Understanding and Managing High Ankle Sprains

A high ankle sprain, also known as a syndesmotic sprain, is a type of ankle sprain that occurs when the ligaments that connect the two leg bones, the tibia and fibula just above the ankle joint, are stretched or torn. Unlike a typical ankle sprain, which involves the ligaments on the outside of the ankle, a high ankle sprain involves the ligaments above the ankle joint. Syndesmotic sprain refers to the syndesmosis, or high ankle ligaments.

What ligaments are affected by a high ankle sprain?

Ankle Ligaments Infographic

The ligaments involved in a high ankle sprain are the anterior inferior tibiofibular ligament, found in front of the tibia and fibula, the posterior inferior tibiofibular ligament, found in back of the tibia and fibula, and the interosseous membrane, the membrane that stabilizes the tibia and fibula because it’s located in the middle space between the two bones. Any of these ligaments can be stretched, torn partially or torn completely in a high ankle sprain.

What causes a high ankle sprain?

High ankle sprain is often caused by a twisting or rotational force on the ankle while the foot is planted on the ground, such as during sports that involve sudden changes of direction or while running or jumping such as in football, basketball, wrestling, ice hockey, soccer, or skiing.

It also can occur from falling from a height and landing on the foot in an awkward position or from direct trauma or impact to the leg, causing the ligaments to stretch or tear. It will cause pain above the ankle joint, swelling, bruising, difficulty walking, being unable to walk on your toes and a feeling of instability in the ankle.

High Ankle Sprain Illustration

Should I go to the doctor for a high ankle sprain?

It is important to consult a healthcare professional, such as a doctor or a sports medicine specialist, for an accurate diagnosis and appropriate treatment plan for a high ankle sprain. They can assess the severity of the injury and provide personalized advice based on your specific condition.

How does a doctor diagnose a high ankle sprain?

Doctor tests ankle

To diagnose a high ankle sprain, your provider will most likely:

  • Have you sit down with your legs and foot hanging down. They’ll push up on your foot and twist it a little toward the outside. If there’s a lot of pain, it’s likely that you have a high ankle sprain.
  • Do the syndesmosis squeeze test. They’ll squeeze your tibia and fibula together, putting pressure on the interosseous membrane, the membrane that separates the two bones. If you feel pain higher up on your leg, you probably have a high ankle sprain.
  • Press on the ligament across the front of your ankle to see if there is pain.
  • Order imaging tests, such as X-rays, magnetic resonance imaging (MRI) scans, computed tomography (CT) scans and even possibly ultrasounds. The MRI is the best test for a high ankle sprain, but your provider might use X-rays to rule out other injuries.

What are some common treatments for a high ankle sprain?


Treatment will include what is known as R.I.C.E. (rest, ice, compression and elevation) for three to five days:

  • Rest and immobilization: It is crucial to rest the affected ankle and avoid putting weight on it by using crutches if necessary. Immobilization with a brace, cast, or walking boot may be recommended to prevent further damage and allow healing.
  • Ice therapy: Applying ice packs wrapped in a cloth to the injured area can help reduce pain, swelling, and inflammation. Ice should be applied for about 15-20 minutes every 2-3 hours for the first few days following the injury.
  • Compression: Wrapping the ankle with an elastic bandage or using a compression sleeve can provide support, reduce swelling, and prevent further injury. It is important not to wrap too tightly, as it may interfere with circulation.
  • Elevation: Elevating the injured leg above the level of the heart helps reduce swelling by promoting fluid drainage. This can be done by propping the leg up on pillows or using a recliner.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), over-the-counter pain relievers like ibuprofen or naproxen sodium can help alleviate pain and reduce inflammation. However, it is advisable to consult a healthcare professional before taking any medication.
  • Exercising in water. Being in water will lessen the amount of weight your ankle has to bear.
  • Physical therapy: Once the initial acute phase has passed, a physical therapist may recommend exercises to improve strength, flexibility, and stability of the ankle. They will
  • guide you through a gradual rehabilitation program to restore full functionality.
  • Surgery (in severe cases): Surgery is rarely required for high ankle sprains. However, in severe cases where the ligaments are significantly damaged; or the joint is unstable, surgical intervention may be necessary to stabilize the ankle and promote proper healing.

Man holding ice  pack on ankle

How long will it take to recover?

It usually takes six to eight weeks to recover from a high ankle sprain and you’ll probably be more prone to ankle injury in the future. If you are an athlete, it may take longer to be cleared to play again.

How do I avoid the risk of a high ankle sprain?

Man doing exercises and stretching ankles with roll pad

To minimize the risk of a high ankle sprain, there are several precautions you can take.

  • First and foremost, it's essential to wear appropriate footwear that provides adequate ankle support, especially during physical activities or sports.
  • Additionally, engaging in regular strength and balance exercises can help strengthen the muscles around the ankles, enhancing stability and reducing the likelihood of injury.
  • Maintaining a healthy body weight can also alleviate excess stress on the ankles.
  • When participating in high-impact activities, it is crucial to warm up properly, stretch, and gradually increase intensity to allow the body to adjust.
  • Lastly, be mindful of your surroundings and avoid uneven or slippery surfaces, as they can increase the risk of ankle sprains.

By incorporating these preventive measures into your routine, you can significantly decrease the chances of experiencing a high ankle sprain.

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