High Ankle Sprain

A High Ankle Sprain: What is it?

A high ankle sprain is caused by tearing or injuring the high ankle ligaments that connect the tibia and fibula. A sprain occurs when a ligament is stretched beyond its normal limits or ruptured. Sprains come in three levels of severity:

• Grade 1 sprains occur when ligaments strain but do not tear.
• Grade 2 sprains: A partial tear in the ligaments.
• Grade 3 sprains: The ligaments are fully ripped.

These ligaments are called syndesmosis, even though the term pertains to the joint. You could hear your high ankle sprain referred to as a syndesmotic injury.

Our ankles link the leg and foot bones. There are two angles: one upper and one below. These two bones form the upper ankle. The talus sits between the upper and lower ankles, fitting into the arch of the other two bones.

Ligaments are fibrous structures that link bones together.

What causes a high ankle sprain?

High ankle sprains almost always happen while you are running or leaping, and they are caused by your foot being bent upward and then twisted inwards or outwards. Almost usually, they are the consequence of a collision rather than the rolling motion that results in other ankle sprains.

What signs and symptoms indicate a high ankle sprain?

The following are the signs and symptoms of a high ankle sprain:

• Swelling.
• Activities such as climbing stairs become difficult because of the injury’s inability to sustain weight.
• Unable to walk on your toes.
• Bruising, that develops several days after the accident.

What ligaments are impacted by a high ankle sprain?

The following ligaments may be torn or damaged by high ankle sprains:

• In front of the tibia and fibula lies the anterior inferior tibiofibular ligament.
• The back of the tibia and fibula is where the posterior inferior tibiofibular ligament is situated.
• The tibia and fibula are stabilized by the interosseous membrane, which is located in the middle of the two bones.
• A high ankle sprain can cause any of these ligaments to be stretched, partially torn, or completely torn.

What differentiates a minor ankle sprain from a high one?

Location is not the only factor that distinguishes a high ankle sprain from a low one. With your foot extended up, twisting inward or outward might result in high ankle sprains. Some low ankle sprains happen when the ankle rolls outward, but most happen when the ankle rolls inward. The high ankle ligaments are not affected by low ankle sprains. We often think of low ankle sprains when we hear about someone having a sprained ankle.

How is a high ankle sprain diagnosed?

When you see your doctor, they will ask you about your medical history and how you damaged your ankle. After that, they’ll perform a physical examination to establish the source of your pain. A physical exam can include:

An external rotation test: An external rotation test involves sitting with your knee bent at a 90-degree angle. Your doctor will gently rotate your foot to the outside and assess the severity and location of your pain.

A squeeze test: Your doctor will compress your tibia and fibula together to apply pressure to the interosseous membrane. Pain from this test is typically indicative of a high ankle sprain.

Your doctor may arrange an imaging test to confirm your injuries or determine their severity.

MRI. The most helpful test for a high ankle sprain is magnetic resonance imaging or MRI. An MRI creates pictures of tissues within the body by using a powerful magnet and computer-generated radio waves.

X-rays. X-rays generate images through the emission of radiation waves. Dense solids, such as bone, absorb less radiation than less dense materials, such as organs, causing bones to appear white on an X-ray. Your doctor can use an X-ray to ensure that the bones are still in place following your ligament injury. They may also do an X-ray to ensure that none of your ankle bones have been injured.

A CT scan, which utilizes X-rays to create 360-degree pictures of your body, may also be recommended to provide your doctor with a full view of your injuries.

Treatment for High Ankle Sprains:

Treatment for a high ankle sprain will be determined by the degree of the damage.

You should be able to treat your high ankle sprain at home utilizing the R.I.C.E. approach for the first 3 to 5 days. This approach includes:

• Rest. Avoid activities that exacerbate your pain or edema. Your doctor may urge you to wear crutches and keep completely off your damaged ankle.
• Ice. Ice on the affected region for 15 to 20 minutes every two or three hours. However, you should never put ice directly on your skin.
• Compression. Wrap an elastic bandage across your ankle to help minimize swelling. However, look for indications that the bandage is overly tight, such as numbness, increasing pain, or swelling beneath the bandage.
• Elevation. Keeping the damaged ankle elevated above your heart helps to minimize swelling. Try to rest your ankle on pillows or cushions.

Over-the-counter non-steroidal anti-inflammatory medications (NSAIDS) can be used to reduce swelling and pain. NSAIDs can be taken orally as pills or tablets or applied topically as lotions, creams, or sprays.

Your doctor may advise you to wear a brace, tape, or even a cast to prevent your ankle from bending toward your body.

The three types of ankle braces are:

• lace-up ankle braces
• stirrup ankle braces
• elastic ankle braces

Your doctor may also suggest physical treatment, such as the use of therapeutic bands or water exercises. Being in water reduces the amount of weight your ankle needs to endure.

In extreme cases, your doctor may suggest surgery to repair a damaged ligament.

Ankle Pain Exercises:

Exercises such as ankle pumps, toe curls, toe raises, and towel scrunches, with an emphasis on controlled motions and progressive progression, can help increase ankle and toe mobility and strength.

Here’s a summary of several useful exercises:

Ankle pumps (dorsiflexion and plantarflexion):

Sit or stand with your foot flat on the floor, then raise your toes towards your shin (dorsiflexion) then point them down (plantarflexion).
Benefits: Increases ankle range of motion and strengthens muscles surrounding the ankle.

Ankle Rotations:

To do ankle rotations, sit or stand with your foot off the ground and rotate circularly, first clockwise, then anticlockwise.
Benefits: Improves ankle flexibility and mobility.

Heel raises:

Stand with your feet flat on the floor, then gently elevate up onto your toes, holding for a few seconds before lowering back down.
Benefits: it includes increased calf muscle strength and improved ankle stability.

Towel Scrunches:

How to Perform Towel Scrunches: Place a towel beneath your toes while sitting with your feet flat on the floor. Use your toes to curl the towel towards you, then let go.
Benefits: Strengthens the foot’s intrinsic muscles and increases toe flexibility.

One-leg balancing.

Support your weight with the leg with the injured ankle by lifting your good leg behind you and resting your hands on a wall, counter, or chair back. Hold this for 20 to 30 seconds, if possible. Try it with one or two fingers as your strength increases. Without waiting, do this when you’re stronger.

Toe Raise/Heel Drop:

How: Stand on a step or platform, then elevate your toes and drop your heels.
Advantages: Strengthens the ankle and calf muscles.

Standing Calf Stretch

Stand in front of a wall or a countertop, with your hands on it for support. Place your healthy foot forward and your injured ankle about a step back. Bend the knee of your good leg gradually until you get a modest stretch in the calf on your damaged side while maintaining your back heel level on the floor. Repeat three times, each holding for 30 seconds.

Heel walks:

How: Lift your toes off the ground and walk on your heels.
Advantages: Strengthens the ankle and calf muscles.

Toe Tapping:

Your feet should be level on the ground while you sit or stand. Tap your toes on the ground while maintaining your heels still.
Benefits: Exercises the muscles in your feet and ankles, improving balance.

Marble Pickup:

The Marble Pickup method involves placing a marble or other small object in front of your toes while sitting with your feet flat on the floor. Pick up the thing with your toes and deposit it in a container.
Benefits: Improves toe dexterity and strengthens the foot’s intrinsic muscles.

Toe Yoga:

Sit with your feet flat on the floor. Lift your big toe off the floor while keeping the other four planted. Repeat with the other four toes.
Benefits: Enhances toe flexibility and strength.

Important considerations:

• Warm-up: Before beginning any workouts, warm up your ankles and feet with mild motions.
• Listen to your body: If you experience any pain, stop immediately and seek medical attention if necessary.
• Progress gradually: Start with a few repetitions and progressively increase as you gain strength.
• Consistency: Regular practice is essential for increasing ankle and toe mobility and strength.

How much time does it take to recover from a high ankle sprain?

A high ankle sprain may need six to eight weeks of recovery. If you are an athlete, your comeback to play may take much longer. Low ankle sprains typically heal more quickly than this.

Risks and Complications of a high ankle sprain:

The ankle might become stiff. If surgery is undertaken, there is a risk of infection or injury to the superficial peroneal nerve, which provides feeling to the top of the foot. This is because the nerve runs extremely near to the outside of the leg, where the incision is often made. Arthritis can also develop after a severe sprain if the ankle cartilage is injured at the time of the initial injury.

How can I lower my chances of suffering a high ankle sprain?

Ankle sprains are accidents, and there is no way to avoid them entirely. However, there are several precautions you may take to reduce your chances of suffering a high ankle sprain. You can do:

• Follow a workout routine that will strengthen and stretch your joints.
• Follow an exercise regimen to enhance your balance and proprioception. Proprioception is a component of balance that allows your brain to understand where your body is in space.
• Use braces or tape to protect your ankles.

What is the outcome of a high ankle sprain?

The prognosis for healing from a high ankle sprain is favorable, as most cases may be treated non-surgically. However, you’ll be more likely to injure your ankle again. You may also have stiffness in the joint later on.

High Ankle Sprain Recovery Time:

High ankle sprains take a bit longer to recover than low ankle sprains, often 6 to 8 weeks. However, your doctor may urge that you avoid intense activity for an extended length of time. Your doctor may also suggest physical therapy to help you regain strength and complete range of motion in your damaged ankle.

FAQs

References

• High ankle sprain. (2025, March 19). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/22249-high-ankle-sprains
• High ankle sprain (Syndesmotic injury) symptoms & Causes. (n.d.). FootCareMD. https://www.footcaremd.org/conditions-treatments/ankle/high-ankle-sprain
• What to know about a high ankle sprain? (n.d.). WebMD. https://www.webmd.com/first-aid/what-to-know-about-a-high-ankle-sprain