High Ankle Sprain – When An Ankle Sprain Is Not An “Ankle Sprain”
So what is a “High Ankle Sprain”?
If you follow sport at all, I’m sure you’ve heard sports commentators refer to a high ankle sprain. You may have also heard that they usually takes longer to heal than a typical ankle sprain.
But what exactly is a high ankle sprain and why do they take so long to heal?
WHAT IS A HIGH ANKLE SPRAIN?
A High Ankle Sprain is term commonly referring to what is technically known as a syndesomotic ankle sprain – we think High Ankle Sprain is a lot easier to remember!
The ankle joint is formed by four main bones – the two shin bones (the tibia and fibula) join at the bottom to form an arch to hold the talus bone.
The talus sits squarely within this archway (called the ankle mortise) and its movement within the archway allows the foot to move up and down.
Underneath the talus is the “sub-talar” joint of the ankle – this is where the other main ankle bone, the calcaneus attaches to the talus. Movement of this joint allows inwards and outwards movement of the ankle.
Lateral Ligament Sprain
The majority (90%+) of ankle sprains damage the lateral, or outside ligaments of the ankle. This occurs when the foot turns inwards and the ligaments on the outside of the ankle are stretched and damaged to some degree.
This leads to pain and swelling on the outside of the ankle and can take anywhere from 1 to 6 weeks to recover from, depending on the severity.
Medial Ligament Sprain
Another ankle injury that can occur is the medial ligament injury, where the foot rolls outwards, stretching the ligaments on the inside of the ankle.
High Ankle Sprain
A High Ankle Sprain occurs most commonly when the ankle is forced outwards – into what we call external rotation.
This forces the square-shaped talus bone of the ankle to rotate outwards, forcing the fibula to want to separate from the tibia.
The ligaments that connect these two bones, the anterior and posterior inferior tibio-fibular ligaments are then stretched. If either or both of these ligaments are torn, then the strong union between the two shin bones is damaged, and can lead to pain with weight-bearing, when the body’s weight can try to separate the two shin bones apart.
What Are The Symptoms Of A High Ankle Sprain?
People who suffer this injury are often tender to touch higher up on the ankle than a traditional sprain. And if you look at the anatomy you can see why – the ligaments damaged are the ones keeping the shin bones together, and sit an inch or two above the lateral ligaments of the ankle.
This is why this injury takes so long to get over – you need the ligaments to be nice and strong again before you can put too much weight through the foot.
HOW DO YOU MANAGE A HIGH ANKLE SPRAIN?
Management of this injury varies, depending on the severity. It it recommended the patient goes onto crutches straight away and tries to minimise weight-bearing activity until it is pain-free to weight bear. This can be up to a couple of weeks.
They may also need to immobilise the ankle in a cam walker or “moon boot” to allow the ligaments to be held together as they heal. This can be up to a period of 6 weeks.
Rehab starts as soon as the patient can weight-bear and involves managing the swelling, restoring normal strength and proprioception (balance) around the ankle and then planning a structured return to sport program.
Rarely, the injury is so severe that the anterior and posterior ligaments are both disrupted, and the shin bones significantly widen with weight-bearing. This requires that the two bones are held together with a surgical screw for about 12 weeks, before the screw is removed and running and sport are gradually resumed over a 4-6 week period.
I THINK I HAVE A HIGH ANKLE SPRAIN – WHAT DO I DO?
It is important to recognise the possibility of a high ankle sprains in athletes, as the management of them differs from standard ankle sprains and the recovery is a lot slower.
If you’ve hurt your own ankle it is important that you have it assessed as soon as possible by a sports physiotherapist. At Leading Physiotherapy we actually see this injury more often than we’d like – we can help you recover from it, or identify if it is in need to further opinion by our network of Sports Physicians and Orthopaedic Surgeons.