A high ankle sprain, also known as a syndesmotic injury, involves damage to the ligaments connecting the tibia and fibula, just above the ankle joint. This differs from common ankle sprains, which typically affect ligaments on the outer side of the ankle. High ankle sprains often require a longer recovery period due to the nature of the injured ligaments.
Understanding the Injury
The ankle joint is formed by the tibia, fibula, and talus. While common ankle sprains usually involve ligaments on the outside of the ankle, a high ankle sprain impacts the syndesmotic ligaments. These ligaments, including the anterior inferior tibiofibular ligament (AITFL), posterior inferior tibiofibular ligament (PITFL), and the interosseous ligament, form the syndesmosis, a strong connection between the tibia and fibula.
A high ankle sprain occurs when the foot is planted and the ankle is forcefully twisted outwards or bent upwards. This mechanism can cause the tibia and fibula to separate slightly, stretching or tearing the syndesmotic ligaments. Common scenarios include contact sports like football, where a player’s foot is planted while another player falls on their leg, causing a twisting motion. The syndesmosis acts as a shock absorber, enduring significant force during walking and running, which contributes to the pain experienced with each step.
Initial Steps and Medical Evaluation
Immediately following a suspected high ankle sprain, implement the R.I.C.E. protocol: Rest, Ice, Compression, and Elevation. Rest involves avoiding painful activities and putting weight on the injured ankle. Apply ice to the injured area for 15-20 minutes every 2-3 hours during the first 48 hours to reduce pain and swelling. Use an elastic bandage for compression to control swelling, ensuring it is snug without cutting off circulation. Elevate the ankle above heart level during the initial 48 hours to reduce fluid accumulation.
Seeking professional medical attention is important, especially if you cannot bear weight, experience severe pain, or notice significant swelling. A doctor’s evaluation involves a physical examination of the ankle, foot, and lower leg for tenderness and range of motion.
Imaging tests are often recommended to determine injury extent and rule out fractures. X-rays identify bone fractures. Magnetic resonance imaging (MRI) provides detailed views of soft tissues, including ligaments, useful for assessing syndesmotic injuries. Computed tomography (CT) scans offer more detailed bone imaging and can detect subtle syndesmotic injuries.
Professional Treatment Options
Treatment for a high ankle sprain varies based on severity, graded from 1 (least severe, stretched ligament) to 3 (complete ligament tear with instability). For less severe sprains (Grade 1 and some Grade 2 injuries), non-surgical approaches are often effective. This involves immobilizing the ankle to stabilize the joint and limit movement. Immobilization can be achieved using a brace, splint, or a walking boot, which may be non-weight-bearing initially.
Pain management is part of non-surgical treatment, involving nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation. Immobilization periods range from a few days for milder cases to several weeks for more severe sprains. Some Grade 3 injuries may require up to six weeks of non-weight-bearing immobilization before rehabilitation. Functional immobilization, using devices like lace-up ankle braces or walking boots, can potentially reduce recovery time compared to traditional casts.
For severe high ankle sprains, especially those with significant instability or wide separation between the tibia and fibula (diastasis), surgical intervention may be necessary. The goal of surgery is to realign and stabilize the joint. A common technique is syndesmotic screw fixation, where screws are implanted through the fibula into the tibia to stabilize the syndesmosis. Another popular approach is the TightRope™ procedure, which uses a suture-button construct to stabilize the joint, often allowing for earlier weight-bearing and potentially a quicker return to activity by maintaining more physiological motion than screws.
Rehabilitation and Gradual Recovery
Once the initial acute phase of treatment concludes and inflammation has subsided, rehabilitation begins, focusing on restoring the ankle’s function. Physical therapy plays a central role in this process, guiding the patient through progressive exercises. Early stages of rehabilitation often involve gentle range of motion exercises to regain flexibility, such as ankle pumps to reduce swelling and restore movement. Manual therapy techniques may also be used to improve joint mobility.
As healing progresses, strengthening exercises are introduced to rebuild the muscles surrounding the ankle and lower leg. Examples include heel raises and step-ups, gradually increasing intensity and resistance. Balance training, or proprioceptive drills, are then incorporated to improve the ankle’s ability to respond to movements and prevent re-injury. These exercises may involve standing on one leg or performing clock reaches.
A gradual return to activity and sports is important to ensure a full recovery and minimize the risk of re-injury. This phase involves sport-specific drills and activities that progressively challenge the ankle’s stability and strength. Adherence to the physical therapist’s guidance is important throughout this process, as rushing recovery can lead to persistent pain, chronic instability, or even new injuries. The overall recovery period for a high ankle sprain can be highly variable, often extending longer than that for a lateral ankle sprain, with an average recovery time ranging from 6 to 8 weeks, but potentially longer depending on the injury’s severity.