What is High Ankle Sprain?

A high ankle sprain is a specific type of injury that affects the syndesmosis ligament, a critical connective structure located above the ankle joint. This ligament plays a vital role in stabilizing the ankle and lower leg by joining the two main bones of the lower leg: the tibia, commonly known as the shinbone, and the fibula, the smaller bone located next to the tibia. The syndesmosis ligament is essential for maintaining the proper positioning and movement of these bones, particularly during activities that involve walking, running, or jumping.

High ankle sprains occur when there is excessive force or twisting motion at the ankle joint, leading to damage or tearing of the syndesmosis ligament. This type of sprain is less common than the traditional ankle sprain that affects the ligaments on the outer or inner sides of the ankle but can be more severe and require a longer recovery time. High ankle sprains are often associated with sports or physical activities that involve rapid changes in direction, collisions, or awkward landings.

Major Causes of High Ankle Sprain

• Twisting or Rotational Injuries: Common in sports, these movements can forcibly separate the tibia and fibula, straining the syndesmosis ligament
• Impact during Physical Activities: Direct blows to the ankle, as seen in contact sports like football or rugby, can cause high ankle sprains
• Falls: Landing awkwardly or falling in a way that twists or stresses the ankle joint
• Slips: Losing one's footing and twisting the ankle can lead to this type of sprain
• Overextension: Stretching the ankle joint beyond its normal range of motion, especially in a rotational direction
• Uneven Surfaces: Walking or running on uneven terrain can cause the foot to twist abnormally
• Previous Ankle Injuries: Prior injuries to the ankle can weaken it, making it more susceptible to high ankle sprains
• Wearing Inappropriate Footwear: Shoes that do not provide sufficient ankle support can increase the risk, especially during physical activities

Signs and Symptoms of High Ankle Sprain

Pain

Patients often complain of pain when the ankle is turned to the outside or when the calf is squeezed. The so-called "squeeze test" is the classic test for syndesmotic injuries, but it is not very reliable for diagnosis

Pain Above the Ankle

Particularly between the tibia and fibula, intensified during activities or when the foot is rotated.

Swelling and Bruising

Around the ankle joint, possibly extending up the lower leg.

Tenderness to Touch

Especially at the site of the syndesmosis ligament.

Difficulty Bearing Weight

Pain and discomfort often make it hard to stand or walk on the affected leg.

Limited Range of Motion

Stiffness and reduced mobility in the ankle. A feeling of looseness or weakness in the ankle joint.

Painful Walking

Discomfort increases with each step, particularly on uneven surfaces or during pivoting movements

Visible Deformity

In severe cases, there may be a noticeable gap between the tibia and fibula due to ligament damage

High Ankle Sprain Diagnosis

When a syndesmotic injury is suspected, we will obtain x-ray studies of the ankle, and possible a special view called a "stress view". The ankle can look normal on routine x-rays even with a syndesmotic injury, but when stressed, there is abnormal motion between the bones (the tibia and fibula) where the syndesmotic ligament attaches.

High Ankle Sprain Treatment

Syndesmotic injuries tend not to heal as well as lateral ankle sprains. This is why we are especially concerned about "high ankle sprains." In our office, will first determine if the injury is stable or unstable. If the injury is stable, then the high ankle sprain can be treated in a cast, usually for a period of 6 weeks.

If the injury is unstable, then a "syndesmotic screw" or a special type of suture called a "tight rope" can be placed between the tibia and fibula to hold the bones in proper position while the syndesmotic ligament heals.

Patients will have the screw in place for about 2-3 months while the syndesmotic ligament heals. Patients should understand that the screw can break. The reason for this is that there is normally some motion between these bones when people walk. Therefore, some doctors prefer a second operation to remove the sydensmotic screw before allowing the patient to walk, or to use the tight rope which doesn't have to be removed.