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

Everyone’s An Expert On Ankle Sprains

Ankle sprains are a common injury occurring across many sporting codes. Spraining your ankle is especially common in soccer as well as other footballing codes as well as any jumping and landing sports such as basketball, netball and volleyball… Sports that involving running, jumping and changing direction often have a high incidence of all types of ankle sprain injuries including the high ankle sprain. The frequency of ankle injuries are often increased when playing surfaces are uneven, or slippery.

Ankle sprains being such a common injury in sport often means that most athletes playing any of the aforementioned sporting codes will either have suffered an ankle sprain themselves at some stage during their career, or at the very least are likely to know someone who has. This frequently means anytime someone suffers a sprained ankle there are any number of so called “experts” on hand willing to offer their two cents worth advice. Often much of this advice is good, however often there is some that is not so good… The important thing to remember here is that no two ankle sprains are the same. The ankle is considerably more complex than any layperson may realise, so taking advice from someone simply because they have had a few sprains themselves in the past and seen physios for treatment may well end up with you getting the wrong information. With regard to receiving the best management with your particular injury it is always a good idea to have your ankle assessed by a medical professional such as a physiotherapist.

The “High Ankle Sprain” How Is It Different?

A simple way to separate ankle sprains is to group them into low and high ankle sprains. These two groups of sprains are typically injured via different mechanisms. They result in different tissue being damaged and obviously as a result the injuries will require different management when undergoing rehabilitation.
The high ankle sprain (also known as a syndesmosis sprain) can potentially be quite a devastating injury, and when compared to the classic lateral ankle sprain it frequently requires prolonged recovery time-frames and the possibility of necessitating surgical management.
Syndesmosis sprains classically have a history of an external rotation injury to the foot. This is a way of injuring the ankle where the planted foot relatively rotates outwards on the leg above. However, as with many injuries patients frequently find the exact mechanism at point of injury as being difficult to describe given that things happen so quickly it is pretty common as a physiotherapist to have patients who can’t recall exactly what happened during the actual event that injured their ankle. A somewhat vague history of injury will ultimately place greater emphasis on the importance of a thorough examination of the ankle. Someone having suffered a syndesmosis sprain taking standard advice from fellow “ankle sprain sufferers” will quite possibly be given inappropriate guidance and therefore may well miss out on administering the appropriate early management.

Ankle Syndesmosis Sprain Signs:

There are a few tests that are considered to indicate suspicion of a high ankle sprain including:

• A positive external rotation test
• Positive Tib-fib squeeze test
• And tender on palpation of the length of syndesmosis

The above few tests can assist in the diagnosis and prognosis of high ankle sprains. With regard to formal imaging a weight bearing X-ray and an MRI can be performed to help grade the injury and guide on what would be the most appropriate course of action. Your average “expert” will be unaware of what to look for when assessing an ankle sprain “low, or high” and any potential differentiation tests required to ensure correct diagnosis will not be preformed. This reinforces the need to have your ankle examined professionally by a physiotherapist, or otherwise appropriately skilled medical practitioner. So, no matter how minor the sprain may seem or what “old mate” reckons you have done and how you will best fix it, do the smart thing and go see someone whose job it is diagnosing and helping rehab injuries.

There is no Such Thing As “Just” A Twisted Ankle

Seldom is an ankle sprain “just” an ankle sprain and differentiating between a low and a high ankle sprain is only part of the problem. Gathering enough information from the patient regarding the relevant history and mechanism of injury, then using this history combined with further information gained from any physical examination helps decide what tissue (be it, ligament, bone, tendon…) was injured and to what severity. Knowing what injury and the graded severity you are dealing with enables the appropriate treatment paths to be taken. This is the challenge for any practitioner assessing an ankle injury and at times this can be a challenge for trained and experienced sports physiotherapists, so what chance does your fellow teammate despite their good intentions stand in getting the diagnosis and advice right.

Disclaimer: This information is provided as an educational service and is not intended to serve as a substitute for personalized medical advice. Sydney Physio Clinic does not endorse any treatments, procedures, products mentioned in this post. Anyone seeking specific advice, or assistance regarding a “high ankle sprain” should consult his, or her physiotherapist, orthopaedic surgeon, general practitioner, sports medicine specialist, or otherwise appropriately skilled medical practitioner.