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

Ankle sprains are the most common site of sport related trauma among all body sites and types, and account for more than 80% of injuries.

 

To understand the difference between a common ankle sprain and a high ankle sprain, it’s important to have a brief understanding about the anatomy.

Three bones in the lower leg; the tibia, the fibula and the talus form the ankle joint. The ligaments surrounding the joint help to stabilise the ankle.

 

Lateral Ankle Sprains

 

Lateral ankle sprains are the most common ankle injuries that occur as a result of falling on an inverted ankle or “rolling over on your ankle”. This usually involves an injury to the Anterior Talofibular Ligament (ATFL), which runs between the end of the fibula to the talus on the outside of the ankle. Symptoms include pain, swelling and bruising, particularly just below the ankle, on the outside of the foot.

 

Medial Ankle Sprains

 

Medial ankle sprains are the result of falling forced eversion or rolling in of the ankle. This will typically involve the deltoid ligament, which runs between the end of the tibia to different bones in the foot including the navicular, calcaneus and talus.  As the deltoid ligament is much stronger than the ATFL, and the medial ankle has more bony structure to help stabilise, these injuries are less common and require more force to injure. Isolated deltoid ligament injuries are rare and usually occur in combination with other fractures. 

 

High Ankle Sprains

 

High ankle sprains are less common but more debilitating. They commonly occur from forced dorsiflexion and external rotation or a sudden twisting force when your foot is planted on the ground. 

A high ankle sprain will usually involve the Anterior Inferior Tibio-fibular Ligament (AITFL) and other ligaments that form the syndesmosis. This complex structure connects your tibia and fibula above the ankle joint and prevent them from widening. The Syndesmosis is a shock absorber and is therefore exposed to high levels of force when walking, and even greater during running. For this reason, those who have a high ankle sprain will often be quite painful on every step. Pain and swelling will typically be the front of the ankle and radiate up the leg, however the swelling is often less than observed in a lateral ankle sprain.

Depending on the severity of injury your physiotherapist may recommend an Xray or MRI to confirm diagnosis and assess the severity. The radiologist will measure if there is a significant gap between the tibia and fibula near the ankle. If the ligament and syndesmosis is severely damaged, the gapping is significant and the joint is unstable, surgery may be recommended. This usually requires a “syndesmotic screw” fixation or “tightrope” between the tibia and fibula to hold the bones in position while the syndesmosis heals. Severe high ankle sprains are often associated with fractures, which may require additional orthopaedic attention.

 

Treatment

 

Progression in your rehabilitation is very individual and dependent on clinical assessment and function.

All ankle sprains are treated similarly in the acute phase with protection from activities that cause aggravation of pain, elevation and compression. It is also important to avoid anti-inflammatories in this early phase as they can effect the healing process.  Based on your injury, referral for diagnostic imaging as required may be required to exclude possible fractures.

Due to anatomy of structures injured in a medial and high ankle sprain, the recovery time is often much longer than a lateral ankle sprain. Often patients with a high ankle sprain will require a walking boot to prevent the two bones from continually separating as you walk and allow the ligaments to heal, where as a lateral ankle sprain may benefit from early mobilisation. Other physiotherapy techniques such as massage and strapping can help relieve pain and accelerate rehabilitation early on.

After the acute phase you can start regaining full range of motion in the ankle, restoring muscle strength and proprioception through a guided exercises program.  Our physiotherapists will carefully monitor your improvement and determine when it is appropriate to progress your exercises. Doing so too early can delayed healing and lead to re-injury.

If you play sport you will be progressed to a sport specific training program to enable a safe return to play and minimise the chance of future injury.

 

Early diagnosis and treatment is key to successful rehabilitation, reduced time loss from sports and reduced risk of re-injury. 

 

If you have any questions regarding your ankle injury or would like to consult with one of your Physiotherapists at Jubilee Sports Physiotherapy please feel free to make on appointment or contact us.

Share this post

Hi, would you like to chat with one of our physios?

Please provide your contact details and one of our experienced physiotherapists will give you a free, no obligation call to assist you with your query. 

Ashley Williams
Ashley Williams
10:55 03 Apr 24
best in the business the team here are the very best at their jobs
G G
G G
16:52 05 Mar 24
I came to Jubilee Sports Physio for help on how to exersise and get fit without injuring myself constantly.During my initial consultation Michael said, I was standing wrong, sitting wrong and exersises I did were not suitable for my body.After four sessions, 15 minutes of daily exercises in between and I can go on hikes, lift weights and feel many years younger.I now have the life I want and very grateful to Jubilee Sports Physio, for their professionalism from booking, greeting and being able to do all I want physically.I highly recommend Jubilee Sports
Lara Mangelli
Lara Mangelli
08:56 18 Dec 23
I would like to express my sincere appreciation for the exceptional care provided by Michael and James for attending to my son, both before and after his shoulder reconstruction. Michael and James' combination of kindness and professionalism played an important role in helping my son navigate through what was his first significant life challenge.They both demonstrated an unwavering commitment to my son's well-being, providing not only expert physiotherapy but also a level of compassionate support that went above and beyond.Thank you Jubilee team for your outstanding commitment to patient care. It's reassuring to know that professionals like Michael and James are dedicated to not just addressing physical challenges but also fostering a supportive and empathetic environment for individuals facing health setbacks. The receptions ladies were kind and helpful too.
Judith Gifford
Judith Gifford
06:00 18 Dec 23
Over a period of 4 years my husband and I have had the expertise and professionalism of Michael Gabriel and staff at Jubilee Sports Physiotherapy Each of our ageing conditions required commitment to exercises to improve. When the conditions were clearly explained we gained confidence and understanding of realistic outcomes. We feel very fortunate for all of our treatments..and highly recommend Michael and staff.
Georgia Manos
Georgia Manos
12:08 13 Dec 23
The whole Jubilee team is fantastic. They are professional, knowledgeable and have always gotten me back playing football as quick as possible!
Jordan Figon
Jordan Figon
06:36 13 Dec 23
The team at Jubilee have been looking after me for over 15 years. Specially Michael with the help of Kieran. They have rehabbed me through 4 major surgeries as well as long standing injuries. It is because of these guys, I am able to still be involved in the game I love, stretching my career out as long as possible. In addition, my whole family is part of the Jubilee family
David Washington
David Washington
05:02 13 Dec 23
I have relied on Michael Gabriel for my physiotherapy needs for a number of years now. His professional work has allowed me to continue to chase the love I have for outdoors recreation.
Luke Payne
Luke Payne
22:05 12 Dec 23
Michael and his team are the best. So professional and knowledgeable and have kept me moving for years.
Diane sutton
Diane sutton
21:58 12 Dec 23
I have been a patient of Jubilee Sports Physio for many years, being treated for various injuries & chronic conditions. Michael’s diagnostic skills are excellent. I can highly recommend this practice for their care, proficiency & friendliness.
Nicole Simpson
Nicole Simpson
10:53 12 Dec 23
Micheal has helped over the years to heal and help with my injuries.. The entire team gives a five star help. I can’t praise them enough…Thank you so much
Judy Andrews
Judy Andrews
10:26 12 Dec 23
Michael has treated me on a number of occasions. He is very professional and very easy to talk to. He obviously knows his stuff and never fails to set you on the right path with his treatments
BERGE GABO
BERGE GABO
09:28 12 Dec 23
"I have been going to Jubilee Physiotherapy for many years.Very professional from the receptionists to the principal Physioswith lots of experience and straight to the point thatsave time and money"
Corinne Favaloro
Corinne Favaloro
04:09 02 Nov 23
I have been attending Jubilee physio, on and off, for many years.In fact three generations of my family are presently receiving treatment there. I have had several of the physiotherapist at Jubilee work on different problems and have found them all to be professional, knowledgeable and very caring in their treatment.
Nicole Di noia
Nicole Di noia
22:19 01 Nov 23
Thorough, professional and passionate team of physiotherapists.
Steve Chidgey
Steve Chidgey
02:04 04 Jul 23
The the treatment I received for injury was first class. Caring, knowledgeable and highly professional. The electronic home exercising provided to me showed me the required exercises so I was not let to a piece of papers directing me. Loved the app. This physio is the best I have used. Highly recommended.
Margaret Peace
Margaret Peace
01:29 01 Jul 23
I have attended Jubilee Physiotherapy for many years and have always had a positive experience. The staff are professional and knowledgeable. I always feel comfortable and safe in their care.My therapist, Samuel Leslie, knew exactly how to treat my new neck issue. As a result, I have made a very good recovery.
Angelina Mastoris
Angelina Mastoris
23:09 01 Mar 23
The guys at Jubilee are amazing! Been going for a couple years and each time I’ve had a great experience. Massive shout out and thanks to our team Physio Sam for helping me with my rehab and recovery. He’s helped improve my overall game and has made me stronger than before. He’s a legend. Would highly recommend, overall fantastic experience!
See All Reviews
js_loader

Hi, would you like to chat with one of our physios?

Please provide your contact details and one of our experienced physiotherapists will give you a free, no obligation call to assist you with your query.