High Ankle Sprains


This is Patient Education Article –High Ankle Sprains. It explains the basics of the pathology including signs, symptoms and basic treatment options.

Lateral ankle Ligaments

Anatomy of Lateral Ankle Ligaments

A high ankle sprain is an injury to one or more ligaments in the ankle. A ligament is a tissue that connects one bone to another bone. It is called a high ankle sprain because the ligaments that are injured are above the ligaments of a typical ankle sprain. These ligaments are located on the outside of the ankle and attach the tibia and fibula. High Ankle Sprains are also known as syndesmosis injuries. They are rarer than a regular “Low Ankle Sprain”.

Some ankle sprains are much worse than others. The severity of an ankle sprain depends on whether the ligament is stretched, partially torn, or completely torn, as well as on the number of ligaments involved. Ankle sprains are not the same as strains, which affect muscles rather than ligaments.

What Causes a High Ankle Sprain?

High ankle sprains are commonly associated with a twisting motion of the foot which causes the ankle to rotate and tear the ligaments between the tibia and fibula. High ankle sprains commonly occur while participating in sports.

Signs & Symptoms

The signs and symptoms of ankle sprains may include:

  • Pain or soreness at the anterolateral ankle
  • Swelling
  • Bruising
  • Difficulty walking
  • Stiffness in the joint

These symptoms may vary in intensity, depending on the severity of the sprain. Even if you don’t have pain or swelling with a high ankle sprain, treatment is crucial because missed injuries can result in end stage ankle arthritis. Any ankle sprain—whether it’s your first or your fifth—requires prompt medical attention.

If you think you’ve sprained your ankle, seek medical attention for an appointment as soon as possible. In the meantime, immediately begin using the “P.R.I.C.E.” method—Protection, Rest, Ice, Compression, and Elevation—to help reduce swelling, pain, and further injury.

Why Prompt Medical Treatment is Needed

There are four key reasons why an ankle sprain should be promptly evaluated and treated.

  1. An untreated ankle sprain may lead to chronic pain and end stage ankle arthritis.
  2. You may have suffered a more severe ankle injury along with the sprain. This might include a serious bone fracture that could lead to troubling complications if it goes untreated.
  3. An ankle sprain may be accompanied by a foot injury that causes discomfort but has gone unnoticed thus far.
  4. Rehabilitation of a sprained ankle needs to begin right away. If rehabilitation is delayed, the injury may be less likely to heal properly.


In evaluating your injury, Dr. DeMill will take your history to learn more about the injury. He will examine the injured area, and may order x-rays, an MRI study, or a CT scan to help determine the severity of the injury.

Non-Surgical Treatment & Rehabilitation

When you have a high ankle sprain, it is imperative to know if the ankle is unstable as this will determine treatment. If there is no instability high ankle sprains can be treated successfully without surgery. However, the recovery is typically prolonged and variable compared to regular ankle sprains. The recovery may extend to twice the time it takes a normal ankle sprain to recover. Usually non-surgical treatment is as follows:

  • Immobilization.Non-weight-bearing in a cast or a boot until walking is pain free. Depending on the severity of your injury, you may receive a short-leg cast or a walking boot to keep your ankle from moving. You may also need crutches.
  • Physical Therapy.Your doctor will start you on a rehabilitation program as soon as tolerable to promote healing and increase your range of motion. This includes doing prescribed exercises.
  • Medications.Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation. In some cases, prescription pain medications are needed to provide adequate relief.
  • Icing.You may be advised to ice your injury several times a day until the pain and swelling resolves. Wrap ice cubes, or a bag of frozen peas or corn, in a thin towel. Do not put ice directly on your skin.
  • Compression Wraps.To prevent further swelling, you may need to keep your ankle wrapped in an elastic bandage or stocking.

When is Surgery Needed?

When there is instability or widening between the tibia and fibula, surgery may be required to adequately treat a high ankle sprain. Surgery often involves holding the tibia and fibula together in the proper position to allow the ligaments to heal.

After surgery, a period of rest is required to give time for the ankle to recover and the ligaments to heal. Rehabilitation is extremely important. Completing your rehabilitation program is crucial to a successful outcome. Be sure to continue to see Dr DeMill during this period to ensure that your ankle heals properly and function is restored.


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