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Injury/Pain

All About High Ankle Sprains

Overview

Just the term “high ankle sprain” is enough to grab the attention of, if not frighten, the toughest athletes. Even if you're not exactly sure what's involved, you probably know that it's an injury that could keep you out of action for months. And you're right. High ankle sprains are much less common than the garden variety low ankle sprain, which can be serious enough, but they're hard to treat and can cause long-term problems.

“In a high ankle sprain, the ligaments that connect the two lower leg bones together are injured,” explains M. Ramin Modabber, MD, of the Santa Monica Orthopaedic and Sports Medicine Group.

“The location is higher up the leg, it is usually associated with a higher degree of injury, and requires a longer time to recover and return to sport. The forces on these ligaments are greater and they need to be healed before athletes can tolerate running, jumping, and cutting—another reason for the longer time to return to sport."

While you can often return from standard ankle sprains in days or weeks, Dr. Modabber says high ankle sprains can take weeks to months.

  • A grade 1 sprain is the mildest form of injury and consists of a stretch to the ligaments.
  • A grade 2 sprain is a partial tear of the ligaments.
  • A grade 3 sprain is a complete tear.

In spite of increased awareness, the mechanism of high ankle sprains is still not completely understood, and there is an ongoing debate about the best ways to diagnose and manage the injury.

How It Happens

A high ankle sprain usually occurs when the ankle rolls outward beyond its normal range of motion and tears the ligament between the two bones (tibia and fibula) of the lower leg at the level of the ankle. It could happen when a basketball, football, or soccer player lands awkwardly after jumping, gets stepped on or hit by another player, or makes a quick change in direction. The medical term for the injury is ankle syndesmosis, and many sports-related high ankle sprains are misdiagnosed or recognized long after the initial injury when the person does not recover according to schedule.

By the Numbers

5-10
Percentage of all ankle sprains that are high ankle sprains

50
Percentage of athletes who have a recurring ankle sprain

40
Percentage of athletes who have long-term ankle instability after a severe sprain

Who’s at Risk

Football, soccer, and basketball players are in the highest risk group. Downhill skiers and hockey players also use movements that make them more susceptible to this kind of injury than other athletes.

Symptoms

  • Pain when the ankle is turned to the outside
  • Pain when the leg is squeezed at the midpoint of the calf
  • Possible bruising
  • Possible snapping or popping sound when the injury occurs
  • Limited ankle motion
  • Difficulty in walking

Initial Treatment

  • Protect the ankle from further injury with a sprint or wrap.
  • Use a compression wrap to minimize swelling.
  • Apply ice packs for 15-20 minutes, 3-4 times a day.
  • Use a pillow or cushion to elevate the affected leg as much as possible during the day and while sleeping at night.
  • Aspirin, acetaminophen, ibuprofen, and naproxen may relieve pain. Aspirin, ibuprofen, and naproxen may relieve pain and reduce inflammation.

Comeback Strategy

  • For grade 1 and 2 sprains treated without surgery, it may take six weeks or longer until you are able to resume athletic activities. For grade 2 and 3 sprains treated with surgery, return to sports can take several months.
  • Return to training when you have full range of motion in the injured ankle, when you have near-full strength, and when you can go through the movements required in your sport without pain. Examples: a football player should be able to explode out of his stance; a hockey player should be able to skate with no pain when pushing off to the side.
  • Tape or wrap the ankle to prevent outward rotation of the ankle.

Prehab

Incorporate these prehab moves into your comeback routine:

  1. Sidelying Hip Abduction 
  2. Foam Roll or Tennis Ball Massage (gentle massage to the backside and outside the surrounding area, but not directly on the injured tissue)

How to Avoid This Injury

  • Wear athletic shoes that fit well and provide adequate lateral support.
  • Consider taping the ankle or wearing a brace if you have had a previous ankle injury.

Movement Prep

Incorporate these movements into your warm-up routine:

  1. Foam Roll or Tennis Ball Massage
  2. Calf Stretch (with foot pointed forward and with foot pointed inward)
  3. Kneeling Dowel Dorsiflexion Stretch (moving the foot upward toward the shin)

Jim Brown, Ph.D. has written 14 books on health, medicine, and sports. His articles have appeared in the Washington Post, New York Post, Sports Illustrated for Women and Better Homes & Gardens. He also writes for the Duke School of Medicine, UCLA School of Medicine, Cleveland Clinic and Steadman-Hawkins Research Foundation.


Tags: Injury, Lower Body, Ankle, Ankle Pain, Injury Prevention

References

  1. M. Ramin Modabber, MD, Santa Monica (CA) Orthopaedic and Sports Medicine Group
  2. Anna J. Hartman, MS, ATC, CSCS, Manager, Performance Physical Therapy Services, Athletes’ Performance, Phoenix, Arizona
  3. Children’s Memorial Hospital, Institute for Sports Medicine, Chicago
  4. Sports Medicine Advisor
  5. The Physician and Sportsmedicine
  6. University of Michigan Health System

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