High Ankle Sprains vs. Traditional Ankle Sprains: Healing Time Comparison
Yes, high ankle sprains typically take significantly longer to heal than traditional lateral ankle sprains due to the complexity of the syndesmotic injury and the biomechanical importance of the affected structures. 1
Differences in Recovery Timeline
- High ankle sprains (syndesmotic injuries) involve damage to the syndesmosis between the tibia and fibula, requiring more intensive rehabilitation and longer recovery periods compared to lateral ankle sprains 1
- Traditional lateral ankle sprains typically involve the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL), which generally heal more quickly 2
- While 80% of traditional ankle sprains make a full recovery with conservative management, high ankle sprains commonly result in prolonged recovery periods 2, 3
- High ankle sprains can lead to significant participation restriction time, with 47.1% resulting in ≥7 days of participation restriction and 15.8% resulting in >21 days of participation restriction 4
Diagnostic Considerations
- High ankle sprains can be detected using specific tests such as the crossed-leg test, which causes pain when pressure is applied to the medial side of the knee 1
- Diagnostic maneuvers for high ankle sprains include the squeeze test and the external rotation test, which help differentiate them from traditional ankle sprains 3
- Reexamination 3-5 days after injury, when pain and swelling have improved, may help with accurate diagnosis 5
Treatment Approach for High Ankle Sprains
- Initial management includes the PRICE protocol (Protection, Rest, Ice, Compression, Elevation) to minimize pain and swelling 1
- Semi-rigid braces or lace-up ankle supports are more effective than tape or elastic bandages for treating ankle sprains 5, 1
- Functional rehabilitation should begin within 48-72 hours after injury, including range of motion exercises, strengthening exercises, and proprioception training 1
- High ankle sprains without radiographic diastasis can be treated nonoperatively, but grade 3 sprains (complete tears with instability) may require surgical intervention 3, 6
Rehabilitation Protocol
- A 3-phase rehabilitation program is recommended for high ankle sprains 7:
- Acute phase: Protecting the joint while minimizing pain, inflammation, and muscle weakness
- Subacute phase: Normalizing range of motion, strength, and function in daily activities
- Advanced training phase: Preparing for return to sports with perturbation training, agility drills, and sport-specific exercises
Long-Term Outcomes
- A recent study with ≥18-year follow-up showed that nonoperative management of high ankle sprains without diastasis was associated with acceptable functional outcomes and low rates of subsequent ankle injuries 6
- However, there was a high incidence of arthritis (27% had Kellgren-Lawrence grade >2 osteoarthritis), though most cases were not clinically significant 6
- If misdiagnosed or managed incorrectly, syndesmotic injuries can lead to unfavorable late sequelae 3
Common Pitfalls to Avoid
- Inadequate treatment of ankle sprains can lead to chronic problems such as decreased range of motion, pain, and joint instability 5
- Prolonged immobilization delays recovery and shows no benefits 1
- Therapeutic ultrasound appears to have no value in the treatment of acute ankle sprains 1
- Setting unrealistic expectations for recovery time can lead to frustration; clinicians should prepare patients for a longer recovery period with high ankle sprains 3