"High" Ankle Sprain?

You've probably heard the term "high ankle sprain" before.  I don't really like that term very much. It doesn't really tell us much and it just seems like we should also have a "low ankle sprain" too (maybe we do, but it is never referred to as that).

So let's start today with a bit of a lesson on injuries and anatomy.

Most ankle injuries are the same thing. The foot is turned to the inside, maybe from jumping up and coming down on somebody's foot, quick changes of direction, or landing on some other object.  But in any case, the foot turns in, injuring the outside of the ankle.

Specifically, it is in the area in front of and just below that bony prominence on the outside of your ankle, known as the lateral malleolus.   The tissue most often injured is the Anterior Talo-Fibular Ligament or ATFL. 

It will hurt.  It will probably swell.  In most ATFL injuries, there is some microscopic tearing of the ligament but it remains intact.  All it needs is the proper treatment and rehab and it is just about as good as new. 

More extreme injuries to the ATFL can occur but rarely is surgery needed to get good results.  Often it is just time spent in a boot or brace.  The worse the injury, the longer the immobilization. 

Treatment is ice, compression (if there is swelling--and there almost always is some), and protection. 

A "high ankle sprain" is actually a syndesmosis sprain.   The syndesmosis of the ankle is the connective tissue connecting the fibula and the tibia where they meet at the ankle.

OK, maybe I better back up a minute.  The tibia and fibula are the bones of the lower leg.  The Tibia is the big one, the fibula is the long, thin one on the outside of the lower leg. 

They come together and form the roof of the ankle.  The lateral malleolus that I mentioned above is actually the bottom end of the fibula while the medial malleolus (its counterpart on the inside of the ankle) is the bottom end of the tibia.

Connecting them just at the ankle is a really strong band of connective tissue called the syndesmosis.

It takes a lot of force to injure the syndesmosis.  Most of the time it happens when a lot of force is placed upward into the ankle, usually when landing on a dorsiflexed ankle (that's the position when your foot is bent up toward your knee as far as it will go.

What happens in most of these is that the bones that form the base of the ankle are pushed upward into the roof of the ankle, sort of wedging apart the tibia and fibula and injuring (you guessed it) the syndesmosis.

Syndesmosis sprains are nasty creatures simply because any weightbearing aggravates the sprain.  In the most extreme cases, we take them off any weightbearing on that ankle through crutches.  They will at least get a boot to protect the ankle.  Again, ice and compression are essential to the post-injury care.

Syndesmosis sprains tend to linger because weightbearing can be difficult until those tissues are completely healed.  Running and landing hard on that foot are also impossible, sometimes for several weeks.

Right now, I'm dealing with one athlete that has injured both.  He has a syndesmosis sprain and an ATFL sprain.  It makes getting better even harder.

In either case, you need an athletic trainer or sports physical therapist to help you get back on the playing field quickly, safely, and efficiently.