By Dr. Tarick Abdo
January 31, 2013
Category: Sports Injury

While lateral ankle sprains are the most common athletic injury occurring in sports, high ankle sprains have been responsible for more lost time from game play and training activities. Unfortunately, high ankle sprains are commonly mistaken for lateral ankle sprains, thus they are less commonly reported. 

Misdiagnosing a high ankle sprain can result in lingering pain and recovery as the treatment course is much longer, requiring longer periods of offloading and rehabilitation in comparison to lateral ankle sprains. 

A high ankle sprain refers to injury of the ligaments that join the lower leg bones, tibia and fibula. High ankle sprain injuries commonly occur in collision sports, such as football, hockey, and court sports  such as basketball. The most common mechanism of injury is when the foot is anchored to the ground while being struck to the outside aspect of the lower leg. This forceful twisting injury may be accompanied by an audible pop and the patient’s inability to bear weight after the injury.  

On examination, patients often present with swelling and bruising above the ankle. The most commonly utilized test is the fibular squeeze test which can produce pain at the lower ankle by squeezing the outside and inside aspect of the leg at the middle of the leg.  In addition, your doctor can move the lower leg inward and this can elicit severe pain. At this stage, your doctor will order an x-ray the classic finding is widening of the tibia and fibula at the level of the ankle.  If the x-ray is inconclusive then a MRI scan provides the best confirmation of widening of the lower leg and identify specific syndesmotic ligaments that are disrupted. Treatment is then determined based on the degree of separation and the ligaments that are involved.

In some case where the degree of separation is severe usually greater than 4mm than surgical intervention is necessary to achieve anatomic reduction and can improve functional outcomes and facilitate a quicker return to activity. Without this intervention, patients can have long term pain and instability and develop post traumatic arthritis. Patients with less than 4mm of separation can be managed conservatively with immobilization for 1 week then placement in a double upright hinged ankle brace, known as a Velocity Brace this begins the next phase of rehabilitation. Then range of motion exercises are implemented with low intensity resistance and high repetition.  Gait training and light balance exercises may begin at the patient’s tolerance. The last phase of rehabilitation begins once a patient is able to hop on the injured foot without any pain. Patients then begin more active range of motion and change of direction exercises and can shortly return to full sports activity. 

The key to quick recovery from high ankle sprains is quick diagnosis by an experienced clinician. Then appropriate treatment based on the degree of instability. Most patients make a full recovery and have  no limitations once they return to activity. Hopefully this gives you some insight into this injury.    

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