A sprain results from the stretching and/or tearing of the stabilizing ligaments of the ankle as a result of a force causing the ankle to move beyond its normal range of motion. The most commonly seen ankle sprain is an inversion ankle sprain, which occurs when the ankle is rolled in. The ligaments that are affected are the ATFL, CFL and PTFL. The ligaments are on the outside portion of the ankle and attach the fibula (outer leg bone) to the foot.
On the other hand, a high ankle sprain involves ligaments which attach between the two lower leg bones, the tibia and the fibula. These ligaments include the tib-fib ligaments as well as the interosseus membrane. These ligaments are involved in stabilizing these two bones together throughout movements and stresses of the lower limb.
How does a high ankle sprain happen??
This injury is common in sports such as hockey, football, wrestling and soccer where the chances of being tangled underneath someone else are increased. A high ankle sprain usually occurs when the ankle is forcefully twisted outward causing stress on the ligaments and membrane that hold the tibia and fibula together. A high ankle sprain can also occur with hyper-dorsiflexion where the most superior foot bone is jammed up in between the tibia and fibula causing stress on the ligaments. Either way, it is the a force causing separation between the tibia and fibula which causes this injury.
Symptoms
There generally tends to be less swelling with a high ankle sprain, however there tends to be pain that is more severe and longer lasting. The pain and tenderness is usually located just above the ankle joint and tends to be worse with ‘The Squeeze Test’ and outward rotation of the ankle. If instability is an issue, an x-ray may be helpful, but otherwise they will be unremarkable. An MRI will show damaged tissues, however is not necessary in most cases.
The Squeeze Test--> squeezing the tibia and fibula together.
Treatment
If there is suspected instability, the ankle will be immobilized for up to 6 weeks with either a cast or boot, or surgically with pins depending on how unstable it is. A stable high ankle sprain is treated much the same as an inversion sprain with soft tissue therapy, laser and acupuncture etc. The only difference is the heavy emphasis on rehabilitation of the ankle joint, increased patience and caution when returning to sport. Where the average inversion ankle sprain may take up to 4 weeks to heal, it may take anywhere from 6 weeks-6 months to fully rehab a high ankle sprain.
This injury is common in sports such as hockey, football, wrestling and soccer where the chances of being tangled underneath someone else are increased. A high ankle sprain usually occurs when the ankle is forcefully twisted outward causing stress on the ligaments and membrane that hold the tibia and fibula together. A high ankle sprain can also occur with hyper-dorsiflexion where the most superior foot bone is jammed up in between the tibia and fibula causing stress on the ligaments. Either way, it is the a force causing separation between the tibia and fibula which causes this injury.
Symptoms
There generally tends to be less swelling with a high ankle sprain, however there tends to be pain that is more severe and longer lasting. The pain and tenderness is usually located just above the ankle joint and tends to be worse with ‘The Squeeze Test’ and outward rotation of the ankle. If instability is an issue, an x-ray may be helpful, but otherwise they will be unremarkable. An MRI will show damaged tissues, however is not necessary in most cases.
The Squeeze Test--> squeezing the tibia and fibula together.
Treatment
If there is suspected instability, the ankle will be immobilized for up to 6 weeks with either a cast or boot, or surgically with pins depending on how unstable it is. A stable high ankle sprain is treated much the same as an inversion sprain with soft tissue therapy, laser and acupuncture etc. The only difference is the heavy emphasis on rehabilitation of the ankle joint, increased patience and caution when returning to sport. Where the average inversion ankle sprain may take up to 4 weeks to heal, it may take anywhere from 6 weeks-6 months to fully rehab a high ankle sprain.
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