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How To Rehab A High Ankle Sprain

Ankle sprains…let’s face it. Most of us have had at least one in our lifetime. When you hear ankle sprain, you envision your foot rolling out when stepping on an uneven surface or missing a step down a flight of stairs. Both of these examples are known as a lateral ankle sprain, which account for up to 85-90% of all ankle sprains. These are much more common than other ankle sprains due to the innate mechanism of injury that is more likely to occur in this plane of movement, as well as the weaker soft tissue structures on the outside versus inside of the ankle.

However, other ankle sprains do still happen! High ankle sprains are a fairly common injury that is more common in athletics…

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Featured

  Not All Ankle Sprains are Created Equal

Ankle injuries are the most common orthopedic complaint we see in the ED. While most of these presentations are simple sprains, there are other more severe injuries that will resemble uncomplicated sprains. Given the sheer volume of ankle injuries we see, we undoubtedly have all missed some of these more complicated injuries. A high ankle sprain is one of these injuries.

 A Personal Story: My London Fall, the ankle injury

I had outpatient surgery around my ankle yesterday morning. It's stems from an injury when I fell in London that is still haunting me. I'm doing well, resting at home, binge watching Netflix, and praying this is the last stretch for a full recovery. If you're interested in the full story, continue reading.

 Mastering The Treatment Of High Ankle Sprains

Misdiagnosing a high ankle sprain can result in lingering pain and recovery as the treatment course for syndesmosis injuries is often protracted, requiring longer periods of offloading and rehabilitation in comparison to lateral ankle sprains. For recreational and elite athletes, high ankle sprain is the most common contributor to persistent ankle pain and disability.

 The Dreaded “High Ankle Sprain”

In the high ankle sprain, there are several structures potentially damaged. These include ligaments that connect the tibia to the fibula known as the tibfib ligaments, as well as a tissue called the interosseous membrane. The severity of this injury often depends on how many of these structures are damaged. The recovery time frame varies from 8 weeks to 6 months and this is why the high ankle sprain is so dreaded.

 The Dreaded “High Ankle Sprain”, But What’s The Difference?

High ankle sprains are less common but more debilitating. They commonly occur from a sudden twisting force when your foot is planted on the ground. It can also occur when the foot is forced into excessive dorsiflexion.

 The High Ankle Sprain

In my experience as a ProSport / STACK Physical Therapist, pain is the largest limitation in an athlete’s recovery. I have found that the ZAMST A2-DX brace helps support the interosseous ligament reducing pain significantly without completely limiting range of motion. Once basic strength has returned and weight bearing is pain free, dynamic strength control and single leg balance exercises are next.

 The High Ankle Sprain: What’s New in Soft-Tissue Injuries

The real question is: What is new in treating these injuries? And what is coming next?

Articles of Interest

High Ankle Sprains… A guest blog by Tom Whittamore

The aim of this blog is to look at what the syndesmosis is, how it is injured, what tools we have to diagnose the ‘high ankle sprain’, and how I undertook a recent rehabilitation of this injury.

Do I Have a High Ankle Injury?

Syndesmosis injuries commonly occur when the foot is forcibly rotated outwards whilst the knee and lower leg is turning inwards.

Guide to the Prevention & Treatment of a High Ankle Sprain

In the case of a high ankle sprain, the mechanism of injury is excessive ankle dorsi-flexion (where the toes come up towards the knee) as well as external rotation of the shin, which causes damage at the ankle ‘syndesmosis’.

High Ankle Sprain (Syndesmotic Injury)

The "high ankle sprain" is named in distinction to the "low ankle sprain." You may have heard the term while watching American football or other sports broadcasts. The high ankle ligaments (also called the syndesmosis) are located above the ankle, as opposed to the more commonly injured ligaments on the outside of the ankle.

High Ankle Sprain: A Difficult Athletic Injury

Because the syndesmosis is so stable, it takes a large force to cause a significant injury; therefore it is not surprising that many syndesmotic injuries are accompanied by a fracture. The most common mechanism of injury is forceful external rotation of the foot and ankle, most often when the foot is dorsiflexed and slightly pronated...

High Ankle Sprain: A Dreaded Strain of Sprain

High ankle sprain that results in a fracture is known as Maisonneuve Fracture where the fibula breaks at a high level. When this happens, bearing weight can be very painful at the point just above the ankle area. High ankle sprains that do not involve a fracture can make bearing weight difficult, but less painful. The ligaments connecting the tibia and fibula are damaged with this type of injury. There are other structures of the foot that can sustain damage with high ankle sprain like the interosseous membrane. The recovery time can vary substantially depending on the number of structures damaged.

High ankle sprain: An uncommon orthopedic injury

Treatment of high ankle sprains depends on the severity of injury, specifically the presence of separation or diastasis of the tibia and fibula, and the presence of ankle instability.

High Ankle Sprain: Not Your Average Ankle Injury

A ‘high’ ankle sprain, also known as a “syndesmotic sprain” occurs when the syndesmosis (ankle ligaments) that binds the tibia and fibula together is exposed to injury from an extreme outward rotation and/or dorsiflexion of the foot

High Ankle Sprains {Syndesmotic) in Athletes

Compared with lateral ankle sprains, syndesmotic or high ankle sprains occur less often in the general and sport populations and usually experience a longer recovery period further compounding the difficulty of evaluating and treating this type of injury.

How to fix a high ankle sprain – ankle syndesmosis injury

In summary, it is important to get your ankle injury assessed, as a missed high ankle sprain can have long-term consequences. A thorough rehab programme in place from our physios can get you back on the playing field as soon as possible.

Implications of high ankle sprains in college athletes

High ankle sprains in collegiate athletes differ from lateral or medial ankle sprains in multiple clinically relevant ways. These include loss of sports participation time, mechanism of injury, rates of injury during competition versus practices, and the possible long-term risk of osteoarthritis.

Syndesmosis Sprains: Beware the "High Ankle Injury"

There is a high incidence of other injuries occurring when you damage the syndesmosis. This includes painful bone bruises... damage to the cartilage in the ankle joint, microfractures and injury to other ligaments.

The High Ankle Sprain

So, why all the hype? What is it about a high ankle sprain that makes it so different than a regular run-of-the-mill ankle sprain?

The High Ankle Sprain: What's the Difference?

A high ankle sprain is an injury that involves a different set of ligaments than in the common ankle sprain. These ligaments are located above the ankle joint and between the tibia and fibula. They form what is known as the syndesmosis (pronounced "SIN-des-MO-sis").

The Yin and Yang: Identifying and Limiting the High Ankle Sprain

Unlike the common lateral ankle sprains when ligaments around the ankle are injured through an inward twisting, high ankle sprains are caused when the lower leg and foot externally rotates (twists out).

Was A High Ankle Sprain The Last Straw For Andrew Luck?

The mechanics of a high ankle sprain is the primary reason why it can take so long for certain players to return to play.

What’s a High Ankle Sprain?

When the foot is twisted outward, as might happen when players collide, the sudden motion can stretch or tear some of these ligaments, leading to a sprain high on the joint, just below your shins.

Resources

Ortho Bullets

High Ankle Sprain & Syndesmosis Injuries are traumatic injuries that affect the distal tibiofibular ligaments and most commonly occur due to sudden external rotation of the ankle.