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The High Ankle Sprain: Not All Ankle Sprains Are The Same

The High Ankle Sprain: Not All Ankle Sprains Are The Same
High Ankle Sprain Not All Ankle Sprains Are The Same

Ankle Sprains: Everybody’s An Expert

Ankle sprains are an injury occurring commonly across many sporting codes, especially common in soccer and other football codes as well as sports like basketball and netball. Typically sports involving running, jumping and changing direction often have a high incidence of ankle sprain type injuries including high ankle sprain and the frequency of these injuries occurring is often increased when the playing surface is either uneven or slippery.
Being common often means that most athletes playing any of the above sports will either have suffered an ankle sprain themselves at some stage during their career or at least know someone who has. This often means any time someone sprains their ankle you can have any number of “experts” willing to offer all sorts of advice, some good, some not so good. The important thing to remember is that no two ankle sprains are the same, the ankle is considerably more complex than the layperson may think and taking advice from someone simply because they have had a few sprains in the past most likely will not end in you getting the right information regarding the best management of your particular injury.

What Is A High Ankle Sprain

A very simple way to separate ankle sprains is into high and low ankle sprains. These high and low ankle sprains are typically injured under different mechanisms, involve different tissue damage and obviously resulting in the injuries requiring different management.
The high ankle sprain (syndesmosis sprain) can be a potentially devastating injury with prolonged recovery and may possibly require surgery. Syndesmosis sprains classically have a history of an external rotation injury to the foot where by the foot rotates outwards on the leg. However as with many injuries the exact mechanism is difficult to describe exactly what happened during the the event. This means examination of the ankle is crucial and this is where training is vital. Someone with a syndesmosis sprain taking advice from fellow “ankle sprainers” will most likely be given undesirable guidance and thus miss out on the appropriate early management.
The external rotation test, Tib-fib squeeze test and palpation of the length of syndesmosis tenderness are a few tests that can aid in the diagnosis and prognosis of a high ankle sprain. Frequently a weight bearing X ray and MRI will also be done to help grade the injury and guide on the most appropriate management. Your average “expert” will be unaware of what to look for and any potential differentiation tests required to ensure correct diagnosis, reinforcing the need to have your ankle examined professionally no matter how small an issue you feel it may be or however many times you may have “rolled” it in the past.

It’s Not JUST An Ankle Sprain

Seldom is an ankle sprain “just an ankle sprain,” differentiating between high and low ankle sprains is only part of the problem. Gathering enough information from the patient regarding their history and mechanism of injury and using this with further information gained from your physical examination to decide what ligament, bone, tendon has been injured and to what severity so you can start on the appropriate treatment path is the challenge for any practitioner assessing an ankle injury. A challenge for even trained and experienced sports physiotherapists so what chance does your fellow “expert” teammate stand in getting the diagnosis right.

Disclaimer: Sydney Physio Clinic does not endorse any treatments, procedures, products mentioned. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific advice or assistance regarding high ankle sprain management should consult his or her orthopaedic surgeon, general practitioner, sports medicine specialist or physiotherapist.

Hayden Latimer is the founder of and principle physiotherapist at Sydney Physio Clinic. Since graduating from Otago University, Dunedin, New Zealand he’s gained wide experience practicing across the globe for over 15 years and is now extremely knowledgeable in helping people reduce discomfort and restore function and mobility.