Sprain/Strain

Symptoms, Treatment, and Everything about High Ankle Sprain

high ankle sprain

There are different types of ankle sprains, and one of them is a high ankle sprain.

If you are an athlete, especially sports where you get tackled, such as football, you are at risk for this type of ankle sprain.

It pays to know what a high ankle sprain is since treatment should be performed immediately.

What Exactly is a High Ankle Sprain? 

Unlike the other types of an ankle sprain, this particular injury, which is also known as a syndesmotic sprain, takes place in the tissues connected to the fibula (your outer bone leg) and the tibia (shin bone).

When injured, it includes the syndesmosis, which is a fibrous joint in which two leg bones meet through connective tissue or ligaments.

In reality, high ankle sprains are not as common as other kinds of ankle sprains, but they are more disabling, especially when left undiagnosed during the early stages.

This significant injury can easily sideline an athlete longer than it would take if he or she has a typical ankle sprain.

In sports, ankle sprains are among the most common acute injuries in which 10% of them are treated by physicians, according to the research by the University of North Carolina.

A high ankle sprain is a twisting injury that can also happen in the setting of a fracture of the ankle, which means the ankle bones are broken.

Some cases have the ligament on the interior of the ankle, known as the deltoid), to be torn.

When the deltoid is torn, the force of the injury passes through the high ankle ligaments (syndesmosis) from the deltoid.

It goes up to the leg and through the fibula, which means the fibula is extremely broken.

This type of fracture is known as the Maisonneuve fracture, according to the American Orthopaedic Foot & Ankle Society.

High Ankle Sprain vs. Low Ankle Sprain 

Many medical experts agree that the ankle is among the most complex joints we have in our body.

It is also among the most heavily used, which is why there are about 25,000 ankle injuries daily in the US alone.

About 5.7 percent of these are high ankle sprains without fracture as confirmed by the Podiatric Surgical Residency Program of the Oakwood Healthcare System in Dearborn, Michigan.

Ankle injuries can either be a high or low ankle sprain. When it is a high ankle injury or syndesmotic, it occurs when the ankle and the foot pivot together. It causes the tissues holding the fibula and the tibia to stretch.

As the name suggests, a high ankle injury occurs above the joint of the ankle itself. It usually requires a much longer rehabilitation time for the person to recover unlike when the low ankle is involved fully.

When a person damages his or her low ankle, it can be described as what most people picture when they think about a regular ankle sprain.

Commonly, it is called an inversion ankle sprain since the ankle rolls inwardly, which results in the stretching of the tissue in the ankle joint.

Most of the low ankle injuries – approximately 80% – are inversion sprains, while the remaining 20% is an eversion sprain. By definition, an eversion ankle sprain is an opposite in which the ankle rolls outwardly.

High Ankle Sprain Causes 

The most frequent cause of high ankle sprain is when an individual land on another person’s foot when returning to the ground after jumping.

The weight of the person, along with the force of gravity, fuses and overpowers the interosseous membrane and the ligaments and the bones of the ankles.

As a result, both the distal posterior and anterior tibiofibular ligaments are harmed and torn because of extremely forced dorsiflexion, which involves the toes to the frontal lower leg. Typically, the damage also combines with severe sprains in the ankle.

Forceful twisting of the ankle outwardly may be rare, but it is a little bit more common in sports, especially wrestling, soccer, football, and hockey.

These sports have increased chances of becoming tangled with or under another individual.

High Ankle Sprain Symptoms 

Some indications of a high ankle sprain include swelling, pain, and bruising above the ankle.

Usually, the injured person finds it difficult to walk or bear his or her weight. The pain gets even worse when the foot is externally rotated.

High ankle sprains typically occur after a traumatic injury in the ankle. Patients frequently report that they feel pain above their ankle, which gets worse when the foot is rotated outwardly.

Most injuries cause bruising and swelling just like other ankle sprains. However, the inflammation is across the higher ankle and not around the malleolus, which is common in patients with different types of ankle damages.

Another typical symptom of a high ankle sprain is that the person cannot raise his or her leg calf.

Often, the severity of the symptoms is based on the grade of the injury, which starts from mild to moderate to severe.

When there is a pain in the posterior part of the ankle, it is usually something to be concerned about, since it can be associated with bone bruising or avulsion fracture.

High Ankle Sprain Causing Knee Pain 

The foot and the ankle are the parts of the body that come in contact with the ground when you walk or run.

If you cannot walk properly with decent body dynamics, it will affect other parts of the chain.

The next joint in this particular chain is your knee joint. The ankles can be wiggled, thanks to the mobility of the ankle joint.

On the other hand, the knee joint is not designed that way because it should be stable.

When the knees become “mobile,” it causes an injury called MCL or ACL tears, which occur approximately 100,000 times a year.

About 70% of ACL and MCL tears are non-contact, meaning the body mechanics break down, leading to serious damage even without other people touching them.

When the ankle is sprained and becomes immobile, they usually do not heal their ankle correctly, which leads to a reasonably weak ankle joint.

If the person goes back to sports even when the ankle has not healed yet, the knee will compensate for the immobility of the ankle. The knees try to become more mobile, which can result in a severe knee injury.

The best way to avoid the knee pain when a person has a high ankle sprain is to let the sprain heal completely before going back to rigorous activities.

What Does It Mean When You Hear A Pop In Your Ankle? 

When you turn your ankle, and you hear a popping sound, it can mean that you have a possible fracture or a severe sprain.

The popping sound usually occurs after your other symptoms have disappeared. It may be produced because the ligament has become looser than how it used to be.

A loose ligament creates the popping sound because the bones are moving around.

Normally, the popping sound is not something to worry about, although it can be troubling.

It does not indicate long-term conditions, but it is still worth having an ankle sprain test to ensure a tendon did not snap over your bones or you have a chronic ligament injury.

High Ankle Sprain Bruising 

Bruising can happen to those with a high ankle sprain, but it is possible not to have bruises.

A bruise or contusion is when small blood vessels in the ankle are damaged because of the trauma. Sprains can cause bruising, but in some cases, it can be due to a fracture.

Do High Ankle Sprains Swell? 

Yes, high ankle sprains cause swelling or inflammation. The injured part is typically sensitive and warm to the touch.

Medication can help bring down the swelling, but it is important to have it checked right away.

High Ankle Sprain Test 

A physiotherapist, ankle surgeon, or a sports doctor will check on the patient to clinically assess the ligaments in the ankle of the patient.

If the doctor thinks it is a syndesmosis injury, a CT scan, MRI, or a weight-bearing X-ray will be performed to confirm the diagnosis.

After the test, a radiologist will determine if there is a gap in the inferior tibiofibular joint.

If the radiologist finds a hole that is at least two millimeters, it will be classified as an unstable joint, which may often require surgical stabilization.

There are also other important tests that need to be done, including the external rotation and the squeeze tests.

In the external rotation test, the patient will be asked to bend his or her knee, while the ankle is positioned in neutral, meaning 90 degrees with the feet based on the orientation of the leg.

During this particular test, the patient’s foot will be turned to the outside. If he or she experiences pain at the syndesmosis (high ankle ligament area), it means there is an injury.

Meanwhile, the squeeze test is where a doctor will squeeze the leg below the knee. The pain would radiate to the high ankle ligament area, suggesting that the patient has a high ankle sprain.

How Do You Treat A High Ankle Sprain? 

The goal of the treatment for a high ankle sprain is to have the fibula and the tibia in their correct alignment.

These two should heal in their right position, which is essential. A tremendous amount of force passes through these areas whenever you run and walk.

There are several options for treatment, and the choice will depend on the case. If you overstretch or rupture the ligaments in your high ankle, the bones of the lower leg will move farther apart whenever you take a step, which causes pain and even loss of ankle stability.

Typically, the patient will need a walking boot or crutches during the treatment. If the injury is unstable, they may require surgery.

However, if it is a stable injury, it can be treated at home with the help of high-quality physiotherapy.

There are various stages for treating the injury, and there is no specific timeframe for the progress.

The physiotherapist will decide when the patient will move on to the next part of the treatment program.

The first step typically involves injury protection to relieve pain and inflammation. As with most injuries involving soft tissues, the initial treatment is to rest the ankle from any postures or activities that provoke pain.

Next is to apply ice to reduce swelling and pain for 20 to 30 minutes every two to four hours. The injury may become warm, and that indicates it is time to place some ice.

A compression bandage, kinesiology supportive taping, or compression stocking can help provide support for the injured soft tissue.

It will also help with the swelling. Finally, you should elevate the ankle above your heart, which assists gravity to reduce the swelling as well.

In most cases, you may be given some anti-inflammatory medication and creams to reduce the inflammation and the pain.

However, these drugs are typically avoided during the first 48 to 72 hours since they may encourage bleeding. Paracetamol may be used as a pain reliever.

High Ankle Sprain Taping 

This sprain responds well to taping, whether it is acute or severe, although the tapes used are different.

Taping relieves pain, improves the stability of the joints, and reduces recurrence of the injury.

Sports injuries typically need a rigid strapping tape, which is the firmest type of strapping tape available.

An elastic strapping tape can be used for support, which is for those who may already be in their healing process.

Meanwhile, kinesiology tape is suitable for mild sprains and can also help assist with muscle function.

High Ankle Sprain Surgery 

Unstable injuries usually need surgeries, which can be a grade 2 or grade 3 injury. Surgeries help regain the full strength, the range of motion, and agility of the patient.

How Long Does It Take To Recover From A High Ankle Sprain? 

High ankle sprains are often not as simple as common ankle sprains, so they take longer to heal completely.

They should be diagnosed at an early stage, and the appropriate treatment should be provided right away.

Syndesmotic injuries take some time to go away, which is why a health professional should take a look at the situation.

The orthopedic surgeon, sports doctor, or physiotherapist will take a look at the injury first and figure out whether it is unstable or stable.

If it is stable, the high ankle sprain can recover using a walking boot or a cast, which can take up to six weeks.

Grade 1 High Ankle Sprain Recovery Time 

A grade 1 case means it is mild so that you can expect the full healing of your ligament in about six weeks. However, it may take some more time if you plan to participate in sports activities.

Resting does help, but many patients note of stiffness in the joints, muscle weakness and tightness, and ligament laxity. It can also lead to reduced balance and awareness of the joints (proprioception).

What Is A Grade 2 Ankle Sprain? 

When the high ankle sprain is considered grade 2, it means it is a moderate injury and can typically take from six to 12 weeks to recover.

A grade 2 injury is when there is significant ligament damage that forces the ligament to stretch excessively.

The rehabilitation procedure can be more complicated than with grade 1 injury. Additionally, it can either be unstable or stable. If it is unstable, it will often require surgery.

If you have a grade 2 injury, you need rehabilitation to gain back your ankle’s full strength, a full range of motion, power, and agility.

Do Grade 3 Sprains Require Surgery? 

A grade 3 ligament injury is severe, which means the ligament is ruptured completely.

It is serious damage that can also include bone fracture, which requires additional time for rehabilitation.

An unstable injury needs a tightrope or a syndesmotic screw to hold the bones together.

The screw, which is positioned between the fibula and tibia, will stay there for about three months.

The patient should understand that even a simple walk can cause the screw to break.

Rehabilitation can take three to six months, but it will depend on the specific injury.

In short, this type of high ankle sprain is surgically repaired. However, it can also be treated with an ankle brace, according to the US National Library of Medicine.

The advantage of surgeries is that the patients can go back to their activities without worrying about the recurrence of the ankle ligament injury.

High Ankle Sprain Rehab 

The physician will work with the patient to plan a personalized treatment. High ankle sprains are often treated with physical therapy, and the patient should not carry or do specific activities for at least one week after the injury.

Rehabilitation may include the use of a heel lift, brace, or splint to stabilize the ankle and facilitate healing.

Once the swelling and pain resolve, the therapist will begin the progress of the rehabilitation program, which will depend on the goals of the patient.

Goals can include controlling pain and swelling and protecting healing structures with a brace, which will advance to maintaining motion and improve flexibility. An example of a rehabilitation program is available from the South Shore Hospital.

High Ankle Sprain Complications 

The sprain can lead to stiffness in the ankle. If it underwent surgery, there might be damage or infection in one of the nerves called the superficial peroneal nerve, which is responsible for giving sensation to the upper part of the foot.

This nerve runs close to the outer leg where the incision of the surgery is normally made. Additionally, arthritis may develop due to a serious sprain if the ankle cartilage is damaged.

High Ankle Sprain Brace 

The high ankle brace is useful in restricting severe rotation during the recovery process of the sprain. It offers stability while immobilizing the strained ligaments to promote healing.

PowerLix Ankle Brace Compression Support Sleeve

The PowerLix Ankle Brace Compression Support Sleeve is designed for injury recovery for a high ankle sprain to reduce swelling and joint pain.

It also provides arch support and also helps with arthritis, tendonitis, and other ankle pains. Check the prices of PowerLix Ankle Brace Compression Support Sleeve on Amazon.

UncleHu Ankle Support

UncleHu Ankle Support is a breathable ankle stabilizer brace that can be adjusted for comfort.

It is best for athletes, including those who are recovering from their injury. It is made from an elastic material that provides substantial protection and stops ankle sprain from recurring. Check the prices of UncleHu Ankle Support on Amazon.

Mcdavid Ankle Brace and Support

Mcdavid Ankle Brace and Support is designed for volleyball and basketball players and anyone who is actively participating in sports.

It is made of single-layer polyester fabric that leaves it lightweight but offers full support. Check the prices of Mcdavid Ankle Brace and Support on Amazon.

High Ankle Sprain Boot 

Wearing a walking boot is often needed for at least two weeks after the injury to help the ankle heal properly.

Even after the treatment, it may still be helpful to weak the boot, which can prevent reinjuring the ankle.

BraceAbility Short Broken Toe Boot

BraceAbility offers a Short Broken Toe Boot, which is for fracture recovery and helps with an ankle sprain and other injuries of the foot and toe. Check the prices of BraceAbility Short Broken Toe Boot on Amazon.

Ossur Rebound Air Walker Boot High Top

Ossur Rebound Air Walker Boot High Top is for people with high ankle sprains. It has an air pump and provides comfort and stability regardless of the severity of the injury. Check the prices of Ossur Rebound Air Walker Boot High Top on Amazon.

Mars Wellness Premium Polymer

Mars Wellness Premium Polymer has a foot stabilizer and fracture ankle boot. It is created to treat sprains and stabilize the ankle and foot while ensuring patient comfort. Check the prices of Mars Wellness Premium Polymer on Amazon.

Can You Still Walk With A Sprained Ankle? 

It is not advisable to walk on your sprained ankle. You should also limit bearing weight and other activities.

If necessary, you should use crutches. However, if you have no fracture, you can put a little pressure on the leg. It is always helpful to talk to a doctor before you start walking.

How Can You Prevent An Ankle Sprain? 

If you engage in sports or you run frequently, it is essential to know how to reduce the incidence of injuries involving your ankles.

Some precautions to take include maintaining strong muscles through ankle band exercises and wearing the right shoes for your sport.

You may also wear a brace to help prevent injuries in the future. Taping can also provide extra support, especially if you are just returning from an ankle injury.

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