What is a High Ankle Sprain?

A high ankle sprain is a type of injury where the ligament above the ankle joint gets stretched or torn. These ligaments connect the two lower leg bones together creating stability.

Unlike a regular “low ankle sprain” which affects either side of the ankle, a high ankle sprain occurs at the shin. This often makes symptoms such as pain, swelling and difficultly walking more significant than a traditional ankle sprain.

The high ankle ligament otherwise known as the “syndesmosis area” is a much thicker ligament than lower ankle ligaments. Stretching this thicker ligament can cause instability and longer recovery timelines.

Why does it happen?

High ankle sprains are less common than a traditional low ankle sprains, but they are the most severe and difficult to return to sports participation.

High ankle sprains are typically seen as basketball injuries, volleyball injuries, and pickleball injuries.

High ankle sprains occur when there is a sudden twisting or rotating force applied to the ankle and lower leg.

In basketball or volleyball this occurs with sudden change in direction or landing on someone’s foot causing a sudden twist or rotation.

With pickleball injuries involving the high ankle this is typically seen when changing sudden directions to track down a ball and the ankle suffers a sudden twist or rotation.

What are the symptoms?

What separates the traditional lower ankle sprain from a high ankle sprain are the symptoms and location. The main symptoms of a high ankle sprain are:

Symptom 1
Pain: Is felt above the ankle around the lower shin bones.

Symptom 2
Tenderness to touch: Pain is significant when pressure is applied between lower leg bones

Symptom 3
Swelling: Fluid buildup above the ankle joint

Symptom 4
Difficulty bearing weight: Pain is significant with walking and standing

Symptom 5
Bruising: Discoloration around the ankle or lower leg

Symptom 6
Limited range of motion: Difficulty with moving ankle joint. Symptoms range depending on severity of the injury which are classified in grades.

How Long Does it Take to Heal?

The healing time for a high ankle sprain can vary depending on severity. High ankle sprains are less common but traditionally more severe with timelines for healing. Healing time is always dependent on grade level.

Grade I sprain come with a recovery timeline of 1-4 weeks.

Grade II sprains come with a recovery timeline of 4-8 weeks.

Grade III sprains typically have a recovery timeline of more than 3 months and if the separation between the two shin bones is severe surgery is often performed.

TREATMENT

High ankle sprains typically take longer time to heal vs traditional ankle sprains. Physical therapy has different phases of treatment based on phases of healing. Acute phase (immediately after), post inflammatory phase, and return to play phase. The treatment protocol usually consists of three focused areas.

1. P.O.L.I.C.E (Protection, optimal loading, ice compression, and elevation)

One of the most important techniques used for helping the healing process is decreasing the pain and inflammation early on. Using ankle support or ankle stabilizers such as an ankle brace can help with protection and inflammation. Early exercises such as ankle pumps, 4-way ankle movements and ABC’s can help with gentle loading during this period.

2. Mobility and Strength exercises

When the ankle has decreased in pain and ready to accept load, exercises for balance, stability, and proprioception will help gain range of motion and strength

3. Functional sport specific exercises

When ankle is pain-free and full range of motion has been gained now it’s time to start training for your sport.

PT, DPT, MS

Evan Jeffries

EVAN JEFFRIES is a physical therapist with a Doctorate in Physical Therapy (DPT) from the University of St. Augustine for Health Sciences. He has vast knowledge of the musculoskeletal system and has treated many orthopedic conditions by bringing a proactive approach to healthcare and lifestyle.