Key takeaways:
High ankle sprains are different from typical ankle sprains. They occur just above the ankle, in the lower part of the leg.
This ankle injury is more common in athletes. It most often happens when your toes are pointing up and your foot rotates or collides with another player.
Rest and ice can usually treat high ankle sprains, but it can take around 2 months to heal.
Ankle sprains are one of the most common ankle injuries. Most of us know what it feels like to twist an ankle — and know the pain and swelling that follows. But not all ankle sprains are the same. They can vary in severity as well as location.
An ankle sprain occurs when a ligament — a thick band that holds bones together — stretches or tears. A high ankle sprain is an injury to specific ankle ligaments called the “syndesmosis.” These ligaments connect the tibia and fibula, two bones in your shin. They usually function as shock absorbers during intense activities like running, skiing, and jumping.
In this article we’ll explain:
How these ankle injuries happen
How to know if you have one
What the recovery process looks like
Search and compare options
What causes a high ankle sprain?
Ankle sprains can happen easily, like when someone rolls their ankle while walking. But a high ankle sprain requires a little more force.
The injury occurs during a twisting or rotating movement at the ankle. Think of your foot and your leg turning in opposite directions. This puts a strain on the ligaments that band together the two lower leg bones — the tibia and fibula. A high ankle sprain occurs when those ligaments stretch or tear. This injury is particularly common in athletes since it occurs during running, jumping, or colliding. A high ankle sprain can also happen alongside an ankle fracture.
How is a high ankle sprain different from other types of ankle sprains?
The main difference between a high ankle sprain and the more common ankle sprain is the location of the injured ligaments.
More common ankle sprains injure the ligaments on the lower and outer part of your ankle. A high ankle sprain is an injury to the ligaments higher on the ankle that connect your shin bones.
Another important difference is how the injury occurs. High ankle sprains tend to happen during twisting motions, while the more common ankle sprain usually happens when you roll your ankle.
High ankle sprains can also take a lot longer to heal than other types of ankle sprains.
How do you know if you have a high ankle sprain?
High ankle sprains have a variety of symptoms, many of which overlap with symptoms of the more typical ankle sprains. These include:
Swelling
Bruising, which usually develops a few days after the injury
Pain above the level of the ankle
Difficulty putting weight on your foot or toes
Increased pain with activities, especially those that cause the foot to be flexed upward (like climbing stairs)
A healthcare provider can perform some physical exam tests that can help diagnose a high ankle sprain. Tests include:
External rotation test: With your knee bent at 90 degrees, the provider puts gentle pressure on your foot to turn it outward. If this causes pain in the ankle area, it may be a sign of a high ankle sprain.
Squeeze test: The provider gently squeezes your leg below the knee. If the pain travels down to the ankle, this may be another sign of a high ankle sprain.
Your provider may also order imaging tests to look for damage to the bones or other areas of the ankle. These can include:
X-ray: This is useful to look for a break, or fracture, in the bones.
CT scan: This can provide a little more detailed picture than an X-ray. It can pick up smaller injuries to the bone that an X-ray may miss.
MRI scan: This test provides a very detailed view of the muscle, ligaments, and tendons. A high ankle sprain shows up on an MRI because it provides a good picture of the injured ligament. But you don’t need an MRI to diagnose the injury when symptoms and a physical exam make the diagnosis obvious.
How do you treat a high ankle sprain?
These injuries take longer to heal than typical ankle sprains. Fortunately, most injuries don’t need surgery. They just need time.
“RICE” is a common method that helps with healing and reducing inflammation, especially in the first few days after your injury. RICE is a helpful acronym to remember treatment methods:
Rest: Take it easy! This may mean minimal activity or only putting weight on your foot if it doesn’t cause too much pain. To protect your ankle, your provider may give you a boot for walking.
Ice: Wrap a cloth around some ice, or put an ice pack on your ankle to help reduce the swelling for 15 to 20 minutes, about every 2 to 3 hours.
Compression: This means using a wrap (like an ACE bandage) to help stabilize and support your ankle.
Elevate: Keep your foot elevated on some pillows, ideally above your heart. This helps decrease the swelling.
To help with the pain, you may try anti-inflammatory medications, like NSAIDs (ibuprofen, celecoxib, and naproxen) and acetaminophen (Tylenol). If you have any questions on which medication will be best for you, talk to your pharmacist or provider. Be sure to follow dosing guidelines carefully since NSAIDs and Tylenol can be toxic at high doses.
Topical ointments, like Voltaren Gel, Bengay, and Icy Hot can provide some temporary pain relief. Some also say the herbal remedy Traumeel can be useful, too.
Physical therapy can also help to strengthen the ankle ligaments and decrease joint stiffness. Surgery may be necessary in some severe cases or those associated with ankle fractures.
How long does it take to recover from a high ankle sprain?
High ankle sprains may take a while to heal. Most are better in about 6 to 8 weeks. If symptoms haven’t improved after about 6 weeks, you can see your provider to make sure you don’t have another injury, like a small break in your bones.
Sometimes soft tissue, like ligaments, takes up to 6 months to heal. Just be patient with yourself and your body. Most people get back to their normal level of activity with time. If you find that you’re prone to ankle injuries, wearing an ankle brace can lower your risk of future sprains.
The bottom line
High ankle sprains are less common than typical ankle sprains. They are important to diagnose properly, given the prolonged healing time and possibility for other associated injuries. Fortunately, using the RICE method for 6 to 8 weeks usually results in a full recovery.
Why trust our experts?
References
FootCareMD. (n.d.). Ankle sprain. American Orthopaedic Foot & Ankle Society.
FootCareMD. (2020). High ankle sprain (syndesmotic injury). American Orthopaedic Foot & Ankle Society.
Hunt, K. J., et al. (2015). High ankle sprains and syndesmotic injuries in athletes. Journal of the American Academy of Orthopaedic Surgeons.
Kaminski, T. W., et al. (2019). Prevention of lateral ankle sprains. Journal of Athletic Training.
Physiopedia. (n.d.). Syndesmotic ankle sprains.
