High Ankle Sprain

High Ankle Sprain

- Article by John Miller

High Ankle Sprains

What are High Ankle Sprains?

High ankle sprains, injuries to the upper ankle ligaments above the ankle joint, often involve the syndesmosis, the fibrous connection between the tibia and fibula. These sprains differ from lower ankle sprains in severity and treatment. Early diagnosis by a physiotherapist or foot doctor is crucial.

The Nature of High Ankle Sprains

High ankle sprains, or syndesmotic injuries, present challenges due to their lack of passive ankle stability in weight-bearing, leading to long-term functional instability. The differentiation between stable and unstable high ankle injuries is critical. Stable sprains may be treated conservatively, while unstable ones often require surgery.

Causes of High Ankle Sprains

These injuries typically occur when the foot is planted and twisted outwards excessively, or when the ankle is heavily loaded and pushed into extreme dorsiflexion, common in football tackles.

Identifying Symptoms

Symptoms include pain above the ankle, especially with outward foot rotation, difficulty in walking, bruising, swelling, and inability to perform single-leg calf raises. The severity of symptoms varies with the sprain grade.

Differentiating High Ankle Sprain and Syndesmosis Injury

High Ankle Sprain

A high ankle sprain affects the ligaments connecting the tibia and fibula above the ankle. It usually results from forceful outward twisting of the foot and ankle.

Syndesmosis Injury

This broader term refers to damage to the entire syndesmosis joint, potentially including ligaments. It arises from similar mechanisms as a high ankle sprain but can encompass more trauma types.

Diagnosis and Treatment

Diagnosing High Ankle Sprains

Physiotherapists, sports doctors, or ankle surgeons assess ligament integrity and may recommend imaging tests to confirm a diagnosis. A gap greater than 2mm in the inferior tibiofibular joint indicates potential instability.

Treatment Approaches

Treatment aims to restore stability between the tibia and fibula. Physiotherapy is crucial, whether the injury is stable or requires surgery. Treatment goals include pain relief, inflammation control, regaining motion range, strengthening muscles, restoring joint proprioception and balance, and returning to normal function.

High Ankle Sprain
High Anke Sprain Treatment

Physiotherapy Treatment Phases

Phase 1: Injury Protection and Pain Relief

Initial treatment includes RICE (Rest, Ice, Compression, Elevation), with active rest crucial. Compression bandages and elevation aid in reducing swelling, while physiotherapists may employ various techniques for pain relief. A moon boot is normally prescribed to provide support for the healing ligaments.

Phase 2: Regaining Full Range of Motion

Targeting joint range of motion, muscle length, and neural tissue motion is essential, avoiding overstretching ligaments.

Phase 3: Restoring Muscle Strength

Strengthening exercises, progressing from non-weight-bearing to full-weight-bearing, are key for dynamic ankle control.

Phase 4: Normalising Foot Biomechanics

Foot arch assessment may lead to using orthotics or specific foot stabilisation programs.

Phase 5: Restoring High-Speed, Power, Proprioception, and Agility

Addressing balance and proprioception minimises re-injury risks and prepares for sport-specific activities.

High Ankle Sprain Treatment
High Ankle Sprain Treatment

Phase 6: Return to Sport

A customised training regimen ensures a safe return to sport, focusing on speed, power, agility, and function.

Recovery and Long-Term Considerations

Recovery Timeline

Recovery times vary with injury severity, from six weeks for mild sprains to several months for severe injuries. Professional rehabilitation ensures proper healing and function restoration.

Risks of Untreated Sprains

Neglecting treatment can lead to joint stiffness, ligament laxity, muscle weakness, and increased arthritis risk. Chronic ankle sprains require more complex treatment due to established complications.

The Importance of Professional Care

High ankle sprains, if misdiagnosed or untreated, can lead to significant joint destruction, necessitating surgery. Early and appropriate intervention is essential.

Conclusion: The Role of Physiotherapy

Physiotherapy plays a pivotal role in diagnosing, treating, and rehabilitating high ankle sprains and syndesmosis injuries. Professional guidance ensures accurate assessment and tailored treatment plans, minimising long-term complications and facilitating optimal recovery.

Remember, if you suspect a high ankle sprain or syndesmosis injury, consult your physiotherapist or healthcare specialist for precise diagnosis and effective treatment. Early and professional intervention is key to a successful recovery and return to normal activity.

Foot, Ankle & Heel Pain Products & FAQs

Common Ankle Injuries

Welcome to an exploration of common ankle injuries. The ever-present sprained ankle is at the forefront, accompanied by various sources contributing to ankle pain. Fractures, stress fractures, and tendinopathies are part of this landscape, each with implications. Ankle impingement and foot posture issues emerge, and biomechanical issues take centre stage, affecting alignment and eventually fast-tracking ankle arthritis. Even the younger population experiences heel concerns, with Severs disease impacting many young athletes' seasons. This article serves as a concise guide to understanding the complexities of ankle problems.

Sprained Ankles

The most common ankle injury is a sprained ankle, but ankle pain can have numerous sources.

Ankle Fractures

An ankle fracture occurs when there is a break in one or more of the bones. The most common ankle fractures are avulsion fractures of your distal fibula, which can be a side effect of an ankle sprain. All suspected fractures require medical investigation and professional management by your health professional to avoid long-term foot and ankle issues. If your healthcare professional suspects an ankle fracture, you will be referred for at least an X-ray and potentially an Orthopaedic Surgeon.

Ankle Tendinopathies

While muscle strains are more common in your legs, there are essential muscles that converge into tendons that wrap around your ankle to stabilise your ankle and foot to protect them from sprains and allow you to walk and run. These muscles and their tendon vitally provide a normal foot arch and avoid flat feet. Your muscles or tendons can become injured or inflamed due to overuse or trauma. The inflammation is called tendonitis. They can also tear, completely rupture, or sublux out of place. Medically tendon injuries are known as tendinopathies, and at the ankle may include:

Ankle Arthritis

Your ankle pain and dysfunction can lead to degenerative conditions such as ankle osteoarthritis. While arthritis usually is a chronic deterioration of your ankle joint, it is crucial to slow ankle arthritis progression. Would you please seek the professional advice of your ankle and foot health practitioner, e.g. physiotherapist or podiatrist?

Biomechanical Conditions

Biomechanical disorders may result in foot deformation, painful weight-bearing and potentially nerve compression. In simple terms, this is where your foot and ankle do not have normal bone alignment and motion control. Here are a few possible conditions related to poor ankle biomechanics.

Muscle Injuries

Nerve-Related Ankle Pain

Children & Youth Conditions

Systemic Conditions That May Cause Ankle Pain

Soft Tissue Inflammation

Other Useful Information

Foot, Ankle & Heel Pain FAQs

Welcome to our comprehensive FAQ guide on Foot, Ankle & Heel Pain. In this guide, we aim to address common questions and concerns related to foot, ankle, and heel pain. We will cover various topics, including ankle injuries, heel pain, Achilles pain, foot pain, shin pain, youth injuries, and balance and proprioception. Whether you're experiencing discomfort or seeking preventive measures, this guide will provide valuable insights and advice to help you understand and manage these conditions effectively.

Ankle Injuries

Heel Pain

Achilles Pain

Foot Pain

Shin Pain

Youth Injuries

Balance & Proprioception

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