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High Ankle Sprain

A high ankle sprain is an injury to the higher ankle ligaments, which are located above the ankle joint . The most common ankle sprain that many of us have had, affects the lower ligaments of the ankle. 

These high ankle ligaments connect your tibia (shin bone) to the fibula (outside leg bone). The injury involves the syndesmosis between the lower tibia and fibula just above the ankle joint. 

Your syndesmosis is a fibrous joint where the two leg bones are connected together by ligaments or connective tissue and usually have very little mobility. 

 High ankle sprains are much less common but are more disabling than your traditional lower ankle sprain.  

What Causes a High Ankle Sprain? 

High ankle sprains most commonly occur when your foot is planted on the ground and then an excessive outwards twisting of your foot occurs. 

High ankle ligaments can also sprain when your ankle is loaded severely and pushed into excessive dorsiflexion. This often occurs in football tackles. 

What are the Symptoms of a High Ankle Sprain? 

High ankle sprains occur following a traumatic ankle injury. 

Patients often report: 

  • The pain felt above the ankle that increases with outward rotation of the foot. 

  • Pain with walking and often significant bruising and swelling across the higher ankle rather than around the outer ankle bone. 

  • Unable to perform a single leg calf raise. 

Your severity of symptoms will depend on the grade of ankle sprain: mild, moderate, severe. 

Patients with a high ankle sprain without fracture may be able to bear weight but will have pain over the junction between the tibia and fibula just above the level of the ankle. This is higher than the more traditional sprains. Pain over the posterior aspect of the ankle is of particular concern and may be associated with an avulsion fracture or bone bruising. 

How is a High Ankle Sprain Diagnosed? 

Your ankle  will be assessed  for ankle ligaments integrity.  A weight-bearing X-ray, CT scan or MRI may be needed to confirm the diagnosis.  

The radiologist will check for a gapping in the inferior tibiofibular joint as shown in this X-ray. It is thought that a gap >2mm can become unstable. It is the unstable group who may require surgical stabilisation. 

What’s the Treatment for High Ankle Sprain? 

Once you rupture or overstretch these high ankle ligaments, the bones of your lower leg move apart with every step causing pain and loss of your passive ankle stability. You will often require crutches or a walking boot during this phase. While unstable injuries will usually require surgery, stable injuries can be treated conservatively with hands on treatment, stretching, active and passive movements along with some modalities such as ultrasound or laser therapy.