A high ankle sprain, medically termed a syndesmotic sprain, involves damage to the ligaments connecting the two long bones of the lower leg, the tibia and the fibula, just above the ankle joint. These syndesmotic ligaments stabilize the ankle mortise, unlike a common lateral ankle sprain which typically affects the ligaments on the outside of the ankle. This type of injury often occurs from a forceful external rotation of the foot combined with dorsiflexion, which forces the lower leg bones apart. This guide offers instruction for emergency or supportive taping but should not replace professional medical diagnosis or a comprehensive treatment plan from a healthcare provider.
Essential Supplies and Preparation
Non-elastic athletic tape, typically 1.5 inches wide, provides the necessary rigid stabilization. To protect the skin from irritation and blistering, a pre-wrap or underwrap must be applied before the adhesive tape.
Additional protective items include heel and lace pads or a simple lubricant to cushion sensitive areas. Optional adhesive spray can be applied to the skin to improve the tape’s grip, especially in high-moisture environments. The skin must be clean, dry, and free of hair in the area extending from the mid-foot up to approximately a third of the way up the calf. The patient should be positioned comfortably, with the foot held in a neutral position, ideally at a 90-degree angle to the lower leg, to maintain proper joint alignment during application.
Step-by-Step Syndesmotic Taping Technique
The syndesmotic taping technique is designed to compress the tibia and fibula bones together, supporting the injured ligaments. This application is often layered over a foundational ankle taping for comprehensive stability. Begin by applying two anchor strips of rigid tape: one just below the calf muscle belly and a second around the mid-foot.
Next, apply a series of three non-elastic strips in a basket weave pattern, starting medially, passing under the heel, and finishing laterally. These initial strips (stirrups) are followed by three horseshoe strips applied directly to the skin or pre-wrap. This foundational layer provides general ankle support and a base for the specialized compression strips.
The application of the compression strips requires maximum tension to create the “syndesmotic squeeze.” These strips, often applied in an X or figure-8 pattern, begin posteriorly on the fibula, are pulled anteriorly and medially across the front of the lower leg, and then secured to the tibia. This action physically draws the two bones closer together, reducing stress on the damaged ligaments.
Ensure these strips do not wrap completely around the lower leg, leaving the Achilles tendon exposed to prevent restricting circulation. This non-circumferential application is repeated two or three times, slightly overlapping the previous strip for consistent compression. Finally, apply smooth closure strips around the initial anchors and over all exposed pre-wrap to lock the structure in place.
Immediate Assessment and When to Seek Medical Attention
Immediately following the tape application, a thorough assessment is necessary to confirm that the support is effective without causing harm. The first step involves checking the circulation in the foot by performing a capillary refill test on the toes. Pressing lightly on a toenail should cause the color to blanch, with the pink color returning within two seconds, indicating adequate blood flow.
The patient should also be asked if they experience any numbness, tingling, or excessive pressure, particularly in the toes or foot. These sensations can signal nerve impingement or overly tight application. Any complaint of throbbing pain or discoloration means the tape must be removed immediately and reapplied with less tension.
Taping is contraindicated if there is a suspected fracture, excessive swelling that changes the foot’s shape, or an inability to bear any weight on the injured leg. These signs suggest a more severe injury, such as a complete ligament rupture or a concurrent bone fracture, which requires professional medical evaluation. If the patient is unable to walk or if there is visible deformity, taping should be avoided, and the individual should be immobilized and transported for an X-ray.