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 lateral 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.

High Ankle Sprains

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.

A high ankle sprain will usually involve the Anterior Inferior Talofibular Ligament (AITFL) and Syndesmosis, which connect 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 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.

Both ankle sprains are treated similarly in the acute phase with rest, ice, compression and elevation (RICE). However due to anatomy of structures injured in a high ankle sprain, the recovery time is often twice as long as 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. Other physiotherapy techniques such as massage, strapping and dry needling 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.

If you have any questions regarding your ankle injury or would like to consult with one of your Physiotherapists at Jubilee Sports Physiotherapy you are welcome to contact us.

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