A high ankle sprain refers to the overstretching or tearing of ligaments and fibrous connective tissue (syndesmosis) that connects the two bones in the shin; the tibia to the fibula, as illustrated below. These differ to lateral ankle sprains as they occur to the ligaments above the ankle joint and generally involve a longer recovery time due to the potential for these injuries to result in ankle instability.
High ankle sprains typically occur while the foot is fixed on the ground and the ankle is forced into excessive dorsiflexion (ankle bending up) and/or external rotation (toes rotating outward). This is a common occurrence in contact sports that involve twisting and pivoting movement such as basketball, soccer, Australian Rules football and lacrosse.
Those who have suffer from a high ankle sprain will typically present with:
The time to rehabilitate this injury will significantly vary depending on the specific ligaments involved, the severity of the strain and the level of activity the individual is returning to. As a general guide:
These may take anywhere from 1-6 weeks. Typically, a grade 1 injury involves a strain or microscopic tearing to the high ankle ligaments (most commonly the AITFL) however there is no damage to the syndesmosis.
These may take 6-12 weeks. Grade 2 injuries have more significant tearing to the high ankle ligaments and may involve a strain to the ankle syndesmosis.
These injuries can require surgery or a significant period of immobilization. Grade 3 injuries involve complete rupture to 1 or more of the high ankle ligaments and a greater disruption of the syndesmosis. Disruption of the syndesmosis can cause tibiofibular diastasis where the two bones in the shin widen, resulting in significant instability.
Your Physiotherapist can help identify the severity of these injuries and instruct you on the appropriate management. It is important to evaluate what may feel like a ‘minor’ injury due to the potential for ankle instability to develop. Grade 1 tears may even require a small period of immobilization to allow the ligaments to properly heal. Physiotherapy will aid the proper healing of the injured ligaments through hands on treatment and exercise prescription. They will also enable you to return to your given sport or activity and help to prevent the re-occurrence of this injury through the appropriate prescription and progression of rehabilitative exercises.
Syndesmotic Ligament Complex
McKeon, J., Bush, H., Reed, A., Whittington, A., Uhl, T., & Mckeon, R., 2014 ‘Return-to-play probabilities following new versus recurrent ankle sprains in high school athletes’, Journal of Science and Medicine in Sport, vol. 17, No. 1. View link.