High Ankle Sprain Repair:
Causes, Symptoms and Treatment Options

What is a high ankle sprain?

A high ankle sprain, also called a syndesmotic injury, involves an injury above the ankle joint. High ankle sprains often occur when there is a sudden external rotation of the ankle that stresses the ligaments above the ankle. The injury typically involves a tear or damage to the high ankle ligaments, which connect the bones in the lower leg.

These ligaments hold the shin bones together, keeping them stable. Stability is essential for walking and running since those activities place significant force on this junction.

The difference between high ankle sprains and low ankle sprains

High ankle sprains involve the area above the ankle joint, impacting the interosseous membrane. Low ankle sprains occur on the outside of the ankle, typically involving the lateral malleolus.

High ankle sprains are more likely to occur as a sports injury. Identifying a low or high ankle sprain is important to ensure the proper treatment and rehabilitation.

Common symptoms of a high ankle sprain

  • Tearing or popping sensation at the time of the injury
  • Trouble walking after the injury, especially on your toes
  • Pain, tenderness, and swelling in the front of the ankle or lower leg, which can spread to the whole ankle and foot
  • Increased pain when doing activities that cause your ankle to be flexed, like climbing stairs
  • Limited ankle range of motion
  • Pain or inability to bear weight

Who’s most at risk for a high ankle sprain?

You may have heard of high ankle sprains due to injuries to American football players. The Kansas City Chiefs quarterback Patrick Mahomes experienced an ankle injury in the 2023 AFC divisional playoffs. While he continued playing, the Dallas Cowboys running back Tony Pollard was removed from the 2023 NFL divisional playoff game after suffering a high ankle injury. The Georgia Bulldogs’ start tight end Brock Bowers and Tennessee Vols wide receiver Cedric Tilman have both recovered and returned to play before season’s end.

However, these injuries can occur in athletes at all levels of play and nonathletes.

High ankle sprain injuries are less common than low ankle sprains. However, they are increasingly seen in:

  • High-impact sports, like football, soccer, ice hockey, wrestling, and rugby
  • High-velocity activities like trampolining, ice skating, skiing, and basketball

Causes of a high ankle sprain

High ankle sprains occur when your ankle is injured while your foot is flexed upward and then twisted — either inwards or outwards. A high ankle sprain injury can also occur when your ankle is broken, often resulting in the ligament on the inside of your ankle being torn. This can cause the fibula to be broken at a high level. High ankle sprains typically involve a collision and can occur when running or jumping. They’re usually not due to the rolling motion that causes most other ankle sprains.

Non-surgical treatment options

Treatment depends on the severity of your high ankle sprain. Ankle sprains are typically assigned a level of severity, with Grade 1 being the least severe. The severity grades are:

  • Grade 1: Your ligament is stretched with some damage to the fibers but not torn.
  • Grade 2: Your ligament is partially torn, often with a loose ankle joint.
  • Grade 3: Your ligament is torn, including ankle joint instability.

Grade 1 and 2 high ankle sprains can often be treated conservatively with non-surgical options, including:

  • Resting the ankle to allow healing
  • Icing for no more than 20 minutes at a time to reduce swelling
  • Compression by splinting or bandaging the ankle to reduce the motion of the joint
  • Elevating the ankle for periods to reduce swelling

During the acute inflammatory phase, your doctor may recommend taking non-steroidal anti-inflammatory medications to manage pain and swelling. You may also need to use a walking boot to provide support to the joint or use crutches to help prevent putting pressure on your ankle.

After the inflammatory phase resolves, you may be prescribed physical therapy, depending on the severity of your injury. Physical therapy typically focuses on gentle range of motion and strengthening exercises of the lower leg.

Athletes may also be provided additional exercises or routines to prepare them to resume their sports activities. They may also need to wear an ankle brace or have their ankle taped to reduce reinjury once they resume regular activities.

Surgical treatment and when it may be necessary

Surgical treatment is often required to repair a torn ligament or stabilize the joint, which aims to help restore the ligaments to a more normal length and provide stability. High ankle surgery is often an outpatient surgery. Your surgeon may use a small camera to look inside the ankle joint and assess the cartilage.

During surgery, the orthopedic surgeon will remove any loose pieces of cartilage or bone and repair the torn ligament. The surgeon may use a surgical screw or a braided synthetic strong non-absorbing suture to stabilize your leg and restore the original position of your bones for faster healing.

Utilizing the braided synthetic suture is a surgical approach commonly used for repairing ligaments in the ankle, especially the anterior inferior tibial fibular ligament (AITFL). There are many good systems currently being used for this injury (Arthrex Tightrope, Anika Synd-Ez, Smith and Nephew Invisiknot). These systems allow the surgeon to adjust the tension of the repaired ligament and secure and stabilize it to restore normal ankle function and stability.

Some advantages of these systems include:

  • Being minimally invasive
  • Reduced tissue damage
  • Shorter recovery period
  • Potentially better outcomes compared to traditional open surgery

Recovery and Prevention

Recovery from a high ankle sprain can vary depending on the severity of your injury and whether you need surgery. Recovery time can take several weeks to four months or longer. Additionally, you may require physical therapy or additional time before you can resume your regular level of activities.

However, with advances in surgical techniques, many athletes are returning to regular activities faster than in the past. That said, it’s important to follow your doctor’s advice regarding recovery and not to rush the process. Otherwise, you risk re-injuring your ankle.

Since most high ankle sprains are due to accidents or collisions, it’s not possible to completely prevent them. However, you can take actions to minimize the risk of getting a high ankle sprain by:

  • Warming up and stretching completely before practices or games
  • Incorporating balance training activities into your routine
  • Wearing doctor or team physician-approved ankle supports or protective equipment, especially following injury

If you have a high ankle injury that’s not improving with non-surgical treatments or need surgery to heal, call (423) 624-2969 today to schedule an appointment with one of CSMO’s foot and ankle specialists

We will help you heal, recover, and get back to the activities you enjoy.