Most people don’t know that there are different types of ankle sprains and the high ankle sprain, in particular, requires treatment and a longer recovery process. Athletes are particularly at risk for high ankle sprains but they aren’t the only ones. This kind of sprain can be very severe and without proper treatment and rehabilitation, a severely injured ankle may not heal well and could lose its range of motion and stability.
What is a High Ankle Sprain?
A syndesmotic or high ankle sprain is an injury to the higher ankle ligaments, which are located above the ankle joint. These sprains only comprise about 15% of all ankle sprains but that doesn’t mean they’re less harmful. These types of sprains are far more disabling than the traditional low ankle sprain.
The ligaments that are damaged or torn when you have a high ankle sprain are attached to the fibula and the tibia (the two bones that connect your knee to your ankle) and they are responsible for stabilizing the entire area for activities like running and walking. As you can imagine, this makes walking much more difficult and painful. Unlike a more common low ankle sprain, a high ankle sprain should be diagnosed in the early stages so that a treatment plan can be developed for the patient.
High Ankle Sprain vs Low Ankle Sprain
You’re probably sprained your ankle at some point or known someone who has and more likely than not, it was a mild low ankle sprain. Low ankle sprains are incredibly common and happen when you rotate or twist your ankle toward the inside of your leg causing the ligaments on the outside of your ankle to tear or stretch like when you step off a curb funny. You can think of a low ankle sprain as the kind of sprain that might make you say “I rolled my ankle.” The sprain happens low on the ankle hence the name low ankle sprain. This is also known as a lateral ankle sprain.
A low ankle sprain varies in severity. It can be just a strain or it can be a partial or complete tear of the anterior talofibular ligament (ATFL) on the outer side of the ankle. This ligament runs between the end of the fibula to the talus bone on the outside of the ankle.
Unlike low ankle sprains, high ankle sprains are caused when the lower leg and foot twists outward. They can also happen when you have a fractured ankle bone. Sometimes, this type of sprain can happen when the deltoid ligaments, the ligaments on the inside of your ankle, have been torn.
While both are ankle sprains, both refer to sprains or tears of different ligaments in different parts of the ankle. Many people who suffer a high ankle sprain don’t know how they injured themselves or didn’t think they hurt themselves that badly because it doesn’t have the familiar feeling of rolling the ankle inward or outward. High ankle sprains occur above the ankle itself so it may be a surprise to people that this is an ankle injury. In fact, it’s an ankle injury that can require a longer treatment and rehabilitation process than a low ankle sprain.
What Causes A High Ankle Sprain?
A high ankle sprain is also called a syndesmotic ankle sprain named for the fibrous joint where the tibia and fibula connect. This is a more stable part of the ankle that the ankle joint itself and injuries to it usually require a substantial amount of force. For this reason, this type of sprain usually happens during contact or high-impact athletic activities and sports. It isn’t always accompanied by an ankle fracture but it does occur in 13% of all ankle fractures.
Signs & Symptoms
Much like a low ankle sprain, this type of sprain will cause pain and swelling. The big difference in diagnosing a high ankle sprain is where the pain is located. Many people who have sustained this kind of sprain they are likely able to put weight on their foot and ankle, but they have pain above their ankle, between the fibula and tibia.
This sprain causes pain when the ankle bone is flexed upward as it is when climbing up and down stairs. This pain typically increases if you try to twist your foot outward. If you have a high ankle sprain and a fracture you won’t be able to put weight on your foot. Pain while walking and upper ankle bruising are both signs of a high ankle sprain as well.
Treating A High Ankle Sprain With Physical Therapy
High ankle sprains take longer to heal than many other sprains and often require physical therapy. The initial goal of high ankle sprain physical therapy is to reduce inflammation and pain while beginning to restore range of motion.
As with many injuries, we utilize the PRICE method to treat high ankle sprains. This stands for protect (possibly with an immobilizer boot), rest, ice, compress and elevate and it helps control and reduce inflammation. We encourage patients to ice the area for 20 minutes at a time to get the maximum benefit. Patients who have this kind of sprain often have to use crutches in order to protect and rest their ankle as it heals. In this stage, we may do some soft tissue massage, passive range of movement exercises, or ankle mobilization and strengthening exercises.
Once pain and inflammation are under control and the patient is back on their feet (even if they’re still limping a bit), we move on to strengthening and rehabilitating the injured area. Patients do resistance exercises with a resistance band to build up their strength before moving onto adding weight to the exercises. Our goal is to get you back to the condition you were in before your injury and strengthen your tendons to prevent the chance of it happening again.
For severe sprains, or when a ligament is torn completely, surgery may be necessary. This relieves pressure on the ligaments and allows them to scar and heal. After surgery for a high ankle sprain, physical therapy is usually necessary to rebuild strength and restore function.
High Ankle Sprain Recovery Time
Healing from a high ankle sprain can take anywhere from six weeks to three months depending on the severity of the sprain and if there was any bone damage in addition to the soft tissue damage. Many patients experience joint tightness and muscle weakness which can be improved with physical therapy. High ankle sprains should be diagnosed early and appropriate treatment should be started as soon as possible to improve recovery times.
These sprains are certainly a more complicated injury than more common low ankle sprains, which occur lower on the ankle. They can take longer to heal and depending on the severity, can require longer than three months to heal with treatments like splinting, wearing a boot, and physical therapy. The good news is that we can get you back to doing things pain-free after a high ankle sprain.
Do you have an ankle sprain that could benefit from physical therapy? Click here to schedule your initial evaluation!