admin@thefeetpeople.com.au

(07) 3356 3579

BOOK NOW
BOOK NOW

Jump to section

What is a high ankle sprain?
Symptoms
Causes
Diagnosis
Treatment
Rehabilitation and recovery
FAQs

High ankle sprains are sprains that damage the ligaments above the ankle, as opposed to the ligaments on the side of the ankle like in traditional ankle sprains. This is referred to as a syndesmosis injury. 

What Is A High Ankle Sprain?

Above your ankle, between the two bones of your leg (the tibia and fibula), you have ligaments that form a structure called the syndesmosis. By connecting the tibia and fibula, the ligaments of the syndesmosis help prevent the lower leg bones from spreading too far apart as a result the forces and pressure of the walking, running and daily life. These ligaments also help absorb shock to reduce the tension on the foot, ankle and leg. 

In a high ankle sprain, it is these ligaments that comprise the syndesmosis that get sprained and damaged, unlike traditional ankle sprains which most often damage the ligaments on the outside of the ankle after the ankle rolls out and the foot rolls in. While high ankle sprains are notably less common than standard ankle sprains, they can still be very painful.

Symptoms Of High Ankle Sprains

If you’ve sustained a high ankle sprain, you’ll feel pain above your ankle that will worsen when you try to move your foot at the ankle joint, particularly inwards and outwards. Putting pressure and weight on the foot can feel quite sore, especially if you’re trying to do pivoting movements or move from side-to-side between your feet. For a lot of our patients, they’ll also feel much less stable on the affected foot and ankle. 

While bruising and swelling can occur, it doesn’t happen as often as it would with a regular outer ankle sprain, which may make the injury look less serious or severe, although this typically isn’t the case. Depending on the cause of the high ankle sprain, other structures may also get damaged, such as sustaining a fracture to the tibia or fibula bones. This can notably increase the pain and make it very difficult to put any weight at all on the foot.

What Causes High Ankle Sprains?

As the job of the ligaments of the syndesmosis is to keep the tibia and fibula bones secure, stable and close together in the right position, it is typically movements that suddenly twist the ankle (particularly if the foot is planted firmly on the ground) or abnormally rotate the ankle that leads to high ankle injuries. We often see these in basketball, soccer, netball and other sports that have rapid changes in direction and side-to-side movements. The injury occurs because significant stress is placed on the syndesmosis ligaments, causing them to become sprained or torn. Other causes include:

• Direct trauma to the lower leg, such as a forceful impact or collision. The impact can disrupt the integrity of the syndesmosis ligaments, leading to injury and subsequent instability of the ankle joint.
  

• Repetitive stress or overuse of the ankle joint, especially in activities that involve repetitive jumping, pivoting, or running on uneven surfaces. This can weaken the syndesmosis ligaments over time, making them more susceptible to injury and increasing the risk of a high ankle sprain, particularly in athletes or individuals engaged in high-impact sports.
  

• Biomechanical abnormalities in the foot and ankle, such as flat feet, high arches, or abnormal foot alignment, can all alter the distribution of forces through the ankle joint. These abnormalities may predispose a person to instability and injury of the syndesmosis ligaments, leading to a high ankle sprain.
  

Diagnosing High Ankle Sprains

Diagnosing a high ankle sprain can be done by our podiatrists in our clinic by palpating the ankle and lower leg, performing a ‘squeeze’ test, and then completing a biomechanical assessment where we check a variety of foot and leg factors and characteristics, including what happens when your foot and ankle are externally rotated. If we suspect that there may be multiple injuries involved, such as a fracture alongside your high ankle sprain, we may refer you for medical imaging to provide a complete picture of your ankle injury and its severity. 

Treating High Ankle Sprains

Treating high ankle sprains has a very clear goal: to allow the ligaments that comprise the syndesmosis to heal effectively with the fibula and tibia in an optimal position - i.e. not abnormally separated from one another. With good healing and repair in the right way, the ankle is able to regain full strength and function and you won’t feel any pain or discomfort as you move and play sports.

At Home Treatment

Before you can get in to see your podiatrist, following the PRICE principles: protection, rest, ice, compression and elevation. This will help give you some relief from those initial symptoms, as well as reducing the likelihood of the injury getting worse in the meantime. You may also choose to take non-steroidal anti-inflammatory medication (NSAIDs), as directed by your doctor. 

Limit your physical activity, avoid movements that worsen the pain, and keep your feet supported in good shoes that wrap around the ankle and keep it stable, like good walking or running shoes. To help reduce the swelling and manage your pain, you can use ice, applying it for 20 minutes three to four times per day through a towel or other covering so the ice is not in direct contact with your skin.

Podiatrist Treatment

At your appointment with one of our Brisbane podiatrists, they’ll assess the severity of the injury (and any other injuries that may also be present in the area) and will decide whether temporarily using a moon boot or other offloading walker or boot will be best in your circumstances to boost the healing and repair process. If a boot is recommended, it will work to help stabilise your joint, offload the ankle and prevent more stress on the injured ligaments. Your podiatrist will then create a custom management plan based on your unique circumstances that may include:

• Physical therapy via a tailored exercise program that focuses on both strengthening and gentle stretching to address any imbalances, support good ankle function, and help the ankle regain strength and unrestricted movement. Once adequate healing and strengthening has occurred, balance and proprioception exercises may be included into this plan to support best long-term results. 
  

• Using custom foot orthotics to adjust the biomechanics of your feet, whether that looks like creating a deeper heel cup to give your ankle greater stability every time you’re in your shoes, or help account for any other biomechanical factors that may have contributed to your high ankle sprain.
  

• Footwear recommendations to help best support and stabilise the ankle for the long-term (and keeping in consideration your regular sports and physical activities), as well as footwear modifications to help ensure your shoes are doing an adequate job of promoting your confidence and stability on your feet,
  

• MLS laser: MLS is an effective form of pain relief that benefits high ankle sprains in several ways, including minimising pain, supporting the healing and repair process of the ankle ligaments, and optimising your recovery. 
  
• Custom ankle-foot orthotics (AFOs) - in some cases, particularly if your sprain is severe or has occurred alongside another injury to the tibia or fibula, we may recommend using ankle-foot orthotics to help you achieve the best results for your ankle repair and healing.
  

Surgical Treatment

While surgery is not typically recommended for high ankle sprains, if your circumstances mean that you have several injuries alongside your sprain, if your ligaments have severely torn or ruptured, or if you do not respond to standard treatment protocols, then a consult with an orthopaedic surgeon may be recommended. They may discuss:

• Syndesmosis fixation: this involves stabilising the ankle joint through the use of screws, sutures, or other fixation devices to reposition and secure the injured syndesmosis ligaments.
  

• Debridement or repair: this involves removing scar tissue or damaged ligaments, or repairing torn ligaments, to restore stability and function to the ankle joint.
  

Rehabilitation And Recovery From A High Ankle Sprain

A good rehabilitation process is essential for promoting healing, restoring function, and minimising the risk of recurrence. Physical therapy plays a central role in post-treatment rehabilitation, focusing on strengthening the muscles surrounding the ankle, improving flexibility, and enhancing proprioception (the sense of joint position). Adherence to prescribed exercises is crucial for optimising outcomes, as these exercises help rebuild strength and stability in the ankle joint while promoting proper alignment and biomechanics. Additionally, activity modification may be necessary during the early stages of rehabilitation to avoid activities that exacerbate symptoms or place undue stress on the healing ligaments. Gradual progression of activities is key, with a focus on gradually increasing intensity, duration, and complexity in line with what you can tolerate. This is where your podiatrist will stay with you throughout your recovery so you feel confident in knowing exactly what you should be doing and when, so you can get back to doing the things you love.

The timeline for recovery and return to sports following a high ankle sprain can vary - mild to moderate high ankle sprains may require several weeks to a few months for complete recovery, while more severe injuries or those requiring surgical intervention may have a longer recovery period. We recommend a gradual return to sports or high-impact activities, paying very close attention to proper technique, adequate warm-up and cool-downs, and always wearing good, supportive footwear.

Frequently Asked Questions

How does a high ankle sprain differ from a traditional ankle sprain?

A high ankle sprain differs from a traditional ankle sprain primarily in the location and severity of the injury. While a traditional ankle sprain typically involves injury to the ligaments on the outer side of the ankle (lateral ligaments), a high ankle sprain involves injury to the syndesmosis ligaments that connect the tibia (shinbone) and fibula (outer leg bone) above the ankle joint. High ankle sprains often result from sudden twisting or rotational movements of the ankle, and they tend to cause pain and tenderness above the ankle joint rather than on the outer side. Additionally, high ankle sprains may require a longer recovery time and may be associated with a higher risk of chronic instability compared to traditional ankle sprains.

Can high ankle sprains heal without surgery?

Yes, high ankle sprains can often heal without surgery, especially if they are mild to moderate in severity. We’ve listed our non-surgical approach to managing high ankle sprains under the treatment section above. These conservative measures aim to reduce pain and inflammation, promote healing of the injured ligaments, and restore function to the ankle joint. However, severe high ankle sprains or those that fail to respond to conservative treatment may require surgical intervention to stabilise the ankle joint and repair or reconstruct the damaged ligaments

What is the recovery time for a high ankle sprain?

The recovery time for a high ankle sprain varies depending on factors such as the severity of the injury, individual healing capacity, and adherence to rehabilitation protocols. Generally speaking, mild to moderate high ankle sprains may require several weeks to a few months for complete recovery with conservative treatment. More severe injuries or those requiring surgical intervention may have a longer recovery period, ranging from several months to a year or more.

Are there specific exercises to prevent high ankle sprains?

Yes, there are specific exercises that can help strengthen the muscles surrounding the ankle, improve flexibility, and enhance proprioception (the sense of joint position), which may reduce the risk of high ankle sprains. Examples of exercises include calf raises, ankle circles, resistance band exercises for ankle stability, balance exercises (e.g. single-leg balance, wobble board exercises), and agility drills. Additionally, incorporating exercises that target the muscles of the lower leg and foot, such as the peroneal muscles, can help improve ankle stability and reduce the risk of injury.