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High Ankle Sprain

Dr. Mark Landsman

Reviewed by
Dr. Mark Landsman

A high ankle sprain is one in which the syndesmotic ligaments are sprained. Our ankles are made of three bones: the tibia, fibula, and talus. Connected, these bones form the ankle joint. There are soft tissues, ligaments, and tendons surrounding the joint. Syndesmotic ligaments are located closer to the lower leg than the foot, surrounding the ends of the tibia and fibula more. When these ligaments are sprained, it is referred to as a high ankle sprain. High ankle sprains are caused by an outward twisting of the foot and ankle. Athletes, especially soccer, basketball, and football players, are the most common sufferers of this type of sprain.

High ankle sprains, like normal ankle sprains, are graded on a scale of 1–3 based on their severity

Grade 1: There is usually mild pain. The ligaments are somewhat stretched, and perhaps there is minor tearing. There is minimal joint pain or difficulty walking.

Grade 2: You may experience a bit more pain, some instability in the joint, bruising, minor swelling, stiffness, moderate to severe pain, and difficulty walking with this type of ankle sprain.

Grade 3: This is the most severe type of ankle sprain. Symptoms include moderate to severe swelling, extensive bruising, and severe pain. This is due to a total rupture of a ligament that causes major instability within the joint, so future symptoms are possible.

high ankle sprain

High Ankle Sprain Symptoms

If you sprain the syndesmotic ligament, symptoms may include:

  • Inability to walk
  • Severe pain
  • Significant bruising
  • Minor swelling
  • Pain when you try to rotate the ankle outward

High Ankle Sprain Causes

During normal ankle sprains, the foot rolls inward. High ankle sprains occur when the ankle and foot roll outward, spraining the syndesmotic ligament. This is the difference between high ankle sprains and normal ankle sprains. Side-to-side running, starting and stopping your feet repetitively, or turning while in motion are common ways to induce a high ankle sprain.

When to See Your Doctor

If you have experienced a high ankle sprain, you should consider seeking medical attention as soon as it happens. If you suspect a broken bone, have persistent pain, hear a popping sound, or have difficulty using your ankle, you need to see your doctor. Your podiatrist or primary care physician should be able to diagnose and treat you. Never attempt to drive with a sprained ankle, especially if the injury is severe. If you are unable to walk and cannot find a ride to your doctor or the emergency room, do not hesitate to call 911.

Diagnosing High Ankle Sprains

High ankle sprains are said to be harder to diagnose due to the small amount of swelling that occurs. Normal ankle sprains are usually accompanied by significant swelling, making it hard to determine the actual severity of the injury. A podiatrist can offer you a proper diagnosis by examining your foot with x-rays, MRIs (magnetic resonance imaging), and CT scans. MRIs and CT scans are more effective diagnostic tools, especially if the x-ray does not show an injury. These diagnostic tests will also help the doctor to determine the severity of the injury and if there is any displacement between the tibia and fibula.

If a high ankle sprain is diagnosed, your doctor will then determine if it is stable or unstable. If the ankle is stable the injury is not as severe, and the tibia and fibula are generally unaffected. If the ankle is unstable, at least two, and possibly all three of the syndesmotic ligaments are torn, and the tibia and fibula are displaced.

High Ankle Sprain Treatment

There are generally three phases in the recovery process for a high ankle sprain. The first phase involves rest, reducing swelling, and protecting the ankle. Generally, this takes one week. The second phase lasts one to two weeks, and involves restoring the patient’s range of motion, flexibility, and strength. The third phase allows the injured person to gradually return to normal activities. The patient is given physical therapy, doing slower maintenance exercises at first, gradually increasing movements to sharper, more sudden turns. Depending on the severity of the injury, the last phase may last for a month or two.

Your doctor will determine the severity of your injury and create an appropriate treatment plan. For mild to moderate cases, the PRICE method is used. Similar to the RICE method, PRICE stands for Protection, Rest, Ice, Compression, and Elevation. Protecting the ankle is critical to the healing process. Icing should be done according to your doctor’s recommendation, but typically you are supposed to ice your ankle at twenty-minute intervals, four to eight times per day, for the first 24–72 hours. Compression should be done with an elasticized bandage (such as an ACE bandage), which should be removed if any symptoms begin to appear that indicate the blood supply is impaired. Your foot should be elevated at least one foot above your heart level.

Braces, splints, and casts may also be used to minimize movement of the lower leg, ankle, and foot. Ambulatory devices such as crutches are used to protect the ankle from further injury if a person needs to be mobile. In more severe cases, surgery may be required to reestablish stability in the ankle joint. This is done by inserting one or two screws in the lower leg for a few months, or until the ligaments have reformed and are able to hold the bones in their respective positions. Surgery usually requires six months of recovery time, with little or no pressure applied to the ankle or foot during the healing process. If you do not need surgery to recover, you may be able to return to your normal activities within six to eight weeks.

Preventing High Ankle Sprains

It is important to know that once you have incurred a high ankle sprain, your ankle is susceptible to future sprains. This is because the ligaments remain looser than normal even after they have healed. Here are a few prevention tips to help you avoid high ankle sprains:

  • Stretch properly before exercise.
  • Warm up before and cool down after exercise.
  • Start slowly when beginning a new exercise or activity. For example, if you want to begin running a few miles each day, do not try to push yourself to your goal. Instead, start by running just half a mile, and build up your endurance gradually.
  • If you are unsure about specific exercises, ask a professional.
  • Be aware of your foot movements while engaging in high-impact sports or activities.
  • Eat properly and drink plenty of fluids, especially while performing.

Talking to Your Doctor

Here are some questions you may want to ask your doctor about high ankle sprains:

  • What stretching exercises can I do at home to improve my injury?
  • Is it safe to take a shower, or should I take baths instead?
  • If I do not have a bathtub, what would be the best method of bathing?
  • Once I have healed, what can I do to prevent this injury from recurring?
  • Based on the severity of my injury, how likely is it to recur, even with preventive measures?
  • Are there any special orthotics that might benefit me once I have healed and resumed my normal activities?
  • What changes should be made in my diet to improve my health?

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Medical References:

  1. Institute for Sports Medicine, High Ankle Sprain, http://www.childrensmemorial.org/depts/sportsmedicine/high-ankle-sprain.aspx
  2. Wikipedia, High Ankle Sprain, http://en.wikipedia.org/wiki/High_ankle_sprain
  3. Hospital for Special Surgery, The "High Ankle Sprain:" What's the difference? http://www.hss.edu/conditions_high-ankle-sprain-whats-different.asp

This page was last updated on April 18th, 2014



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