Physical Therapy for High Ankle Sprains

We posted a blog recently about inversion ankle sprains, the more common and usually much less painful ankle sprain.  However, there is another type of ankle sprain, the “high ankle sprain” or otherwise known in sports medicine circles as the “syndesmotic  ankle sprain.”  High ankle sprains account for only about 1-18% of ankle sprains, according to a 2006 Journal of Orthopedic and Sports Physical Therapy study.  They are most common in soccer players, skiers, and American football players.  The objective of this post is to talk about the how’s and why’s of high ankle sprains.  If you or your child suffers a high ankle sprain, the sports physical therapy experts at SSOR are your answer to get you back on your feet.

What is a high ankle sprain?

A high ankle sprain is a disruption of the membrane between the tibia and fibula, the bones of the lower leg.  That joint between the two bones with the membrane is called a “syndesmosis.” A good analogy is to think of a wishbone with a sheet of Saran wrap between the two parts of the bone.  A high ankle sprain is a “tear in the Saran wrap.”

What causes a high ankle sprain?

Contrary to an inversion ankle sprain that is usually caused by “rolling” the ankle, a high ankle sprain has a few causes.  One is “hyperdorsiflexion,” or forced movement of the foot towards the shin.  Another mechanism is someone landing on the back of your foot while your foot is pointed downward (“plantarflexed”).  There is also typically a rotational component to high ankle sprains.  Therefore, the foot may be externally rotated or the talus, the bone the tibia sits on, gets rotated in the ankle joint.  Basically, all of these causes of injury drive the ankle joint into the “syndesmosis,” which causes the tearing and the pain.

What are the symptoms of a high ankle sprain?

Symptoms of a high ankle sprain are similar to an inversion ankle sprain, but there are some differences.  First of all, it hurts more to externally rotate the foot (turn it out) than an inversion ankle sprain.  Additionally, the person is usually a little more tender above the ankle, between the tibia and the fibula.  Last, end range dorsiflexion is a little more painful.  Truthfully, it is best to have your ankle examined by an athletic trainer, sports physical therapist, or an orthopedist for an accurate diagnosis.

How long to recover from a high ankle sprain?

No question, high ankle sprains take longer to heal than the more common inversion ankle sprain.  The main reason is that daily activities, like squatting and taking stairs, continue to cause separation of the membrane.  Running, jumping, and doing sports activities also cause that to happen.   Therefore, full recovery can take anywhere from 4-12 weeks.

Rehab for High Ankle Sprain/Exercises for High Ankle Sprain

Believe it or not, there are some subtle differences in the rehab for a high ankle sprain.  Exercises for a high ankle sprain are relatively similar.  First of all, there is really no agreement in the literature about  what to do immediately following a high ankle sprain – should the person be non-weight bearing, in a walking boot, walk as tolerated with a brace, or some have proposed surgically fixating a screw between the two bones to help the membrane heal.  The main issue is that membrane has to heal back together.  If you do too much walking or squat-like movements, the membrane gets repeatedly insulted and it can’t heal.  That is actually why the screw is not a bad idea and there is some research supporting it.  At SSOR, we definitely advocate limited weight-bearing and activity modification.  We also suggest a heel lift for the shoe.  The heel lift serves to negate the need for as much ankle dorsiflexion required for things like descending stairs and squatting.  Like any other ankle sprain, mobility, range of motion, strength and balance need to be restored.
Here’s a summary of what should be done in rehab:

1. Partial weight bearing with crutches.  Use of walking boot determined by physician.
2. Heel lift in the shoe.
3. Range of motion exercises as tolerated.
4. Minimize squatting, lunging, and descending stairs.  Use the uninvolved leg to descend stairs.
5. Strengthening of the gluteal muscles (yes, that’s a fact – gluteal deficits are evident almost immediately after an ankle sprain).
6. Use a pool for gait training and strengthening.
7. Balance exercises once fully weight-bearing.
8. Gradual return of strengthening and functional activities.

The sports medicine experts at SSOR are your first choice for rehabilitation of high ankle sprains in Kansas City, Overland Park, and Johnson County.  It would be a privilege to serve you.  Give us a call, (913) 904-1128.