From the Guidelines
A high ankle sprain is a severe injury to the syndesmosis, the group of ligaments connecting the tibia and fibula bones above the ankle joint, requiring longer healing time and potentially involving surgical intervention if the syndesmosis is unstable 1.
Definition and Characteristics
A high ankle sprain occurs higher up the leg compared to a common ankle sprain and typically results from forceful rotation of the foot outward while the ankle is flexed. This injury is more severe than a standard ankle sprain, with healing times usually ranging from 6-8 weeks or more, compared to 2-4 weeks for common sprains.
Treatment and Management
Treatment typically involves the RICE protocol (rest, ice, compression, elevation), possibly immobilization with a boot or cast. In severe cases, surgery may be necessary if the syndesmosis is unstable, as it can help prevent recurrent ankle sprains by resolving ligament laxity 1. Physical therapy is crucial for recovery, focusing on restoring range of motion, strength, and proprioception.
Importance of Proper Diagnosis and Treatment
High ankle sprains are common in contact sports like football and hockey, where the foot can get planted while the body continues to move. The injury is particularly problematic because the syndesmosis is essential for ankle stability during walking and running, making proper diagnosis and treatment essential to prevent long-term instability and arthritis 1.
Key Considerations
- The severity of ligament damage can be assessed most reliably by delayed physical examination (4–5 days post trauma) 1.
- A short time of immobilization may be helpful in relieving pain and swelling, but the patient with an acute lateral ankle ligament rupture benefits most from use of tape or a brace in combination with an exercise programme 1.
- Surgical therapy is mainly reserved for patients who have chronic instability after a lateral ankle sprain and who have not responded to a comprehensive exercise-based physiotherapy programme 1.
From the Research
Definition of High Ankle Sprain
- A high ankle sprain is a common athletic injury that can be associated with long-term sequelae 2
- It is an injury to the syndesmosis, which is the ligament that connects the tibia and fibula bones in the ankle 3
Characteristics of High Ankle Sprain
- High ankle sprains can cause persistent symptoms, resulting in significant resources spent toward treatment, rehabilitation, and prevention 3
- They are often accompanied by swelling, pain, and difficulty walking 4
- Chronic ankle instability can occur if the ankle continues to have problems with tasks like walking or playing sports 1 year after the original injury 4
Treatment and Management of High Ankle Sprain
- Nonoperative treatment of high ankle sprains utilizing a standardized protocol can result in good long-term outcomes 2
- Functional treatment is currently considered a more appropriate treatment than immobilization, and should be encouraged 5
- Clinical practice guidelines recommend the use of manual therapy, cryotherapy, functional supports, early ambulation, short-term NSAIDs, and rehabilitation for ankle sprain management 6