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High Ankle Sprains & Treatment

A high ankle sprain is what is generally referred to when there has been an injury to the ankle ‘syndesmosis’. The distal tibiofibular syndesmosis is a group of ligaments just above the ankle joint. A high ankle injury affects these ligaments that are responsible for holding the end of the tibia and fibula together.

The tibia is the larger long bone in the lower leg, on the inside of the leg, while the fibula is a smaller long bone on the outside of the lower leg. An injury in this area can be quite painful and disabling, often taking longer to repair than a common lateral ankle sprain.

The Ankle Joint

The ankle is a complex joint as it allows movement in multiple directions, giving us the ability to walk and run as well as change direction. The ankle joint is the articulation between the heel bone, the midfoot and the tibia and fibula.

The syndesmosis has the anterior inferior tibiofibular ligament (AITFL) supporting it at the front, and the posterior inferior tibiofibular ligament (PITFL) at the back. The middle is supported by the interosseous membrane (IO).

Injuries to this area range from grade 1 which is mild, to grade 3 which is severe. A partial injury to the AITFL only is considered a grade 1. If there is severe or complete rupture to the AITFL as well as some injury to the IO, it is considered a grade 2. And a grade 3 is a complete rupture to the AITFL, IO and some injury to the PITFL too.

Due to the complex structure of the ankle, an injury is significant as these ligaments are critical for stability of the ankle joint.

What is the Risk of a High Ankle Sprain?

A high ankle injury commonly occurs when the foot is forcibly rotated outwards whilst the knee and lower leg is moving inwards. This awkward rotation causes the tibia and fibula to spread apart. There can be varying degrees of damage to ligaments or even a fracture to the fibula.

An example of how this may occur is while playing sport and a foot gets caught in a tackle, causing the leg to be pulled in different directions.

Symptoms of High Ankle Sprains

If you were injured in a tackle or had a heavy landing and felt your foot being forced outwards with pain on the inside or across the front of your ankle joint, you may have a high ankle injury. There is likely to be pain around the lower part of your leg also. You should be assessed by a sports physiotherapist as soon as possible to find out if you have a syndesmosis injury.

Early detection and treatment of this type of injury will result in a much better and quicker recovery. If you’ve had pain in your ankle for a few weeks and it doesn’t seem to be improving, and if you have trouble running in an arc or accelerating or jumping well, your syndesmosis may be damaged.

Treatment of a Syndesmosis Injury

Treatment will depend on the severity of your injury, so your physio will firstly determine the extent of your damage, often with the assistance of scans or a consultation with a sports physician. An MRI will clearly show the severity of the damage and a follow up CT scan will be able to determine management of your recovery.

A grade 1 injury may see you in a moonboot for a few weeks to allow the ligaments to repair and then some physiotherapy for the ankle will help to regain strength, endurance and function in the calf and foot. It is likely that recovery from a mild injury will take around 3 months, but this will vary depending on the injury and your body’s capacity to regain its full strength and function.

A grade 2 or 3 injury may mean a referral to a surgeon as surgery may be necessary to regain full capability. Not only will this be determined by the degree of the injury, but whether you are aiming to return to high level agility sports.

Currently the most popular surgery is a “tightrope” procedure which stabilises the distal tibia and fibula and at the same time allows the degree of movement required to mimic healthy ankle function. Another common procedure is putting a screw across the joint. However, this may not be the best option if you’re wanting to return to high level athletic sports.

Physiotherapy for High Ankle Injuries

A sports physio will guide you with every step of your recovery, through movement, strengthening and achieving full ankle function again. This is the safest way to have you moving well again following a high ankle sprain and will be able to provide advice to help prevent further ankle injuries down the track.

The knowledgeable team at Melbourne Sports Physiotherapy have a great deal of experience with ankle injuries and will be able to assist with diagnosing your injury as well as tailoring a treatment management plan for you. Other than ankle sprain physiotherapy they offer a wide array of services including deep tissue massage, physio for hip impingement, soft tissue therapy, and much more. Give them a call to book an appointment or book online.

Image URL: Woman Wrapping Man’s Leg with Bandage · Free Stock Photo (

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