High Ankle Sprains: Overview

High Ankle Sprains: Overview

A high ankle sprain is different than the typical ankle sprain that most people are familiar with. The name high ankle sprain describes it best. It is an ankle sprain, but the injury occurs higher than where a quote-unquote "regular" ankle sprain does. It is not as common as the standard lateral ankle sprain but can cause just as much pain and physical limitation.

This injury is more commonly seen in the military population as well as athletes that play collision sports like American football or ice hockey. Here is a review of the bones and ligaments that are involved and how a high ankle sprain is different than the more common lateral ankle sprain.

This is the fibula viewing from the front and the side. It is the skinny bone that runs along the outside of the leg. The end of the fibula at the ankle is called the lateral malleolus. This is the bone that can be felt on the outside of the ankle.

Looking at the same views, this is the tibia, more commonly known as the shin bone. The tip of this bone is called the medial malleolus, the ankle bone that can be felt on the inside. The next bone to know about is the talus. This bone completes the ankle joint and has many ligaments that attach to it to help stabilize the entire ankle.

The location of a high ankle sprain is where the fibula meets the tibia above the talus, called the syndesmosis. There is a thin sheet of tissue that keeps the edges of these 2 bones together and several ligaments that attach the 2 ends of the bones. All of these structures can get injured in a high ankle sprain.

In the more common lateral ankle sprain, the injury occurs down here at this ligament that attaches the end of the fibula directly to the talus. Not only is the location of the injury different, high ankle sprains happen a little differently than lateral ankle sprains.

One way this can happen is if someone's foot is forced up. This would push the ends of the tibia and fibula apart. Another common way is if someone's foot is pointed to the outside and a direct force hits their leg, making the foot rotate even further.

In this top-down view of a right foot, when the foot rotates to the outside, the green fibula rotates with it and can tear the ligaments that keep it stable. In more severe cases, the injury may cause some damage to the ligaments on the inside of the ankle as well, and maybe even a fracture farther up the fibula.

If a patient gets a high ankle sprain, they will likely report having pain, bruising, a feeling of looseness in their ankle, weakness, and having a hard time putting weight on it. These all happen with a lateral ankle sprain as well. However, when the patient describes how the injury happened, that usually gives the healthcare provider an immediate clue as to what kind of ankle sprain it is.

X-rays are taken to see if there is any fracture of the bones in the ankle, such as the one shown here. They also show the position of the bones. One specific x-ray, called a stress view, can show a large gap between the ankle bone on the inside and the talus. This is a big clue that the patient has a high ankle sprain.

During the x-ray, the doctor will hold the foot and point it toward the outside, as seen here, to recreate how the ankle sprain happened. Here is a real-time view of that same test. It is obvious that the gap widens when the doctor moves the foot.

A CT scan can help look at any fractures in more detail, while an MRI is better to look at soft tissue, like ligaments or cartilage. All of this information is important for the doctor to make the right diagnosis so that the right treatment plan can be made for the patient.