Focus on High Ankle Sprains

What are they?

The ankle is comprised of 3 main bones; the tibia, fibula and talus, which are held together by thick fibrous ligaments. The construction of the 3 bones increases the stability and allows the ankle to rock forwards and back and restrict side-to-side movements.

The ligaments which hold the tibia and fibula together are referred to as a syndesmosis,  a typical ankle sprain occurs at the ligaments closer to the foot, whereas a syndesmoses is referred to as a “high” ankle sprain.

How do they happen?

They commonly occur when you twist inwards while your foot is planted on the ground. Typically, the foot is pushed backwards and rotated outwards, increasing the stress placed in the ligaments of the lower leg. Depending on the amount of force, it can cause the syndesmosis and result in gapping of the two bones, causing instability of the ankle. The injury commonly occurs while playing sports that involve running and jumping, as well as for downhill skiers. Patients struggle to maintain plantar flexion following the injury and therefore can’t walk on their toes.

What is the different between a high and a low ankle sprain?

High ankle sprains are less likely to occur compared to low ankle sprains. The two sprains can be difficult to differentiate, and often mimic the same symptoms as an ankle fracture. The physio will be able to assess and diagnose the injury, however often imaging is required to confirm their findings.

Why does correct diagnosis matter?

High ankle sprains require a longer rehab and therefore it is imperative to acquire a fast diagnosis. Syndesmosis tears that are left untreated can result in chronic instability and pain, making them more vulnerable to further injury in the future

What is the treatment?

Most tears require a supportive boot for 4-6 weeks; however the more severe ones may require surgery. Following the acute period, a rehabilitation program of strengthening, mobilizations, balance, control and agility will need to be commenced before your ankle will be at its pre-injury function.

There are other medical interventions that can be recommended which have shown good results, when accompanied by proper rehabilitation program.

None of the information in this article is a replacement for proper medical advice. Always see a medical professional for advice on your injury.

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