High (Syndesmotic) Ankle Sprain

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A high ankle sprain is an injury to the ligaments between the two major bones of the lower leg (tibia and fibula) at the level above the ankle.
The high (syndesmotic) ankle sprain is caused by an outward twisting of the foot and ankle, which is opposite of a typical ankle sprain where the foot and ankle are twisted inward.

High ankle sprains are slow to heal because there is a very poor blood supply to this area of the ankle and injuries can take six weeks or longer to heal and may require surgery.
Symptoms Include:
  • Ankle pain when foot is rotated outward.
  • Ankle pain when calf is squeezed.
  • Difficult ambulation.
  • Bruising at injury site.
Non-surgical treatment

High ankle sprains can be treated with PRICE.
  • P: Protection from further injury with an ankle brace.
  • R: Rest means keeping off the injured ankle as much as possible. Crutches enable the patient to move about when necessary without placing weight on the injury. An air cast or splint may be applied to the ankle for support and severe sprains occasionally require a hard cast.
  • I: Icing, cold therapy to stimulate blood flow and relieve the ankle pain associated with inflammation. Cold therapy should be applied several times over the course of the day.
  • C: Compression means supporting the ankle and foot with a firmly (not tightly) wrapped elastic bandage, compression stocking, or gel wrap. If swelling causes the bandage to become tight, it should be loosened immediately.
  • E: Elevating the foot above heart level minimizes bruising and swelling. This should be done as often as possible during the first 48 hours.

Nonsteroidal anti-inflammatory medications (NSAIDs such as Ibuprofen, Motrin, Naprosyn and Celebrex may be used to decrease ankle pain. Be sure to talk to your doctor before starting these medications.

High ankle sprains will require much longer healing and will also need extensive physical therapy to strengthen the muscles around the ankle.
Surgical treatment
  • Severe high ankle sprains with substantial displacement of the bones may require surgical stabilization. Surgery consists of screw fixation of the tibia and fibula.

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High Ankle Sprain