The majority of high ankle sprains occur in athletic populations, such as those who participate in high-level sports or the military.[1] An Australian study at the North Shore Private Hospital and the University of Sydney showed that 5.9% of Rugby League and Rugby Union players suffered from high ankle sprains.[2]
The term ‘high ankle sprain’ is used to differentiate between the ‘lateral ankle sprain’, the most common type of ankle sprain injury.[1] A ‘lateral ankle sprain’ injury occurs between the fibula (outside shin bone) and the calcaneus (heel bone), known as the talofibular joint. ‘High’ is used to describe the location of the injury (between the shin bones), which is located above the talofibular joint.
Read on to understand what you should know about high ankle sprains; the risk factors, treatment options and expected recovery time.
What is a High Ankle Sprain?
A high ankle sprain (also known as a syndesmosis sprain) refers to the tearing or overstretching of the ligament(s) between the distal tibiofibular joint.[3] The distal tibiofibular joint is the connection between the shin bones above the ankle, known as the tibia and fibula.
A high ankle sprain is less common than the typical ankle sprain injury since it takes significant force to damage and tear the ligaments surrounding the syndesmosis of the tibia and fibula. A regular ankle sprain involves the ligaments of the foot and occurs more so with a classic “rolling of the ankle.”
What are the symptoms of a high ankle sprain?
The main symptom of a high ankle sprain is pain just above the level of the ankle. Other symptoms include minor swelling (compared to a regular ankle sprain), inability to weight-bear, pain when up on your toes and delayed bruising.
Common symptoms of a high ankle sprain
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Difficulty in weight-bearing
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Pain when bending the ankle upward or downward
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Swelling above the ankle, in the lower part of the leg
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Pain when moving the foot outward
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Instability
In some cases, a high ankle sprain will also result in fractures of the lower parts of the tibia or fibula. If a fracture is present, weight-bearing on the affected leg will be excruciatingly painful, and a boot or cast will be required.
What causes a high ankle sprain?
A high ankle sprain is caused by an injury that forces the ankle to twist outwards with respect to the lower leg. The most common causes are in sports such as AFL, netball and tennis, where there is a sudden change of direction or pivot motion.
Common causes of a high ankle sprain
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Awkward landing from a jump
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Being tackled while the foot is rotated outward
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Weak muscles of the legs
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A sudden twist under pressure
Sports that increase the risk of a high ankle sprain
A high ankle sprain is common in high-impact sports that rely on the stability of the ankles during running or jumping.
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Basketball
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Skiing
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Football
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Soccer
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Netball
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AFL
How is a high ankle sprain diagnosed?
A high ankle sprain can be debilitating and prevent you from participating in sports for a long time. In addition, damage to the ligaments that support your ankles can lead to significant instability and chronic pain.
There are several options available when it comes to diagnosing your ankle pain as a high ankle sprain. One of the most common and most recommended by Australian GPs is an assessment from a physiotherapist.
Physiotherapists are sports rehabilitation experts that deal with ligament injuries like a high ankle sprain. They are medically qualified to diagnose and provide proper treatment to help your recovery.
Your evaluation will start with a consultation. Your physiotherapist will ask you vital questions related to your injury and medical history. Take this time to discuss all your symptoms and how you got injured.
After establishing a background of your condition, your physiotherapist will perform a physical assessment of your ankle and foot to identify specific injured structures of your ankle.
Your physiotherapist will then create a specific treatment plan for you and will guide you through your recovery.
This will also include:
How is a high ankle sprain treated?
A high ankle sprain can be more severe than a regular ankle sprain. If left untreated, it can lead to instability and difficulty in performing high-impact activities on your legs.
There are several options when it comes to treating high ankle sprains. One of the more common and the treatment option referred to by Australian GPs the most frequently is physiotherapy.
A high ankle sprain is a sports injury that physiotherapists routinely encounter. They are in the best position to provide quality care to help you regain your normal function.
The primary goal of your treatment is to decrease your pain, improve joint stability, and create a specialised program to help you safely return to sports.
Depending on the severity of your high ankle sprain, a physiotherapist may provide you with a combination of the following types of treatments:
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Kinesio Taping - Specialised taping techniques to help decrease your pain and provide more stability to the ankle.
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Stretching Exercises - Gentle stretching exercises to help relieve muscle tension and maintain range of motion while recovering.
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Manual Therapy - Hands-on technique your physiotherapist uses to increase the mobility of your ankle joint and relieve stiffness.
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Ultrasound treatment - Ultrasound waves can promote soft tissue healing.
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Therapeutic Exercises - Low-impact corrective exercises to maintain or regain strength and range of motion of your ankle joint.
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Proprioceptive and Balance Training - In later stages of recovery, proprioceptive training will help train your body to react properly to uneven surfaces when running.
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Plyometric Exercises - Used during the later stage of your recovery to prepare your body for high-impact activities of sports.
A typical physiotherapy session with your local physiotherapist will last anywhere between 30-60 minutes. It is not uncommon for patients to feel the benefits in just one session.
Next step - Creating a treatment plan made for you
Your physiotherapist will create a specific treatment plan based on your lifestyle and activity level.
Self-care for a high ankle sprain
If you think you have a high ankle sprain, here are the best things you can do and avoid.
Things to do:
- Rest
Take a break for a couple of weeks from any physical activities that would add stress to your ankle.
- Use an assistive device
Use crutches to minimise the load on your ankle joint and allow proper healing of damaged ligaments. Usually, you will only need crutches in the very early stages of recovery
- Ice
Use a cold compress for at least 15 minutes, every 3 to 4 hours to control the swelling and help you manage the pain. Again, this is only helpful in the early stages of recovery.
- Compression
Apply a compression bandage to help you manage the swelling.
- Gradually strengthen your muscles
As the inflammation subsides, gradually increase load on your muscles and joints by moving your ankles in different directions and mild walking activities while using crutches.
Things to avoid:
- Avoid high-intensity activities
Avoid participating in sports for a couple of weeks until your ligaments have healed.
Do I need a specialist or surgery?
In most cases, a specialist will not need to intervene. Through appropriate rehabilitation and exercises, a full recovery should be expected.
However, for cases that are persisting or not responding positively to conservative treatment, diagnostic imaging should be done to determine the integrity of your ligaments and bones.
A severe high ankle sprain can cause separation of the tibia and fibula bones, which results in chronic pain and instability if not addressed. Doctors may perform surgery to reduce the separation of these bones, however this is quite rare.
Your GP may also prescribe you pain medication to help manage the pain. Additionally, a cast or boot may be prescribed to keep the ankle immobilise while recovering.
What is the recovery time / prognosis for a high ankle sprain?
Ultimately, recovery time is dependent on being proactive and seeking professional treatment along with the severity of your ankle pain and injury.
Full recovery from high ankle sprains can take anywhere from 6 weeks up to 3 months, depending on the severity of damaged soft tissues.
Instability and fractures may complicate your recovery and can take more time for your ankle to completely heal.
Important factors in recovery include:
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Sticking to your treatment program and regularly exercising
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Resuming your sports activity gradually
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Paying attention to pain, and resting as necessary.
Can a high ankle sprain be prevented?
The advice below will help you prevent having a high ankle sprain or help you recover if you already have injured yourself.
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Stretch regularly – stretch your lower body muscles to relieve stiffness and maintain your normal range of motion.
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Strengthen your muscles – strengthening key muscles of your core and glutes can help prevent high ankle sprains and allow your body to overcome the demand you are putting on it.
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Balance and agility training – Include a balance and agility routine in your training program to decrease your risk of having sports injuries.
Outlook and the main takeaways
A high ankle sprain is a complicated injury that requires a longer recovery period than a normal ankle sprain. If overlooked, instability and pain may persist even years after your initial injury. However, excellent recovery can be made with the right help and advice.
Book a visit with a physiotherapist today to have your high ankle injury assessed and start your road to recovery immediately.
Anatomy of the ankle
High ankle ligaments or the “syndesmosis” connect the tibia and fibula to form a joint that allows slight rotation. These connections create a very stable support for your lower leg bones and prevent them from moving apart.
Here are the syndesmosis ligaments of the lower leg:
Injury to these ligaments, such as in the case of a high ankle sprain, can cause tears which leads to instability and pain.
