WHAT IS A HIGH ANKLE SPRAIN? (Syndesmotic Sprain)

by Ryan Klinefelter, MD

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. 

A common ankle sprain or “low ankle sprain” occurs when there is damage to the ligaments inside and outside the ankle joint. Both high and low ankle sprains are injuries that most commonly occur among athletes such as football players. 

However, a high ankle sprain often takes longer to heal than a low ankle sprain. 

If you have had a recent ankle injury and would like an accurate diagnosis, schedule a consultation with our foot, ankle, and podiatry experts at OrthoNeuro. Our doctors offer accurate diagnoses and treatment plans tailored to you.

Call or schedule an appointment online now! 


Anatomy of the Ankle Joint 

The ankle joint is a complex structure composed of bones, muscles, and 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 low ankle sprain is when the ligaments on the outside of the ankle are torn or stretched. 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. 


What Causes a High Ankle Sprain?

A high ankle sprain (syndesmotic sprain) usually occurs along with ankle fractures in the tibia and fibula bones, ligament injuries, or if the ankle is broken. 

A high ankle sprain can also be caused by twisting or rotating the ankle. Again, this is a common injury seen in those who participate in high-impact sports where a quick change in direction is required, such as football, basketball, and soccer. 

Often when making a quick change in direction, the foot is turned outwards and misaligns with the leg. This results in a syndesmotic sprain. 


What Are the Symptoms of a High Ankle Sprain?

Some signs and symptoms of a high ankle sprain include: 

  • 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 when trying to flex or rotate the ankle

If a high sprained ankle is suspected after an injury, the person’s ankle, lower leg, and foot should be immobilized and evaluated by a medical professional. 


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 may perform an 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. 


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. 



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 the state of Georgia.

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! 


Frequently Asked Questions


What Is the Fastest Way to Heal a High Ankle Sprain?

The fastest way to heal a high ankle sprain is by following your doctor’s instructions for recovery. You may need to wear a splint or brace and use crutches to immobilize and keep weight off your injured foot. Physical therapy may also be recommended to help you regain strength and range of motion in your ankle. 


Can You Walk after a High Ankle Sprain?

Yes, most people with high ankle injuries recover within 6 to 8 weeks and can walk and participate in sports afterward. 

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