The High Ankle Sprain

In the world of athletics, March is popular for the NCAA Men’s Basketball tournament known as March Madness. You will see over the course of the tournament how many injuries are specific to ankle sprains. The majority of ankle sprains that will occur are lateral ankle sprains or inversion ankle sprains (when the bottom of the foot turns inwards). I want to discuss a different type of ankle sprain that I feel a lot of the general public may not know too much about, the High Ankle Sprain.

The high ankle sprain, or syndesmotic ankle sprain is a lot different than the more common inversion ankle sprain. Some athletes would come to me telling me that they suffered a high ankle sprain just because they are experiencing some pain and discomfort above the ankle joint. Even with an acute lateral ankle sprain, you can experience pain above the ankle joint.

The mechanism of injury usually will be the best indicator for diagnosis. The high ankle sprain usually occurs when the foot/ankle is forcefully rotated externally (outward) pushing the fibula away from the tibia.

Most high ankle sprains occur with contact sports especially football. One of the most common mechanisms of injury are when a runner is tackled from behind and the defender lands of the back of the runners lower leg/foot causing a forced rotation of the ankle joint and forced dorsiflexion. There are non-contact high ankle sprains common with gymnasts. Gymnasts will often experience “landing short” coming out of a tuck and not rotating their body enough causing them to land in a forced dorsiflexed position. This will cause a separation of the two bones in the lower leg (tibia and fibula) stressing the syndesmotic membrane or connective tissue in between the tibia and fibula. This is why some of the reported pain goes a lot higher up the leg than just the ankle mortise. The injury can be diagnosed by x-ray and/or special tests. A common special test is the “Squeeze Test” where you squeeze both the proximal ends of the tibia and fibula which will create a separation of the tibia/fibula eliciting pain below the squeeze site. X-rays will be able to show any abnormal separation of the bones and also rule out any fractures.

Lateral ankle sprains may look a lot worse with the bruising and severe swelling but a high ankle sprain may be more painful and have a longer recovery time. Typically, high ankle sprains do not swell as much but are very painful bearing weight because of the stress of the ankle mortise causing stress on the syndesmosis. This is why treatment usually consists of being non-weight bearing (in a walking boot) for an extended period of time, icing, anti-inflammatories, and eventually physical therapy for your ankle. Extreme cases may require syndesmotic screw fixation.

Here at Oahu Spine and Rehab, we have all of the specialists and services to treat injuries such as high ankle sprains along with many more. Call now for a complimentary consultation (808) 488-5555.

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