As one of the most common injuries across the United States, you have more than likely suffered from an ankle sprain before. Whether you tripped on a sidewalk or kicked a soccer ball at a bad angle, ankle sprains can be painful for anyone. However, you may not realize that there are different types of sprain, including a high ankle sprain. These injuries can be more serious and require longer periods of rest than the traditional ankle sprain, so it is important to understand the difference and how to know which kind you have suffered.
Lower Leg and Ankle Anatomy
As the joint connecting your leg and foot, the ankle is formed by three bones: the tibia or shin bone, the bone next to and parallel to the tibia in the outer calf called the fibula, and the talus, a dome-shaped bone in the foot below the tibia. Together, these three bones form the ankle joint. This joint can sustain loads of up to three times a person’s body weight during the course of normal daily activity, so it must be strong.
Inside and outside the ankle are bony prominences called malleoli. Those on the outside of the ankle are formed by the fibula. The ankle also contains soft tissue: ligaments connect bones to each other and help stabilize the ankle, while tendons connect muscle to bone and allow for both movement and dynamic stabilization. There are three important ligaments in the ankle:
- The anterior inferior tibiofibular ligament, or the AITFL, runs in the front of the two leg bones.
- The posterior inferior tibiofibular ligament, or PITFL, runs in the back of the leg.
- The interosseous (IO) membrane runs down the middle of the AITFL and PITFL to provide major support between the bones.
Common Ankle Sprain vs. High Ankle Sprain
The ankle sprains most people suffer from can range in severity and are often mild. After a sprain, common symptoms can include swelling and bruising in the ankle and possibly the foot. It can take 6 to 12 weeks for a full return to function, but these injuries do not typically require invasive treatment. More serious cases may also injure other tendons or ligaments, including injury to the anterior talofibular ligament (ATFL). The ATFL is one of the primary stabilizers of the ankle and is usually injured when an athlete “rolls” or internally inverts the ankle with excessive force.
A high ankle sprain involves different ligaments than common ankle sprains. The ligaments in a high ankle sprain are located above the ankle joint, between the tibia and fibula, and form the syndesmosis. About 14% of ankle sprains are related to these ligaments. In a normal ankle, the tibia and fibula will experience high force during weight-bearing and be spread apart, and the syndesmosis serves as a shock absorber to prevent this spreading from being too extreme. These ligaments can typically experience very high force during actions like running.
High ankle sprains are caused by external rotation and/or dorsiflexion, in which the foot bends toward the skin. These usually occur as a result of sudden twisting, turning, or cutting motion when someone is running, jumping, or falling. Athletes commonly suffer these injuries, especially when participating in high-impact running sports like soccer, football, basketball, or lacrosse.
It is common for high ankle sprains to occur alongside medical ligament injuries and/or fractures to the distal tibia and fibula. When the energy of the “rolling” ankle passes from the deltoid to the high ankle ligaments and up the leg, it can cause the bones to be broken at a very high level. This is known as a Maisonneuve fracture.
Signs of a High Ankle Sprain
The primary sign of a high ankle sprain is pain that radiates from your ankle up the leg, generally when bearing weight or pivoting on your foot. Unlike common ankle sprains, swelling and bruising are not common, which can be frustrating as the injury doesn’t “look bad” to an outsider and may be brushed off, especially in the world of sports. The high ankle sprain can also be missed in light of other associated injuries.
In isolation, a high ankle sprain may lead to symptoms like:
- Point tenderness over the anterolateral tibiofibular joint
- Pain when extending the foot
- Pain when rotating the foot
- Mild swelling in the lower leg and above the ankle
If you suspect a high ankle sprain, the lower leg, ankle, and foot should be immobilized while medical care is sought.
Diagnosing High Ankle Sprains
When presenting with ankle pain, your doctor will first ask about what you were doing when you sustained the injury and describe your symptoms. They will then perform a physical examination, particularly a fibular compression test. This test is also known as a high ankle sprain test and is done by the doctor placing hands on each side of the lower leg, then squeezing the tibia and fibula together at a few different points. If this causes pain to radiate down your legs, it suggests a high ankle sprain.
Because of the high associated with fractures and other ligament injuries, you may be sent for diagnostic scans after a physical exam confirms the injury. These scans, including x-rays and MRIs, can help identify other injuries that will need to be treated in conjunction with the sprain.
Treating a High Ankle Sprain
While common ankle sprains may require treatment, high ankle sprains can be more serious and have a longer-term impact that may need more intensive treatment. A main difference in the treatment can involve movement, as common ankle injuries usually benefit from early movement, while high ankle sprains should be treated with more substantial bracing and rest.
Early treatment may involve simple home remedies, including over-the-counter medications like NSAIDs and the RICE protocol. RICE includes:
- Rest: Keep weight off the impacted leg as much as possible, especially avoiding sports and physical activity. The rest period for high ankle sprains is much longer than for other sprains.
- Ice: For the first few days after an injury, ice can help reduce inflammation and pain. Apply ice with a towel or cloth barrier every few hours for about 20 minutes at a time.
- Compression: Wrapping the lower leg in an elastic bandage can help minimize swelling. Be sure not to cut off circulation.
- Elevate: As much as you can, sit or lie down with your foot elevated to a positive above the level of your heart. Doing so can help blood move away from the injury and reduce swelling.
For the first two or so weeks, RICE and pain management will be the priority for your treatment. This gives the injury time to heal and the pain to subside before you begin rehabilitation and physical therapy. Physical therapy will involve a specialized set of exercises designed to help regain strength, range of motion, and function in your ankle, as well as tools to prevent future injury.
The rehabilitation process may also include proprioception therapy, which has been shown to reduce the rate of recurrent injury. Proprioception is the body’s ability to sense the position of your foot and ankle, so therapy will focus on expanding this ability. You may also be advised to use an ankle brace during sports participation for a period of time.
The recovery time for high ankle sprains can range depending on the severity of the sprain and if other injuries are present. Some people can return to sports and activity in as little as six weeks, but about half of patients can experience symptoms for six months.
Surgery is not typically recommended for high ankle sprains, but it may be necessary if the ligament is completely torn. The standard procedure for this would be to insert a screw between the tibia and fibula to hold the bones together, which relieves pressure on the ligaments and allows them to scar in place and heel.
Can I Prevent a High Ankle Sprain?
High ankle sprains can be prevented using the same techniques you might use to prevent a common ankle sprain or another injury. Athletes that rely on running may have athletic trainers that focus especially on ankle strength and safety, but anyone can implement some routines to prevent these injuries.
Some ways you can prevent high ankle sprains include:
- Use ankle band exercises to strengthen the muscles. Regularly perform 3 sets of 10 repetitions in all four ankle directions. This can be done easily at home or under a desk during the day.
- Always wear proper, well-fitted shoes, especially when walking long distances or playing a sport.
- Even without injury, wear a brace to prevent problems.
- Tape the ankle for extra support during physical activity.
- Use warm-ups that involve neuromuscular training, focused on both balance and coordination.
- Engage in continual performance training for strength and balance.
- Get adequate sleep and maintain good nutrition.
Suffering from one ankle injury can make you more susceptible to future injuries, so it can be important to continue these habits even if you have already sprained your ankle in the past.
Returning to Sports After a High Ankle Sprain
Because of the prevalence of high ankle sprains in athletes, patients are often concerned with when they can begin training or playing again. For some, this is a matter of their career, while others simply want to return to leisure activities and maintain physical fitness. Regardless of why you would like to return to sports, it can be frustrating to know that the longer the period of rest, the better your outcome may be. Returning too quickly can cause further injury that could require surgery or lead to chronic pain.
Common ankle sprains typically require about 1 to 3 weeks of rest before returning to prior activities, and it may be recommended to perform light exercise before then. High ankle sprains are very different in this regard- the minimum period of avoiding activities is usually four to six weeks and can be longer in more severe injuries.
The exact amount of time you need to abstain from sports depends on a number of factors:
- The sport: Sports that involve cutting and pivoting, like football, are particularly difficult to play with an existing injury, and you may need a longer break.
- Position: Some positions on sports teams, like a linebacker or running back, will have to change direction quickly during gameplay. This can be more difficult to achieve without being fully healed.
- Treatment plan: Athletes who require surgery will need a longer healing period, usually about four months.
- Past injuries: Any injury makes you more prone to future injuries in the same location. If someone has had multiple ankle injuries, they may need more time to heal and prevent more issues.
Many professional sports organizations have specific rules surrounding returning to playing after an ankle sprain. For example, NFL teams require all players to tape or brace ankles during competition as a way of reducing risks of future injury.
Integrated Care for High Ankle Sprains
Whether you are an athlete, a regular gym goer, or simply hurt your ankle in a car accident, AICA Jonesboro is here to help with your ankle pain. With diagnostic imaging available at our offices and radiologists on staff, we can perform full diagnostics on your ankle to be sure that your treatment plan is specifically tailored to your needs.
Treatment plans at AICA Jonesboro are fully personalized for you, making use of an integrative approach that brings together our multi-disciplinary specialists. Orthopedists, neurologists, physical therapists, and pain management specialists will come together to create a plan of care that meets your needs and helps you achieve your goals.
Visit AICA Jonesboro at the first sign of ankle pain to ensure you are seen in a timely manner with attention to detail. You can begin treatment as soon as possible to help you get back on the field and back to a pain-free life quickly.