High Ankle Sprain (Syndesmosis Ligament Injury)

High ankle sprains occur when the two ligaments holding two of the bones that make up the ankle joint (the fibula and tibia), are either strained (stretched) or completely torn.

They are most frequently caused by a traumatic incident involving the injured leg. Most often the mechanisms of injury involve planting the leg or foot and sustaining an outward rotational force on the limb at the ankle. These injuries can result in significant disability both short term and long term and can result in a long term risk of arthritis of the ankle from associated cartilage injury.

High Ankle Sprain Symptoms and Anatomy

In a high ankle sprain, patients tend to experience pain in the space between the small and big bones that make up the ankle. This pain is usually worse when putting pressure on the limb, and also with twisting the foot outwards. Swelling and bruising of the ankle and leg are often seen with these injuries.

The severity of the injury can vary from a minor stretching of the ligaments holding these two bones together, to a complete tear of either one or two of the ligaments. Sometimes the injury can be so severe that the membrane holding the fibula and tibia together in the leg is also torn. Often when this occurs, the fibula is seen to be broken close to the knee.

The diagnosis of such an injury is usually made with the help of an X-ray of the ankle, where the overlap between the two bones is measured to compare with the non-injured ankle. If the X-rays are not informative enough, then CT scan (which provides more detail when compared to an x-ray) or an MRI (which gives more information about the ligaments). Are sometimes needed.

High Ankle Sprain Treatment Options

Treatment can range from simple immobilization without weight bearing restrictions in a walking boot for minor sprains to more extensive immobilization in a cast with weight bearing restriction to surgical stabilization or reconstruction of the ligaments that are damaged.

If the injury is treated with immobilization, you will be placed in either a walking boot or a non-walking cast to keep the ankle and foot from moving around. These devices will allow the ligaments to scar down in their appropriate locations and help to restore the stability of the ankle.

High Ankle Sprain Surgery

If the injury requires surgical management, then a combination of plates, screws and special suture buttons may need to be used to squeeze together the fibula and tibia and hold them in their appropriate positions relative to one another until the body can heal the ligaments. The hardware that is put in is often not removed.