What a high ankle sprain is
Ligaments are strong, fibrous tissues that connect bones and keep joints stable. AAOS explains that a high ankle sprain is an injury to the ligaments and structures connecting the bones of the lower leg, the tibia and the fibula. This area is called the ankle syndesmosis; MedlinePlus lists “ankle syndesmosis sprain” and “syndesmosis injury” as names for this type of injury.
Like other sprains, the injury can range from stretched fibres to a complete tear. The degree of damage, and whether the two bones stay stable, guide treatment.
High versus low ankle sprain
AAOS explains that around 90% of ankle sprains involve the ligaments on the outside of the ankle, after the foot turns inward. A less common sprain affects the ligament on the inside of the ankle. These are known as low ankle sprains. A high ankle sprain affects the ligaments above the ankle joint, between the tibia and fibula.
The difference matters. AAOS notes that nearly all isolated low ankle sprains can be treated without surgery, while surgery may be recommended for some high ankle sprains with instability of the syndesmosis. Our guide to sprained ankle recovery time covers common sprains.
How it happens
AAOS explains that ankle sprains usually follow a twisting injury of the foot or ankle, sometimes with a pop when ligaments tear badly. They can happen walking or working on uneven ground, falling or tripping, or in sports that involve cutting and jumping, such as basketball, tennis, football and soccer.
Risk factors include poor balance, very loose ligaments, poor ankle alignment, shoes with little support or slippery soles, and a previous ankle sprain. The sources reviewed do not describe the specific movement that causes high ankle sprains.
Symptoms
AAOS lists the symptoms of ankle sprains: pain at rest and when putting weight on the foot or moving, swelling, bruising, tenderness to touch and a feeling that the ankle is unstable or giving way. Symptoms of a severe sprain are similar to those of a broken bone and need prompt medical assessment.
MedlinePlus notes that in more severe sprains you may have strong pain and a lot of swelling, and may be unable to walk or find walking painful. Bruising may take several days to appear.
Warning signs that need urgent care
MedlinePlus advises contacting a health professional if you cannot walk or walking is very painful, the pain does not improve with ice, rest and pain relief, the ankle does not feel better after 5 to 7 days, it keeps feeling weak or giving way, or it becomes increasingly discoloured, numb, tingly or cold, or sensation changes.
AAOS adds that you should be seen if you have trouble putting weight on the ankle or it stays swollen or painful for several weeks despite treatment. A deformed ankle, severe pain or inability to bear weight needs urgent assessment to rule out a fracture.
Diagnosis and imaging
AAOS explains that a sprain is diagnosed from how the injury happened, the symptoms and an examination, which may include checking where it is tender, how the ankle moves and how stable it is. X-rays may be needed to rule out a fracture, and stress X-rays, taken while the ankle is gently pushed in different directions, can show instability.
An MRI scan is not needed for most sprains, but AAOS notes that a doctor may order one if there are signs of a high ankle sprain, to assess ligaments, cartilage and tendons, or if symptoms continue beyond 6 to 8 weeks despite treatment.
Early treatment and protected weight-bearing
AAOS describes a first phase for all ankle sprains: a short period of immobilization, rest and ice to reduce swelling, with support such as a walking boot, brace or, for severe sprains, a cast for a short time. Crutches may be used. MedlinePlus advises raising the foot at or above heart level and using ice wrapped in a towel, never directly on the skin.
How much weight you can put on the leg depends on your injury. MedlinePlus notes that your provider may ask you to put only part or none of your weight on the ankle. With a high ankle sprain, follow your doctor’s instructions rather than general advice for common sprains.
Rehabilitation stages
AAOS describes a second phase of functional rehabilitation, started early, with range-of-motion exercises, isometric strengthening and balance retraining, and ending immobilization to avoid stiffness. A third phase includes more advanced strength and balance work and a gradual return to activities: first those without turning or twisting, later sports with sudden changes of direction.
Strengthening, balance and agility exercises are guided by your doctor or physiotherapist and progressed as pain and swelling allow. AAOS notes that incomplete rehabilitation is the most common cause of chronic ankle instability after a sprain.
Where the sources differ
MedlinePlus (October 2024) gives general aftercare for ankle sprains and includes syndesmosis sprains among its alternative names, but its advice to start putting weight on the foot after 48 hours is written for common sprains. AAOS OrthoInfo describes high ankle sprains specifically as a reason for MRI and possible surgery. Neither source gives a fixed recovery time for high ankle sprains; AAOS notes that the three phases take 2 weeks for minor sprains and up to 6 to 12 weeks for severe injuries.
AAOS explains that surgery may be recommended for high ankle sprains with instability of the syndesmosis, or when other injuries are present; after surgery, a period of protection and rehabilitation over weeks to months follows. After medical assessment, our physiotherapy practice in Bilbao can guide rehabilitation for adults (consultations are in Spanish).
In summary
A high ankle sprain injures the ligaments joining the tibia and fibula above the ankle. It may need an MRI scan, and surgery is considered if the joint is unstable. Treatment follows phases of protection, rehabilitation and gradual return to activity, guided by your doctor and physiotherapist.
A return-to-sport checklist, agreed with your professional, is more useful than a fixed number of weeks: walking without pain or limping, full ankle movement compared with the other side, single-leg balance, hopping without pain, running in straight lines and then with turns, and sport-specific drills. AAOS notes that taping or bracing may be needed on early return.
Frequently asked questions about high ankle sprains
These answers are general information and do not replace an examination or individual medical advice.
What is a high ankle sprain?
An injury to the ligaments connecting the tibia and fibula just above the ankle, an area called the syndesmosis.
How is a high ankle sprain different from a regular ankle sprain?
Common sprains affect ligaments on the outside of the ankle. High sprains affect the ligaments above the joint and may need an MRI and sometimes surgery.
Can you walk on a high ankle sprain?
It depends on the injury. Your doctor may advise partial or no weight on the leg at first. Inability to bear weight needs urgent assessment.
How long does a high ankle sprain take to heal?
The sources give no fixed time for high sprains. AAOS notes that severe ankle sprains may take 6 to 12 weeks of rehabilitation, longer after surgery.
Does a high ankle sprain need surgery?
Not always. AAOS says surgery may be recommended for some high ankle sprains with instability of the syndesmosis.
When can I return to sport?
When your doctor or physiotherapist agrees, based on pain, movement, strength and balance, starting with activities without twisting.
Sources
- American Academy of Orthopaedic Surgeons (AAOS OrthoInfo) · Sprained ankle
- MedlinePlus (NIH) · Ankle sprain: aftercare
This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.