A high ankle sprain is a significant injury involving the syndesmosis ligaments, which connect the tibia (shin bone) and fibula (the smaller bone of the lower leg) just above the ankle. Unlike a standard ankle sprain, which affects the ligaments on the outside of the ankle, high ankle sprains compromise the joint’s stability at a deeper level.
These ligaments hold the ankle mortise together, forming the stable “socket” that cradles the talus bone of the foot. When injured, the two bones can separate abnormally under stress, leading to instability, pain, and if untreated, long-term complications such as arthritis.
A high ankle sprain occurs when the syndesmosis complex is stretched or torn. This complex includes:
- Anterior inferior tibiofibular ligament (AITFL) – the most commonly injured structure.
- Posterior inferior tibiofibular ligament (PITFL).
- Interosseous ligament and membrane – fibres running up between the tibia and fibula.
When these stabilising ligaments are disrupted, the fibula can shift away from the tibia, widening the ankle joint and impairing its function.
Types of High Ankle Sprains
High ankle sprains typically fall into categories depending on severity and associated injury:
- Grade I (mild sprain): Partial stretch of the syndesmosis ligaments without widening of the ankle joint.
- Grade II (moderate sprain): Partial tearing with some instability, often requiring longer immobilisation.
- Grade III (severe sprain): Complete rupture with significant ankle instability, often associated with fractures and requiring surgery.
Associated injuries may include:
- Fibular fractures (Maisonneuve fracture – spiral fracture higher up the fibula).
- Medial malleolus fracture or deltoid ligament rupture on the inside of the ankle.
- Cartilage damage inside the ankle joint.
The Mechanism of Injury for High Ankle Sprains
High ankle sprains usually occur from a twisting force combined with weight-bearing, such as:
- External rotation of the foot while the leg is planted (common in football, rugby, and soccer).
- Sudden pivoting or cutting movements during sport.
- Landing awkwardly from a jump.
- Direct contact or tackles forcing the foot outward.
Unlike standard ankle sprains, the foot often remains flat on the ground while the leg rotates inward, stressing the syndesmosis.
Symptoms and Diagnosis of High Ankle Sprains
Symptoms
The symptoms of high ankle sprains differ from those of typical ankle sprains:
- Pain is felt above the ankle joint, spreading up the leg.
- Swelling and bruising are often less evident than in lateral ankle sprains.
- Pain worsens with pushing off the toes, running, or twisting movements.
- Difficulty walking, especially on uneven ground.
- Sensation of weakness or instability in the ankle.
Diagnosis
Diagnosis requires careful assessment, as these injuries are often missed. Key approaches include:
- Clinical tests:
- Squeeze test – compressing the tibia and fibula higher up the leg causes pain at the syndesmosis.
- External rotation stress test – turning the foot outwards while the leg is stabilised reproduces pain.
- Imaging:
- X-rays – to rule out fractures and check for widening of the ankle mortise.
- Stress X-rays – taken while the ankle is stressed to detect instability.
- MRI – highly accurate for detecting syndesmosis ligament injury and grading severity.
- CT scans – used in complex or surgical cases to assess joint alignment.
The orthopaedic team at Access Orho is an expert in assessing and treating musculoskeletal injuries. The team will carry out a physical examination and arrange the required radiology to ensure an accurate diagnosis and that an injury is not missed.
Treatment Approaches For High Ankle Sprains
Treatment depends on how severe the injury is:
- Mild sprains (Grade I):
- Rest, Ice, Compression, Elevation (RICE).
- Short-term use of a brace or walking boot.
- Gradual rehabilitation with physiotherapy focusing on range of motion, strength, and proprioception.
- Moderate sprains (Grade II):
- Immobilisation in a boot for 4–6 weeks.
- Protected weight-bearing with crutches.
- Progressive physiotherapy to restore function.
- Severe sprains (Grade III):
- Often require surgical fixation using screws or a tightrope device to stabilise the tibia and fibula while healing.
- Post-operative rehabilitation to restore ankle stability and prevent long-term stiffness.
Prognosis For High Ankle Sprains
High ankle sprains take significantly longer to heal than standard ankle sprains:
- Mild injuries: 4–6 weeks for recovery.
- Moderate injuries: 6–12 weeks before return to sport.
- Severe injuries with surgery: 3–6 months before full return to activity.
Untreated or poorly managed high ankle sprains can result in:
- Chronic ankle instability.
- Persistent pain.
- Early onset arthritis in the ankle joint.
With proper diagnosis, treatment, and rehabilitation, most patients recover well and return to full activity. This is why it is essential to seek expert care. Access Ortho offers rapid appointments for acute injuries.
Role of Access Ortho in Diagnosing and Treating High Ankle Sprains
At Access Ortho, we know that high ankle sprains are often more complex than standard sprains and can be easily missed or under-treated in busy emergency settings. Our clinic is designed to give patients direct, specialist orthopaedic care without the delays, long waits, or generalist approach of a hospital emergency department.
Here’s how we provide focused, efficient, and expert care:
- Immediate Appointments
Unlike hospital emergency departments, where wait times can be several hours, Access Ortho offers same-day or next-day appointments for acute ankle injuries. You get fast answers and a clear treatment plan without the frustration of sitting in a waiting room.
- Specialist Orthopaedic Assessment
In emergency departments, sprains are often briefly assessed, and generic advice is given. At Access Ortho, you are reviewed by an orthopaedic-trained clinician who performs detailed ankle stability tests, such as the squeeze test and external rotation test, to detect syndesmosis injuries that are commonly overlooked.
- Rapid Access to Imaging
Emergency departments may provide an X-ray, but rarely arrange advanced imaging unless the case is severe. At Access Ortho, we work directly with local radiology providers to quickly arrange X-rays, MRIs, or CT scans, with results reviewed promptly by our team. This ensures your injury is correctly identified and not dismissed as a “simple sprain.”
- On-the-Spot Management
We provide immediate stabilisation, including boots, braces, and crutches, fitted at your first appointment. In contrast, hospital emergency departments often supply only basic bandaging or generic crutches, leaving patients without the tailored support they need.
- Tailored Treatment Plans
Rather than being discharged with limited advice, patients at Access Ortho receive personalised treatment plans. We match care to the severity of your injury, whether that involves bracing and physiotherapy or surgical referral for syndesmosis stabilisation.
- Close Monitoring and Follow-Up
Emergency departments typically treat ankle injuries as a one-off episode, with little or no follow-up. At Access Ortho, we provide ongoing monitoring and structured review appointments with orthopaedic surgeons, ensuring your ankle heals correctly and reducing the risk of long-term problems.
Why Choose Access Ortho Over Hospital Emergency?
- Fast care – no long waits. Call to make an appointment that suits you.
- Direct orthopaedic expertise – not general emergency care.
- Advanced imaging access – with results acted on quickly.
- On-site stabilisation and bracing – fitted immediately.
- Personalised follow-up – ongoing care until complete recovery.
At Access Ortho, our focus is on early diagnosis, targeted treatment, and long-term joint protection. By treating high ankle sprains properly, we help patients avoid chronic instability and arthritis, ensuring the best possible recovery.