High Ankle Sprain: Symptoms, Causes, Treatment

What are the symptoms of a high ankle sprain?

A high ankle sprain, also known as a syndesmotic ankle sprain, differs from a traditional ankle sprain in that it involves injury to the ligaments that connect the two leg bones (tibia and fibula) above the ankle joint. Symptoms typically include:

1. Pain: Often felt above the ankle joint and may be more severe than a traditional ankle sprain.
2. Swelling: Around the ankle joint, particularly in the front.
3. Tenderness: To touch, especially when pressure is applied above the ankle.
4. Difficulty bearing weight: Walking or putting weight on the affected leg may be painful or challenging.
5. Bruising: May develop around the ankle or extend up the leg.
6. Limited range of motion: Difficulty moving the ankle, especially when trying to rotate or move side to side.

If you suspect a high ankle sprain, it’s important to see a healthcare provider for proper diagnosis and treatment, as these injuries can sometimes be more complex and require specific management compared to typical ankle sprains.

What are the causes of a high ankle sprain?

A high ankle sprain, also known as a syndesmotic ankle sprain, is typically caused by excessive force that disrupts the ligaments connecting the tibia and fibula bones above the ankle joint. The main causes include:

1. Twisting or rotational force: This is the most common mechanism, often occurring during sports activities where sudden changes in direction or pivoting motions place stress on the ankle.
2. Direct impact: A blow to the lower leg or ankle can force the tibia and fibula bones apart, stretching or tearing the syndesmotic ligaments.
3. Falling: Landing awkwardly on the foot or lower leg can also cause the ankle to twist or bend in a way that stretches the syndesmotic ligaments.
4. Sports activities: Certain sports that involve cutting maneuvers (e.g., soccer, basketball), jumping, or contact sports increase the risk of high ankle sprains.
5. Motor vehicle accidents: Injuries from accidents where the lower leg is forcefully twisted or impacted.
6. Overuse or repetitive stress: Prolonged stress or repetitive movements that strain the ankle can weaken ligaments over time, increasing susceptibility to injury.

High ankle sprains are less common than traditional ankle sprains (involving the lateral ligaments), but they often require longer recovery times and careful management due to the nature of the injury involving the higher ligaments between the tibia and fibula.

How is the diagnosis of high ankle sprain made?

The diagnosis of a high ankle sprain is typically made through a combination of physical examination, medical history, and diagnostic imaging tests. Here are the steps involved in making a diagnosis:

1. Physical Examination: A healthcare provider will perform a thorough physical examination to assess the ankle and surrounding areas. They will:
   • Look for signs of swelling, bruising, or deformity.
   • Check for tenderness and pain in the ankle joint, particularly along the medial (inner) aspect of the ankle.
   • Perform a series of tests to assess ankle stability, such as the anterior drawer test, talar tilt test, and inversion stress test.
   • Evaluate the range of motion and strength of the ankle and surrounding muscles.
2. Medical History: The healthcare provider will ask questions about the injury, including:
   • How the injury occurred (e.g., twisting, landing from a jump, etc.).
   • The severity of the pain and discomfort.
   • Any previous ankle injuries or conditions.
3. Imaging Tests: Depending on the severity of the symptoms and the need for further clarification, imaging tests may be ordered to confirm the diagnosis. These may include:
   • X-rays: To rule out fractures or other bony injuries.
   • Magnetic Resonance Imaging (MRI): To evaluate the ligaments and soft tissues around the ankle joint.
   • Computed Tomography (CT) Scan: In some cases, a CT scan may be used to further evaluate the ligaments and bones around the ankle.

A high ankle sprain is typically diagnosed based on the following criteria:

1. Location: The pain and tenderness are located on the medial (inner) aspect of the ankle joint, rather than the lateral (outer) aspect, which is typical of a traditional low ankle sprain.
2. Mechanism of injury: The injury occurred due to forced dorsiflexion (upward movement) of the foot, which puts tension on the syndesmosis ligaments.
3. Physical examination findings: The physical examination reveals limited range of motion, tenderness to palpation (pressure) over the syndesmosis ligaments, and pain with forced dorsiflexion of the foot.

Based on these findings, a healthcare provider can diagnose a high ankle sprain and determine its severity using a grading system such as:

• Grade 1: Mild sprain with minimal swelling and pain.
• Grade 2: Moderate sprain with significant swelling and pain.
• Grade 3: Severe sprain with significant instability and limited mobility.

It’s essential to have a proper diagnosis to ensure appropriate treatment and to minimize complications.

What is the treatment for a high ankle sprain?

The treatment for a high ankle sprain typically involves a combination of rest, ice, compression, and elevation (RICE) to reduce pain and inflammation, followed by rehabilitation exercises to restore strength and range of motion. The severity of the sprain and individual factors such as age, fitness level, and occupation may influence the specific treatment plan. Here’s a general overview of the treatment stages:

Acute Phase (0-3 weeks)

1. RICE: Rest, Ice, Compression, and Elevation:
   • Rest: Avoid activities that aggravate the condition.
   • Ice: Apply ice packs for 15-20 minutes, 3-4 times a day, to reduce pain and inflammation.
   • Compression: Use an elastic bandage or compression wrap to reduce swelling.
   • Elevation: Elevate the ankle above the level of the heart to reduce swelling.
2. Pain management: Over-the-counter pain relievers such as ibuprofen or acetaminophen can be used to manage pain and discomfort.
3. Immobilization: A walking boot or cast may be necessary to restrict movement and allow the ligaments to heal.

Subacute Phase (3-6 weeks)

1. Gentle mobilization: Gradually increase movement and range of motion exercises to prevent stiffness and promote healing.
2. Strengthening exercises: Start with low-level strengthening exercises for the ankle and surrounding muscles, such as toe curls, toe spreads, and ankle alphabet exercises.
3. Balance and proprioception exercises: Exercises that challenge balance and proprioception (awareness of body position) can help improve stability and reduce the risk of future injuries.

Chronic Phase (6 weeks and beyond)

1. Progressive strengthening: Gradually increase the intensity and difficulty of strengthening exercises.
2. Agility and plyometric training: Incorporate agility drills and plyometric exercises to improve ankle stability, power, and speed.
3. Functional training: Incorporate functional exercises that mimic daily activities or sports-specific movements to improve functional ability.

Additional considerations

1. Bracing: A bracing device may be recommended for certain activities or occupations that involve high-risk movements.
2. Physical therapy: Working with a physical therapist can help accelerate the rehabilitation process and improve outcomes.
3. Surgery: In some cases, surgery may be necessary to repair torn ligaments or address chronic instability.

It’s essential to note that every individual’s recovery process is unique, and it’s crucial to follow a customized treatment plan under the guidance of a healthcare professional to ensure proper healing and minimize the risk of complications or re-injury.