High Ankle Sprain
Posted in Physiotherapy on Nov 16, 2021.
Physiotherapy Treatment for High Ankle Sprains
What are High Ankle Sprains?
The ankle consists of three bones, the tibia, fibula and talus, all held together by thick fibrous ligaments. The bottom parts of the tibia and fibula join together and surround the talus in such a way that it is able to rock forwards and back while providing stability and restricting the side-to-side movements.
The ligaments holding the tibia and fibula together are large and thick (referred to as a syndesmosis) while a normal ankle sprain is a tear of the ligaments closer to the foot, a syndesmosis tear is called a “high” ankle sprain. A high ankle sprain is also known as a syndesmotic sprain. It is important to have stability between the tibia and the fibula at this level because walking and running place a tremendous amount of force at this junction.
In the lower leg/ankle, the distal tibia/fibula joint is considered a syndesmosis joint because the tibia and fibula are held together by an interosseous membrane that extends the length of the bones. This membrane secures the two bones and helps stabilize the tibia and fibula to the talus forming the talocrural joint (primary ankle joint) also known as the ankle mortise. This joint is responsible for dorsiflexion and plantarflexion (movements up and down of the foot). The distal tibia and fibula are held tightly together by the syndesmosis membrane, and the anterior and posterior tibiofibular ligaments. A syndesmotic sprain or high ankle sprain is an injury to the distal tibiofibular syndesmosis with possible disruption of the distal tibiofibular ligaments and interosseous membrane.
How do High Ankle Sprains happen?
A high ankle sprain can occur when you twist inwards while your foot is planted on the ground. The foot is typically pushed back and rotated outwards, putting excess pressure on the ligaments that the lower leg bones together. This force can cause the syndesmosis to tear resulting in a gapping of the two bones, which can lead to significant instability of the ankle. This can happen from every-day activities such as a fall, but most commonly while playing sports that involve running and jumping. This is also a common injury for downhill skiers. Patients are often unable to walk on their toes after this injury. A high ankle sprain is a significant injury and can sideline an athlete much longer than a typical ankle sprain.
What is the difference between a high and a low ankle sprain?
High ankle sprains are much rarer than lower ankle sprains, accounting for only 1-11% of all ankle injuries. It can be very difficult to tell the two injuries apart. To complicate things, a fracture of the ankle will also have similar symptoms. Your Shelbourne Physiotherapist will have a set of physical tests they can perform if they suspect a high ankle sprain. Ultimately imaging may be required to confirm the diagnosis.
Why does correct diagnosis matter?
High ankle sprains can take up to two times longer to heal than normal ankle sprains and require more immediate attention. Syndesmosis tears that are left untreated can result in chronic instability and pain, making them vulnerable to further injury in the future. Because syndesmotic sprains can be associated with lateral ligament injuries, medial ligament injuries, and fractures of the fibula, x-rays of the lower leg and ankle are necessary. If the athlete has a total syndesmosis rupture, separation will be evident in the x-ray between the tibia, fibula, and talus.
The difficulty with these types of injuries is that they are often associated with severe lateral or medial ankle sprains or fibular fractures. However, in an isolated high ankle sprain, the athlete or person may experience the following symptoms:
• Point tenderness over anterolateral tibiofibular joint (above lateral malleolus)
• Pain with weight-bearing
• Pain with passive dorsiflexion
• Pain with passive external rotation
• Mild to moderate swelling in lower leg above ankle
What is the treatment for high ankle sprains?
Severe and unstable tears may require surgery and most syndesmosis tears will need to be put into a supportive boot for 4-6 weeks. Following this period a rehabilitation program of strengthening, mobilization, balance, control and agility will need to be commenced before your ankle will be at its pre-injury function. It is important to do early range of motion passively, meaning with the help of a Physiotherapist who moves the ankle to help avoid stiffness.
Other medical interventions may be recommended in some cases and have been shown to have good results, when accompanied by proper rehabilitation program.
How can I help prevent a High Ankle Sprain?
Because a high ankle sprain is a severe ankle injury, preventing a syndesmotic injury can follow the same principles as preventing a regular ankle injury. The following can be done by the athlete to try to reduce the incidence of ankle injuries:
• Maintain strong ankle muscles by strengthening them regularly with ankle band exercises performing 3 sets of 10 repetitions in all four ankle directions. Please see our Shelbourne Physiotherapists.
• Wear proper, well-fitting shoes that are appropriate for the sport.
• Consider wearing a brace to prevent an injury or taping/bracing the ankle for extra support after returning to sport from an ankle injury.
There are many different types of ankle braces available and on the market. For an ankle brace to be effective, the brace should be fitted with a medial and lateral support (strong plastic or similar material) that extends up the sides of the brace. Ankle braces made of only neoprene or other soft material do not provide enough support to prevent additional injuries.
Another consideration for the athlete is to make sure that the brace fits comfortably into the athletic shoe. Some braces that are rigid may not fit comfortably into every athletic shoe. The athlete should try on different braces to ensure that the fit is comfortable and that the brace has additional medial/lateral supports to prevent further injury.
None of the information in this article is a replacement for proper medical advice. Always see a medical professional at Shelbourne Physiotherapy for advice on your injury.
Shelbourne Physiotherapy, Pilates & Massage is a locally owned health company with locations in beautiful Victoria & Saanich, British Columbia. Our clinics offer Physiotherapy, IMS (Intramuscular Stimulation) & Dry Needling, Kinesiology, Athletic Therapy, Exercise Rehabilitation, Massage Therapy, Sports Rehabilitation, Pelvic Floor Pilates Classes and Research, Post-Operative Rehabilitation, Vestibular, Dizziness & Balance Rehabilitation, Women's health (peri-partum and incontinence), Acupuncture, Victoria Dizziness Clinic, Scoliosis Treatment, Clinical Osteofit Classes, Osteoporosis Treatment, Victoria Pelvic Floor Clinic, Real Time Ultrasound, Arthritis and Osteoarthritis Treatment, Electrical Modalities, Pelvic Floor Physio, Pelvic Pain Physiotherapy, Incontinence Treatment, Thoracic Ring Approach Physiotherapy Treatment, Sports Physiotherapy, Chronic Pain Treatment, Shockwave Therapy (ESWT), Yoga, Yogalates, Saanich Physiotherapy, Polestar Pilates, Stott Pilates, Clinical Pilates, Scoliosis Treatment, Kinetic Link Training KLT and Custom Knee Bracing.
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Our experienced and dedicated evidence based Health Care Professionals include Victoria & Saanich Physiotherapists Penny Salmas, Jennifer Kolot, Mark Gottfried, Christine Carrat, Nicole Gill, Mohsen Mirzaie, Robyn Elliot, Holly Mallari, Elyse Nieuwold, Meena Sran, Phil Lawrence, Jessica Shave, Cody McEvay, Kathy Murdoch, Ruan Le Roux, Nina Bai, Kira Crover, Hilary Beck, Shannon Huff, Michael Richards, Alta Bezuidenhout, Leah Taylor and Blair Braz. Our experienced Victoria BC Kinesiologists include Larry Muir, Tegan Johnson, Heidi Nottelman, Our experienced Victoria & Saanich BC Registered Massage Therapists include Taryn Krizan, Selena Curvelo, Jennifer Koebernick, Kathy Pantalon, T'airah Bowker RMT, Molly Scott, Jessica Bundy RMT, Laura Jones and Rebekah Neubert. Our Victoria Athletic Therapists are Tegan Johnson, Emily Callendar, Maya Rahn and Cheryl Mah. Our Certified Victoria Pilates and Yoga Instructors include Chantelle Shah-Poulin, Lisa Hostman, Kelsey Kowalchuk, Penny Salmas, Danielle O'Reilly, Stephanie Cadman & Chris Csak. Renowned Victoria Physiatrist Paul Winston practices at our clinic.
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