High vs. Low Ankle Sprain: How to Tell the Difference and Get the Right Care

What is a High Ankle Sprain? (Syndesmotic Sprain)

A high ankle sprain (also known as a syndesmotic sprain) is caused when there is tearing and damage to the ligaments above the ankle joint. This injury is significantly different and less common than a traditional ankle sprain.

High ankle sprains only account for 10% of all ligament injuries to the ankle, but they are often classified among severe ankle sprains due to instability between the two bones of the lower leg. A common ankle sprain or low ankle sprain occurs when there is damage to the ligaments inside and outside the ankle joint. These common injuries frequently occur when the ankle rolls, particularly during sports.

Both high and low ankle sprains are injuries that most commonly occur among athletes involved in high-impact sports such as football players. However, a high ankle sprain often takes longer to heal than a low ankle sprain, especially when the ligaments involved are completely torn.

Anatomy of the Ankle Joint

The ankle joint is a complex structure composed of bones, muscles, and ankle ligaments, which all play a role in a person’s stability and range of motion.

The ligaments in the ankle are categorized into two groups—the lateral ankle ligaments (located on the outside of the ankle) and the medial ankle ligaments (located on the inside of the ankle). A lateral ankle sprain typically involves the anterior talofibular ligament, calcaneofibular ligament, or posterior talofibular ligament.

A medial ankle sprain affects the deltoid ligament, which is less commonly injured but can occur when the foot turns out during an eversion ankle sprain. A low ankle sprain occurs when the lateral ligaments are stretched or torn, often during an inversion ankle sprain. High ankle sprains occur when the ligaments on the inside of the ankle are stretched or torn.

The high ankle ligaments on the inside of the ankle are connected to the tibia and fibula (the lower leg bones) and can cause much more damage than an average ankle sprain. The tibia and fibula bones are considered syndesmosis joints, and they are responsible for the upward and downward motion of the foot. The high ankle ligaments also help stabilize the lower leg by preventing excessive movement of the ankle bone.

What Causes a High Ankle Sprain?

A high ankle sprain often occurs alongside ankle fractures, torn ligaments, or a broken ankle. This type of injury can happen when the ankle twists forcefully or when the foot is planted, and the leg rotates, especially during physical activity.

Often, the ankle rolls outward, creating stress between the tibia and fibula and damaging the soft tissue that holds the bones together.

What Are the Symptoms of a High Ankle Sprain?

Some signs and symptoms of a high ankle sprain include:

• Severe pain that is located just above the ankle
• Pain when bearing weight on the affected ankle
• Swelling in the lower leg above the ankle
• Increased pain with plantar flexion or rotation

If a high sprained ankle is suspected after an injury, the person’s ankle, lower leg, and injured foot should be immobilized to protect the injured ligament from further injury.

How is a High Ankle Sprain Diagnosed?

A high ankle sprain can be difficult to diagnose because, after the incident, the focus is placed on the more commonly sprained lateral ligaments in the ankle. To accurately diagnose a syndesmotic sprain, an orthopedic surgeon will begin with a thorough clinical examination. This may include the external rotation test and a squeeze test.

An external rotation test is when the doctor bends the knee of the patient and places their foot and ankle at a 90-degree angle in relation to the leg. If there is pain after turning the foot, this would suggest a high ankle sprain.

A doctor performs a squeeze test by squeezing the leg just below the knee to see if there is any pain in the ankle. If the patient experiences pain, then this would also suggest that there is a syndesmotic sprain.

Your healthcare professional will most likely also take imaging tests such as X-rays and an MRI to confirm a diagnosis. Imaging studies confirm whether the ligaments are completely or partially torn.

High Ankle Sprain Treatment

The treatment for a high ankle sprain usually involves immobilizing the ankle in a boot or a cast for 6 to 8 weeks. The recovery time for a high ankle sprain is usually longer than a low ankle sprain.

Some other treatment methods used for high ankle sprains include:

• Icing the ankle for 20 minutes every 2 to 3 hours
• Elevating the ankle
• Compressing the ankle with an ACE wrap
• Wearing an ankle brace

A doctor may prescribe physical therapy after the initial treatment to help improve the flexibility and range of motion in the ankle. However, surgery may be required when there is significant damage to the ligaments, and there is a visible separation of the fibula and tibia bones.

Get Expert Care for High and Low Ankle Sprains at OrthoNeuro

Our board-certified foot, ankle, and podiatry specialists at OrthoNeuro have helped many patients recover from high and low ankle sprains by using a variety of treatment options. We have multiple locations throughout Columbus, Ohio.

If you have had a recent ankle injury and would like to know if you have a high ankle sprain, make an appointment for a physical examination with an OrthoNeuro specialist today!