What is it about the words “high ankle sprain” that make coaches and athletes alike break down and act like Chicken Little? Is there a difference between the common lateral ankle sprain, the less common medial ankle sprain, and the dreaded high ankle sprain? We will attempt to educate you on what a high ankle sprain is and how it can be related to more common ankle sprains, initial care and treatment of the injury, and return to play prognosis after injury.
In order to accurately describe what a high ankle sprain is, we need to look at the more specific anatomical name of the injury and how it occurs. High ankle sprains are also known as a syndesmotic ankle sprain. That is, that the syndesmotic ligaments that attach the tibia and fibula are “stretched” and “sprained”. The reason that this can become more problematic for the individual is that, every time there is weight placed down through the bones of the lower leg, the tibia and fibula are effectively pushed away from each, thus creating more stress on the ankle joint at the talus and throughout the soft tissue that stabilizes the joint.
Typically these injuries occur when a foot is in a “closed packed” positioned and there is a rotational force applied. Common sports and mechanisms can include: hockey (sliding into the boards), baseball (sliding into a base), football (“horsecollar” tackle from behind), and basketball (player on the ground rolling into and over the foot and ankle of the soon to be injured person). While these are some of the more common mechanisms, it is by no means an exhaustive list.
Before progressing to care and rehabilitation of these injuries, it is important to note that no information found below should replace the evaluation and treatment plan of a licensed medical professional. Please seek medical assistance if you have an acute ankle injury.
Immediate care of high ankle sprains are similar to more traditional lateral and medial ankle sprains, although they tend to be more painful and acute pain management takes a little longer. The application of the principles of RICE (previously discussed here ) and typically the use of a walking boot and often times, crutches, will help to decrease the amount of dysfunction and pain that is felt.
In the early stages of rehabilitation, regaining both passive and active range of motion is key. In the intermediate stages of rehab, regaining strength is the focus. In the advanced stages of rehab, regaining function and returning to full activity is the goal. One thing that remains constant thorough all 3 phases is that there should not be any pain present when progressing to the next exercises. The old days of “No pain, no gain” are over! Listen to your body and listen to your therapist. That is not to say that you will not have some discomfort, but it should not be pain.
What if traditional rehab does not work or what if the injury is more severe than a “standard” high ankle sprain? If this is the case, then surgical intervention will probably be required in order to regain pre-injury functional levels. With this procedure, screws are applied to the tibia and the fibula in order to keep them from shifting while the ligaments heal. In cases of ligament and fascia rupture, sutures or anchors applied into the bone may be required. These cases take significantly longer to heal and most patients are out for upwards of 6 months. However this is dependent on the surgeon, rehabilitation compliance, and functional demands of the individual.
In closing, while high ankle sprains have a higher amount of dysfunction than medial or lateral ankle sprains, they do not represent a career ending injury. Proactive assessment and treatment is the best route to follow when faced with the potential of one of these injuries.