effective in detecting damage to the surrounding ligaments. Advances in medical technology now allow for arthroscopic examinations, where a tiny camera (arthroscope) is inserted into the ankle joint. This method provides a clear view of the ligaments and any soft tissue damage that may not be visible on an X-ray.

One particular set of ligaments, known as the syndesmosis, connects the two lower leg bones. X-rays are only about 50 to 64 percent accurate in identifying syndesmotic injuries, while ankle arthroscopy is 100 percent accurate in detecting both fractures and ligament tears. This procedure may be necessary if there’s a concern about soft tissue damage that an X-ray could miss.