High Ankle Sprain

Overview

What is a high ankle sprain?

A high ankle sprain is when you tear or damage the high ankle ligaments that connect the tibia to the fibula. These ligaments are known as syndesmosis, even though that word refers to the joint itself. You might hear your high ankle sprain called a syndesmotic injury.

Our ankles connect the leg bones to the foot bones. There is an upper ankle and a lower ankle. The upper ankle is the tibia and fibula. In between the upper ankle and lower ankle is the talus, which fits into the arch of the other two bones.

Ligaments are tissues made up of fibers (threads) that connect bones to other bones.

What is the difference between a high ankle sprain and a low ankle sprain?

The differences between a high ankle sprain and a low ankle sprain aren’t just location. High ankle sprains involve turning inward or outward while your foot is flexed up. Most low ankle sprains happen when the ankle rolls inward, while other low ankle sprains happen when the ankle rolls outward. The low ankle sprains don’t involve the high ankle ligaments. Low ankle sprains are what most of us think of when we hear someone has a sprained ankle.

What ligaments are involved in a high ankle sprain?

The ligaments that can be damaged or torn in a high ankle sprain include:

  • The anterior inferior tibiofibular ligament: This is found in front of the tibia and fibula.
  • The posterior inferior tibiofibular ligament: This is found in back of the tibia and fibula.
  • The interosseous membrane: This membrane stabilizes the tibia and fibula because it’s located in the middle space between the two bones.

Any of these ligaments can be stretched, torn partially or torn completely in a high ankle sprain.

How common is a high ankle sprain?

A high ankle sprain is less common than a low ankle sprain. High ankle sprains often happen in athletes who play:

  • Football.
  • Basketball.
  • Wrestling.
  • Ice hockey.
  • Skiing.
  • Soccer.

Symptoms and Causes

What are the symptoms of a high ankle sprain?

Symptoms of high ankle sprain include:

  • Some swelling.
  • Inability to bear weight on the injury, making actions like climbing stairs difficult.
  • Inability to walk on your toes.
  • Bruising that starts days after the injury.

What causes high ankle sprains?

A high ankle sprain happens when your ankle is hurt when your foot is flexed upward and then twisted either inwards or outwards. It almost always happens as a result of some type of collision, not simply the rolling motion that causes other ankle sprains. High ankle sprains almost always happen when you’re running or jumping.

Diagnosis and Tests

How is a high ankle sprain diagnosed?

The first thing your provider will do is to ask questions about why you’re there and get your medical history. Then they’ll do a physical examination.

To diagnose a high ankle sprain, your provider is likely to:

  • Have you sit down with your knee bent and leg and foot hanging down. They’ll push up on your foot and twist it a little toward the outside. If there’s a lot of pain, it’s likely that you have a high ankle sprain. Your provider might want to do this test a few days after you’ve had your injury.
  • Do the syndesmosis squeeze test. They’ll squeeze your tibia and fibula together, putting pressure on the membrane that separates the two bones (the interosseous membrane). If you feel pain higher up on your leg, you probably have a high ankle sprain.
  • Press on the interosseous membrane to find out if you have pain.
  • Press on the ligament across the front of your ankle to see if there is pain.
  • Order imaging tests, such as X-rays, magnetic resonance imaging (MRI) scans, computed tomography (CT) scans and even possibly ultrasounds. The MRI is the best test for a high ankle sprain, but your provider might use X-rays to rule out other injuries.

Management and Treatment

How is a high ankle sprain treated?

You can begin treating your ankle injury by following the R.I.C.E. advice: rest, ice, compression (bandaging) and elevation (keeping your foot up) for about three to five days. You might need to use crutches when you need to move.

You can use over-the-counter non-steroidal anti-inflammatory drugs (NSAIDS) to help with pain and swelling. NSAIDs are available in oral forms like pills and tablets, or topical forms like lotions, creams or sprays.

Your provider might recommend a brace, tape, or even some type of cast to help you avoid bending your ankle up toward your body.

Your provider might also recommend physical therapy, including the use of therapeutic bands or exercising in water. Being in water will lessen the amount of weight your ankle has to bear.

You’re unlikely to need surgery to treat a high ankle sprain unless the damage is very severe or if your ankle continues to be unstable.

How long does a high ankle sprain take to heal?

It might take you six to eight weeks to recover from a high ankle sprain. If you’re an athlete, your return to play might take an even longer time. Low ankle sprains generally heal quicker than this.

Prevention

How can I reduce my risk of a high ankle sprain?

Ankle sprains are accidents, and there’s no way to prevent accidents completely. However, there are some things you can do that may make a high ankle sprain less likely to happen. You can:

  • Follow an exercise program that will make your joints stronger and more flexible.
  • Follow an exercise program that will improve your balance and your ability to sense how your body is positioned (proprioception). Proprioception is part of your balance and is the way that your brain knows how your body is positioned.
  • Use protective equipment like braces or tape to protect your ankles.

Outlook / Prognosis

What is the outlook (prognosis) for a high ankle sprain?

The outlook is good for recovering from a high ankle sprain, most often using only non-surgical methods. However, you’ll probably be more prone to injuring your ankle again. Also, you may have stiffness in the joint later on.

Living With

When should I see my healthcare provider for a high ankle sprain?

If you’ve hurt your foot and you can’t put any weight on it, you should call your provider or go to an emergency room. You’ll want to find out if you have any broken bones. You’ll need to follow your provider’s instructions on the best way to take care of the injury.

A note from Cleveland Clinic

Most of us have probably twisted a foot and ended up with a sprained ankle. If you have been participating in an activity that involves jumping or running and you hurt your ankle, you might find you have a high ankle sprain. Make sure that you follow your healthcare provider’s instructions so that you heal completely.

Last reviewed by a Cleveland Clinic medical professional on 12/08/2021.

References

  • American Orthopaedic Foot & Ankle Society. High Ankle Sprain (Syndesmotic Injury). (https://www.footcaremd.org/conditions-treatments/ankle/high-ankle-sprain) Accessed 12/08/2021.
  • Chen ET, McInnis KC, Borg-Stein J. Ankle Sprains: Evaluation, Rehabilitation, and Prevention. _Curr Sports Med Rep. _2019;18(6):2176-223. Accessed 12/08/2021.
  • de-Las-Heras Romero J, Alvarez AML, Sanchez FM, et al. Management of syndesmotic injuries of the ankle. EFORT Open Rev. 2017;2(9):403-409. Published 2017 Sep 21. doi:10.1302/2058-5241.2.160084 Accessed 12/08/2021.
  • Hunt K, Phistikul P, Pirolo J, Amendola, A. High Ankle Sprains and Syndesmotic Injuries in Athletes. J Am Acad Orthop Surg. 2015; 23. 661-673. 10.5435/JAAOS-D-13-00135. Accessed 12/08/2021.
  • InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. How does the ankle work? (https://www.ncbi.nlm.nih.gov/books/NBK279301/) 2014 Apr 23 [Updated 2017 Dec 27]. Accessed 12/08/2021.
  • Kaminski TW, Needle AR, Delahunt E. Prevention of lateral ankle sprains. J Athl Train. 2019;54(6):650-661. Accessed 12/08/2021.
  • Physio-Pedia. Syndesmotic Ankle Sprains. (https://www.physio-pedia.com/Syndesmotic_Ankle_Sprains) Accessed 12/08/2021.
  • Schiftan GS, Ross LA, Hahne AJ. The effectiveness of proprioceptive training in preventing ankle sprains in sporting populations: A systematic review and meta-analysis._ J Sports Sci Med. _2015;18(3):238-244. Accessed 12/08/2021.

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