High ankle sprain
A high ankle sprain, also known as a syndesmotic ankle sprain, is a sprain of the syndesmotic ligaments that connect the tibia and fibula on the lower leg. Syndesmotic ankle sprains are known as high because their location on the lower leg is above the ankle. Unlike common ankle sprains when ligaments around the ankle are torn or receive injury through an inward twisting, high ankle sprains are caused when the lower leg and foot twist out.
Athletes with high ankle sprains usually come to a physician, physical therapist, athletic trainer or other specialist complaining of a dull or sharp pain in the outside-front of the lower leg above the ankle. The pain is usually sharper when twisting is applied. In other cases the high ankle sprain is diagnosed only after treatment for the common ankle sprain fails. High ankle sprains may be harder to diagnose than normal ankle sprains because swelling is usually minor or nonexistent. For this reason some may underestimate the severity of the injury. The physical therapist, athletic trainer, or physician will test for high ankle sprain in a number of ways. The most common approach is the squeeze test (squeezing the calf or lower leg, usually with slight turning). CT scans or radiographs are sometimes used for diagnosis or to check for displacement of the tibia and fibula.
Treatment of high ankle sprains depends on severity. An athlete may be out for as little as two to three days or as long as six months. Minor high ankle sprains can be healed by reducing movement of the lower leg and foot with a brace or cast. As with common ankle sprains, using the RICE technique works well:
- Compression (wrapping, splint or cast)
When a high ankle sprain is diagnosed the doctor will determine if the injury is stable or unstable. Stable injuries are the less severe high ankle sprains when the placement of the tibia and fibula stays normal. Unstable high ankle sprains occur when two or all three syndesmotic ligaments are torn and the tibia and fibula are free to move around. Unstable injuries require more treatment, and usually surgery. During the surgery one or two screws are inserted in the lower leg for a few months (usually three) or until the ligaments have reformed and are able to hold the bones in the proper position. Recovery from a high ankle sprain can take 6 months or longer.
Rehabilitation is very important when dealing with a high ankle sprain. A great deal of high ankle sprains also involve medial and/or lateral ankle sprains; so the rehabilitation has to do with strengthening the different compartment muscles in the lower leg to give the ankle the stability that was lost from the injured ligaments. The effectiveness to rehab and how quickly a person fully recovers from an ankle sprain all depend on the person's body and how well it responds to treatment.