Ankle Sprain: High Ankle Sprain

The 26 Review

  • What is a High Ankle Sprain Injury to ligaments above the ankle joint
  • Causes Injury occurs due to twisting, rotating, or physical trauma
  • Symptoms Pain, swelling, and difficulty walking, flexing foot upward, and climbing up or down stairs
  • Diagnosis Physical examination, X-rays, and MRI
  • Treatment Ice, rest, elevation, anti-inflammatory medications, physical therapy, surgery

Let’s take a closer look…

A high ankle sprain, as previously mentioned, is a sprain in the upper ligaments of the ankle above the ankle itself. These ligaments are attached to the tibia and fibula, which stabilizes the entire area while walking and running. The syndesmosis is a fibrous joint held together by ligaments. It is located above the ankle joint, between the tibia and the distal fibula. This joint is made up of several ligaments, and the primary ones include the anterior inferior tibiofibular ligament, posterior inferior tibiofibular ligament, interosseous ligament, and the transverse tibiofibular ligament.

The syndesmosis ligament acts as a shock absorber, aiding in providing stability and support for the ankle. Its main job is to align the fibula and tibia and prevent them from spreading too far apart. When the syndesmosis ligament is injured, it can cause the tibia and fibula to separate, resulting in a high ankle sprain. Continue reading to learn more about an ankle syndesmosis ligament tear, a high ankle sprain.


The most common causes of a high ankle sprain are swift twisting or rotating motions. Most patients get this type of sprain from rotating the foot toward the outer side of the leg. These types of sprains tend to happen during contact or high-impact physical or athletic activities, so athletes tend to be at higher risk of developing a high ankle sprain.

The seriousness of a high ankle sprain depends on the extent of the circumstances and tear. For this injury to occur, there usually needs to be a significant force involved, accompanied by injuries to other ligaments, tendons, or bones. Additionally, it is not unusual to have a syndesmosis sprain with one or more bone fractures. Athletes participating in sports like football, rugby, downhill skiing, and hockey tend to see more syndesmosis sprains than the average individual.


Along with typical symptoms of an ankle sprain, like pain and swelling, there are a few other symptoms to look out for in case of a high ankle sprain. Individuals may experience pain above the ankle when weight is placed on the foot. In conjunction, an individual will likely experience more pain when climbing up or down stairs because it causes the ankle bones to split apart.

A high ankle sprain may also result in a fractured fibula, meaning placing any weight on the foot will cause pain. While syndesmosis injuries are generally less likely to bruise, there are plenty of other symptoms to look out for, such as tenderness to the touch and trouble raising the calf. Symptoms can vary depending on the severity of the injury, so it is crucial to speak with a podiatrist if you believe you have a high ankle sprain. 


Diagnosing a syndesmosis ligament injury can pose challenges, but explaining what occurred to the medical professional will help the doctor determine where to look first. First, the medical professional will most likely conduct a physical examination, which can be uncomfortable. During the examination, the doctor will squeeze and manipulate the leg and foot to see how well it can flex, rotate, and bear weight. After a physical examination, an X-ray may be necessary. X-rays can help rule out broken bones and other injuries. If the X-ray isn’t enough, other imaging studies can be conducted, like a CT scan or MRI. Those two tests can help detect tears and injuries to the ligaments and tendons. 


Generally, high ankle sprains take longer to heal than most other ankle sprains. If the ailment is not severe, surgery will not be required. However, resting, icing, compression, and anti-inflammatory medications can speed up the healing process or at least make it more bearable. In certain cases, physical therapy may also be needed in order to strengthen the tendons and prevent the recurrence of this type of injury.

Healing times depend on how badly an individual injured the soft tissue and if there was any bone damage. A podiatrist may recommend a high ankle sprain corrective surgery if there is too much separation between the fibula and tibia. If surgery occurs, the patient must wear a cast or boot for 6 weeks while they recover. Severe syndesmotic sprains are typically followed by physical therapy once the boot or cast comes off. Full recovery can take between 2 to 4 months. 

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