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.
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.