High ankle sprain | Symptoms, treatment, recovery, bandaging and surgery (2023)

Por Terry Zeigler, Ed.D., ATC

Last updated on Feb 4, 2023 byDeportesMD

A high ankle sprain is a serious injury and can sideline an athlete much longer than a typical ankle sprain. Ankle injuries are one of the most common sports injuries, accounting for approximately 10% of all acute injuries treated by physicians. An ankle sprain can occur on the lateral side of the ankle (more common), the medial side of the ankle (less common) or it can occur as a syndesmotic sprain when the ligaments between the distal tibia and fibula are injured, also known as a ankle sprain. high ankle.

What is a syndesmosis joint?

A high ankle sprain usually occurs in combination with medial ligament injuries and/or distal tibial/fibular fractures. These are serious injuries and can sideline an athlete much longer than a typical ankle sprain. In the lower leg/ankle, the distal tibia/fibula joint is considered a syndesmosis joint because the tibia and fibula are held together by an interosseous membrane that runs the length of the bones.

This membrane protects the two bones and helps stabilize the tibia and fibula on the talus, forming the talocrural joint (primary ankle joint), also known as the ankle socket. This joint is responsible for dorsiflexion and plantar flexion (up and down movements of the foot).

The distal tibia and fibula are held together by the syndesmosis membrane and the anterior and posterior tibiofibular ligaments. A syndesmotic sprain or high ankle sprain is an injury to the distal tibiofibular syndesmosis with possible disruption of the distal tibiofibular ligaments and interosseous membrane.

Syndesmosis tears are also associated with specific types of ankle fractures. Distal fibular fractures are associated with syndesmosis tears 50% of the time and are usually caused by external rotation of the foot/ankle.

However, a certain type of fibula fracture, known as a type C fibula fracture, almost always involves syndesmosis injuries and can include high fibula fracture, internal inferior tibiofibular ligament tear, and interosseous membrane tear. These types of fractures are considered unstable and will likely require surgery to stabilize the joint.

Signs and symptoms of a high ankle sprain

High ankle sprain | Symptoms, treatment, recovery, bandaging and surgery (1)The difficulty with these types of injuries is that they are usually associated with severe lateral or medial ankle sprains or fibula fractures. However, in an isolated high ankle sprain, the athlete or individual may experience the following symptoms:

(Video) Don't let a High Ankle sprain recovery take longer than needed. Stabilize it with Taping

• Point of tenderness over the anterolateral tibiofibular joint (over the lateral malleolus)
• Pain when bearing weight
• Pain with passive dorsiflexion
• Pain with passive external rotation
• Mild to moderate swelling in the lower leg above the ankle.

If a syndesmotic ankle injury is suspected, the athlete's lower leg, ankle and foot should be immobilized and the athlete transported for immediate emergency medical evaluation.

High ankle sprain diagnosis

Because syndesmotic sprains can be associated with lateral ligament injuries, medial ligament injuries, and fibular fractures, x-rays of the lower leg and ankle are required. If the athlete has a complete tear of the syndesmosis, the separation will be evident on the radiograph between the tibia, fibula and talus.

the feared# high ankle sprainis more specifically called#syndesmosewound. This fabric is among the#tibia&#fibula. Symptoms are usually similar to a# ankle sprainhowever, treatment and recovery times will be very different.pic.twitter.com/8lZL7shFa6

— 2PT Bag of Chips (@2PTsNaBagOChips)April 24, 2019

In addition to x-rays, your sports medicine doctor may also order stress x-rays or magnetic resonance imaging (MRI). MRI is a better diagnostic tool for looking at soft tissue injuries, including torn ligaments and interosseous membranes.

Who has a high ankle sprain?

The incidence of high ankle sprains has been reported to be as high as 10% of allankle sprains.However, they often go undiagnosed because attention is often focused on the more common lateral ankle ligament injuries.

Ankle injuries commonly occur in sports where quick changes in direction are required (eg, soccer, handball) or where athletes must jump and land over and around multiple athletes (rebounding in basketball, blocking in volleyball).

Syndesmotic injuries can also occur in skiing accidents when the foot is stabilized in the boot and the body rotates as during a fall when bindings do not release. The body's twisting force initially tears the ankle ligaments. However, if the force continues, the interosseous membrane can rupture along the length of the leg.

High ankle sprain causes

The most serious ankle injuries usually occur when an athlete lands on the foot of another athlete returning to the ground after a jump. The athlete's weight plus the force of gravity combine to create a force greater than the tensile strength of the ankle ligaments, ankle bones, and interosseous membrane can withstand.

(Video) RECOVER FASTER! Ankle Sprain Treatment At Home from a Physical Therapist

The distal anterior and posterior tibiofibular ligaments are torn with extreme external rotation or forced dorsiflexion (toes facing forward of the leg) in combination with severe ankle sprains.

How can I help prevent a high ankle sprain?

Since a high ankle sprain is a serious ankle injury, prevention of a syndesmotic injury can follow the same principles as prevention of a normal ankle injury. The athlete can do the following to try to reduce the incidence of ankle injuries:

• Keep your ankle muscles strong by regularly strengthening them withankle bandexercises performing 3 series of 10 repetitions in the four directions of the ankle.
• Wear appropriate, well-fitting clothingshoesuitable for sport.
• Consider using aclampto prevent an ankle injury or bandage/brace for additional support upon return to sports following an ankle injury.

There are many different types of anklets available and on the market. For an anklet to be effective, the anklet must be equipped with amedial and lateral support(resistant plastic or similar material) that extends along the sides of the orthosis. Anklets made only from neoprene or other soft material do not provide enough support to prevent further injury.

Another consideration for the athlete is ensuring the device fits comfortably in athletic shoes. Some rigid orthoses may not fit comfortably in all athletic shoes. The athlete should try different orthotics to ensure the fit is comfortable and that the orthosis has additional medial/lateral supports to prevent further injury.

high ankle sprain treatment

While treatment for a high ankle sprain follows the same principles as treatment for a regular ankle sprain, the time period can be much longer. Partial syndesmosis tears are treated with immobilization inwalking castoto throw awayfor a minimum of two weeks and longer if necessary depending on the severity of the injury.

Initially, the treatment of sports injuries using thePRICE. principle– Protection, Rest, Freezing, Compression, Elevation can be applied to a high ankle sprain.

Upper ankle sprain surgery

Full ruptures may require high ankle sprain surgery, followed by immobilization in a cast for up to eight weeks, and then partial weight bearing for an additional three to four weeks.

After immobilization, traditional therapy can be started with an initial focus on improving ankle range of motion, followed by strengthening exercises and neuromuscular training (balance training).

high ankle sprain bandage

High ankle sprains respond very well torecording. For more severe, acute and high ankle sprains,Aggressive stabilization with rigid strapit Works very well. With milder sprains, a simplekinesiology tapeThe technique is very effective.

(Video) Mayo Clinic Minute: Ankle sprains 101

high ankle sprainSuspenders

High ankle sprain recovery time

It is important to understand that because the structures involved in a high ankle sprain can cause instability in the primary ankle joint, rehabilitation and complete healing requires a much longer recovery time than a traditional ankle sprain. This is the point that coaches need to understand. ALL ANKLE STRAINS ARE NOT EQUAL.

Recovery from a mild ankle sprain can take several days, whilerecovery from a severe ankle sprain can take several months. In contrast, recovery from a partial syndesmosis tear can take several months, while recovery from a full tear can take up to six months.

The goal of rehabilitation is the athlete's safe return to sport. Returning an athlete too soon can cause further damage to damaged tissue. In the case of a high ankle sprain, returning an athlete too soon can cause an unstable ankle and can lead to osteoarthritis in the joint over time.

Because each athlete's injury is unique, each athlete must undergo functional testing before being cleared to return to play, rather than following a schedule in a book. For these types of injuries, the athlete may return to play after being cleared by a sports medicine professional and after achieving the following:

• Full range of motion of the injured ankle compared to the uninjured ankle
• Total strength of the injured ankle compared to the uninjured ankle
• Peak power (jumping ability) of the injured ankle compared to the healthy ankle
• Ability to perform functional skills related to the athlete's sport
• Ability to run, run and run without pain

More inHigh ankle sprain recovery time

Can telemedicine help?

Telemedicine is gaining popularity because it can help you and your doctor meet more quickly and efficiently. It is particularly suitable for sports injuries and facilitates the diagnosis and treatment of these injuries. Learn more about speaking with a specialist sports provider through24/7 SportsMD Telemedicine Service.

common questions

Q: How long does it take for a high ankle sprain to heal?

A: Recovery from a mild high ankle sprain can take several weeks and recovery from a severe high ankle sprain can take several months. It is important to note that not all ankle sprains are created equal. High ankle sprains take longer to heal.

Q: Can you walk with a high ankle sprain?

(Video) Sprained Ankle? How to Wrap Ankle Sprains Correctly! (Updated)

A: While it is possible to walk with a high ankle sprain, it is not recommended as it can slow down the healing process and increase the risk of complications. Depending on the degree of severity, the doctor may prescribe an orthosis or even a boot to help with recovery.

Q: How severe is a high ankle sprain?

A: A high ankle sprain is a serious injury and can sideline an athlete much longer than a typical ankle sprain.

P: How does a high ankle sprain feel?

A: Patients with a high ankle sprain usually experience pain just above the ankle and severe pain when going up or down stairs or bending the ankle upwards.

LeBron responds after being sidelined indefinitely with an ankle sprain.pic.twitter.com/oVGdw81Ren

— ESPN (@espn)March 21, 2021


Anderson, MK, Hall, S. & Martin, M. (2005). Fundamentals of sports training: prevention, treatment and management. (3rd ed.). Lippincott Williams & Wilkins: Philadelphia, Pennsylvania.

Bahr, R. & Maehlum, S. (2004). Clinical Guide to Sports Injuries. Human Kinetics: Champaign, IL.

(Video) Twisted or Rolled Ankle Sprain Treatment: FASTER Home Recovery Time!

Brukner, P. and Khan, K. (2002). Clinical Sports Medicine. (2nd ed.). McGrawHill: Australia.

Irvin, R., Iversen, D. & Roy, S. (1998). Sports Medicine: Prevention, Assessment, Management and Rehabilitation of Sports Injuries. Allyn and Bacon: Needham Heights, MA.

Rouzier, P. (1999). The Sports Medicine Patient Advisor. SportsMed Press: Amherst, MA.


How long does it take to recover from a high ankle sprain with surgery? ›

Recovery timelines for a high ankle sprain vary greatly from athlete to athlete. In some cases, an athlete can return to the sport in 4 to 6 weeks, but in cases where the injury is more extensive, or surgery was required, that timeline can be pushed out to at least 6-12 months for a full recovery.

What is the surgical treatment for a high ankle sprain? ›

The gold standard for these injuries has always been the use of rigid trans-syndesmotic screw fixation. The tightrope offers a viable alternative with a durable and flexible construct that allows early restoration of ankle stability, motion and function.

Can you fully recover from a high ankle sprain? ›

They can take longer to heal and sometimes require longer than three months to resolve with treatments like splinting, wearing a boot or a walking cast, and physical therapy. With the proper treatment, however, your high ankle sprain can heal completely.

How many weeks does it take to recover from a high ankle sprain? ›

How long does a high ankle sprain take to heal? It might take you six to eight weeks to recover from a high ankle sprain. If you're an athlete, your return to play might take an even longer time. Low ankle sprains generally heal quicker than this.

How painful is ankle surgery recovery? ›

Pain Management

Expect to be in some degree of pain following surgery. The bones in your foot and/or ankle are being manipulated in the operating room to correct the problem, which will cause pain. In general, the pain subsides after a few days to a week after surgery, depending on the type of surgery.

How long is bed rest after ankle surgery? ›

Recovery guidelines

We'll likely recommend that you rest and elevate your ankle for about two weeks following surgery and then gradually reintroduce activity.


1. Wrapping a Sprained Ankle - Ask Doctor Jo
2. Pain & Swelling after Ankle Surgery : Reasons, Recovery time & Ways to reduce- Dr. Gururaj S Puranik
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3. How To Strap An Lateral Ankle Sprain - Frenchs Forest Physio
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4. AVOID These 2 Exercises After an Ankle Sprain!!
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5. Ankle Pain - Everything You Need To Know - Dr. Nabil Ebraheim
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6. How to apply a compression bandage to a sprained ankle
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