High Ankle Sprains

What is a High Ankle Sprain?

A high ankle sprain, also known as a syndesmotic ankle sprain, is an injury to the ligaments that connect the two bones of your lower leg (tibia and fibula) just above your ankle joint. These ligaments form a structure called the syndesmosis, which helps keep your ankle stable when you walk or run.

At Willoughby Health, our team of Physiotherapists and Chiropractors often see patients with high ankle sprains and understand how worrying and painful injury can be. So we’ve put together this guide to help people better understand this condition and the treatment and rehabilitation required to properly recover from it.

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How is a High Ankle Sprain different from a regular ankle sprain?

A high ankle sprain is different from a common ankle sprain in several ways:

• Location: It affects the ligaments above the ankle, while common sprains affect ligaments on the outside of the ankle.
• Mechanism of injury: It often occurs when the foot is forced upward and outward, while common sprains usually happen when the foot rolls inward.
• Recovery time: High ankle sprains typically take longer to heal than common ankle sprains.
• Treatment: They often require more intensive treatment and sometimes surgery.

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What are the symptoms of a High Ankle Sprain?

The symptoms of a high ankle sprain can include:

• Pain above the ankle, especially when rotating the foot outward
• Swelling above the ankle
• Difficulty walking or putting weight on the affected foot
• Pain when pushing off with the foot, like when climbing stairs
• Tenderness when pressing on the area above the ankle
• Instability in the ankle joint
• Bruising in some cases
• Pain that increases with activities that spread the tibia and fibula, like squatting

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What causes a High Ankle Sprain?

High ankle sprains are typically caused by:

• Sudden twisting or rotating of the ankle
• The foot being forced upward and outward
• Landing awkwardly after jumping
• A direct blow to the ankle while the foot is planted
• Rapid changes in direction while running or playing sports

These injuries are common in sports that involve sudden stops and changes in direction, like football, soccer, and basketball.

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Who is most at risk of getting a High Ankle Sprain?

While anyone can suffer a high ankle sprain, certain groups are at higher risk:

• Athletes, especially those in contact sports or sports with quick direction changes
• People with previous ankle injuries
• Individuals with weak ankle muscles or poor balance
• Those who wear improper footwear during sports or physical activities
• People with certain foot structures, like high arches

Understanding your risk factors can help in prevention and management.

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How is a High Ankle Sprain diagnosed?

When you visit Willoughby Health with symptoms of a high ankle sprain, our healthcare professionals will use several methods to diagnose your condition:

1. Medical history: They'll ask about your symptoms, how the injury occurred, and your activity level.
2. Physical examination: Your Physiotherapist or Chiropractor will:
   • Check for swelling and tenderness above the ankle
   • Assess your ankle's range of motion
   • Perform specific tests to check the stability of your syndesmosis like the squeeze test, external rotation test, or fibular translation test.
3. Imaging tests: X-rays, MRI, or CT scans may be recommended to assess the extent of the injury and rule out fractures.

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What role does imaging play in diagnosing High Ankle Sprains?

Imaging can play an important role in diagnosing and assessing high ankle sprains:

• X-rays: These can show if there's widening between the tibia and fibula, which indicates a high ankle sprain. They can also rule out fractures.
• MRI (Magnetic Resonance Imaging): This gives a detailed view of the soft tissues and can show the extent of ligament damage.
• CT (Computed Tomography) scan: This can provide detailed images of the bones and is useful for assessing the alignment of the ankle joint.

At Willoughby Health, our Physiotherapists and Chiropractors in Willoughby can refer you for these scans if necessary and explain what the results mean for your condition and treatment.

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How are High Ankle Sprains treated?

Treatment for high ankle sprains aims to reduce pain, promote healing, and restore function. These include:

• RICE protocol: Rest, Ice, Compression, and Elevation to manage pain and swelling
• Immobilisation: Using a boot or cast to protect the ankle while it heals
• Exercise Rehabilitation: Our Physios, Chiros, and EPs can design an exercise program to improve your ankle strength, stability, and range of motion
• Pain management: Over-the-counter pain relievers or prescription medications may be recommended
• Gradual return to activities: We'll guide you through a safe return to your normal activities
• Surgery: In severe cases or for athletes needing a quicker return to sport

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When is surgery required for a High Ankle Sprain?

Surgery for high ankle sprains is generally considered when:

• There's significant instability in the syndesmosis
• Conservative treatments haven't improved your symptoms
• You're an athlete needing to return to high-level sports quickly
• There's a fracture associated with the sprain

The most common surgery for high ankle sprains involves placing screws or a special suture device to hold the tibia and fibula together while the ligaments heal. If surgery is being considered, our Physiotherapists and Chiropractors can help recommend good orthopaedic surgeons to perform this procedure, and guide you through the post-surgical rehabilitation process required afterwards.

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What role does exercise play in recovering from a High Ankle Sprain?

Exercise is a crucial part of recovering from a high ankle sprain. It helps to:

• Restore range of motion in your ankle
• Strengthen the muscles around your ankle
• Improve balance and proprioception (your body's ability to sense its position in space)
• Prepare your ankle for a return to normal activities or sports

Our Physiotherapists and Chiropractors at Willoughby Health can design an exercise program tailored to your specific needs and stage of recovery. This might include:

• Range of motion exercises
• Strengthening exercises
• Balance and proprioception training
• Sport-specific exercises (if you're an athlete)

Remember, it's important to follow your exercise program consistently but carefully. We can guide you through this process safely, ensuring you don't push too hard and risk re-injury.

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How can I prevent ongoing problems after a High Ankle Sprain?

To prevent ongoing problems and reduce the risk of re-injury after a high ankle sprain:

• Complete your rehabilitation program: Follow through with all exercises prescribed by your physiotherapist
• Gradually return to activities: Don't rush back into sports or high-impact activities
• Use proper footwear: Wear shoes that provide good support, especially during physical activities
• Consider ankle bracing or taping: This can provide extra support during activities, especially early in your return to sports
• Maintain strength and flexibility: Continue with exercises to keep your ankle strong and flexible
• Practice balance exercises: These can help improve your ankle stability
• Warm up properly: Always warm up before physical activities
• Listen to your body: If you feel pain or instability, stop the activity and rest

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How long does it take to recover from a High Ankle Sprain?

Recovery time for high ankle sprains can vary depending on the severity of the injury:

• Mild sprains: 3-4 weeks
• Moderate sprains: 6-8 weeks
• Severe sprains or those requiring surgery: 3-6 months

It's important to note that everyone's recovery is different. Factors like your age, overall health, and how well you follow your treatment plan can all affect your recovery time.

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Can I still play sports after a High Ankle Sprain?

Many people are able to return to sports after a high ankle sprain, but the timeline can vary:

• For mild sprains: You might return to sports in 1-2 months
• For moderate to severe sprains: It might take 3-6 months

The decision to return to sports should be made in consultation with your healthcare providers. They'll assess your ankle strength, stability, and function to ensure you're ready.

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What's the difference between a High Ankle Sprain and a fracture?

While high ankle sprains and fractures can have similar symptoms, they are different injuries:

• High ankle sprain: Involves damage to the ligaments above the ankle
• Fracture: Involves a break in one or more of the bones in the ankle or lower leg

Sometimes, a high ankle sprain can occur alongside a fracture. That's why proper diagnosis, often including imaging tests, is important.

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Can High Ankle Sprains recur?

Yes, high ankle sprains can recur, especially if:

• The initial injury wasn't fully healed before returning to activities
• Rehabilitation wasn't completed properly
• There's ongoing instability in the ankle

That's why it's crucial to complete your rehabilitation program and follow all advice from your healthcare providers.

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When should I see a healthcare professional about ankle pain?

You should consider seeing a healthcare professional if:

• You have severe pain or swelling in your ankle
• You can't put weight on your affected foot
• You heard a popping sound at the time of injury
• Your ankle looks deformed or misaligned
• You have pain above your ankle, especially when rotating your foot outward
• Your symptoms don't improve after a few days of home care

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Take home message

High ankle sprains are serious injuries that can significantly impact your mobility and quality of life. However, with proper diagnosis, treatment, and rehabilitation, most people with high ankle sprains can return to their normal activities and even high-level sports.

At Willoughby Health, our team of friendly and experienced Physiotherapists and Chiropractors can help you manage your high ankle sprain effectively. We offer a range of treatments and can provide personalised advice on exercises, return to activity, and strategies for preventing future injuries. Remember, early intervention is key in managing high ankle sprains.

If you've experienced an ankle injury or are having symptoms of instability, don't hesitate to contact us at Willoughby Health. We also have clinics conveniently located around Sydney in Mt Kuring-Gai, Asquith, Milsons Point, Dural, and Blacktown, so you can get the right advice and treatment for your high ankle sprain.

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