High Ankle Sprain (Syndesmosis Ligament Injury)

A high ankle sprain, or syndesmotic ankle sprain, occurs when the ligaments that stabilize the ankle joint (the fibula and tibia) are stretched or completely torn. Learn more about high ankle sprain treatment, symptoms, causes, and more from our expert physicians at Resurgens Orthopaedics.

What You Need To Know About a High Ankle Sprain

What Is a High Ankle Sprain?

A high ankle sprain, or syndesmotic ankle sprain, occurs when the two ligaments that connect the fibula and tibia bones are stretched or torn. When the ankle is functioning properly, the feet are connected to the leg bones by the ankles, which consist of an upper and lower part. The upper ankle comprises the tibia and fibula bones, while the talus bone is positioned between the upper and lower ankle bones and fits into their arch.

When weight is applied to the leg, the tibia and fibula bones are subjected to forces that cause them to spread apart. To prevent excessive spreading, the ligaments of the syndesmosis act as shock absorbers. During activities like running, especially those involving sudden changes in direction, the syndesmosis ligaments experience significant forces.

The severity of the injury can range from minor stretching of the ligaments to a complete tear of one or both of them. In severe cases, the membrane that holds the tibia and fibula bones together in the leg may also tear. In such cases, the fibula bone is often observed to be broken near the knee.

What Causes a High Ankle Sprain?

A syndesmosis ligament injury is usually 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. Typically, this happens during high-impact activities that involve running, jumping, or quick changes of direction. Sports such as football, soccer, lacrosse, and basketball are often associated with this injury. It's also possible to injure the syndesmosis ligaments when the ankle is broken.

High Ankle Sprain Symptoms

Individuals with high ankle sprains typically experience pain in the area between the ankle's big and small bones. This pain usually intensifies when weight is placed on the affected limb or when the foot is twisted outward. Swelling and bruising of the ankle and leg are also common symptoms of this injury.

How Is a High Ankle Sprain Diagnosed?

To diagnose a syndesmotic ankle sprain, your healthcare provider may perform the following tests:

  • Ask you to sit down with your knee bent and leg and foot hanging down, then push up on your foot and slightly twist it outward. If you experience significant pain, it's likely that you have a high ankle sprain. This test may be repeated a few days after the injury.

  • The syndesmosis squeeze test: by applying pressure on the interosseous membrane that separates the tibia and fibula bones. If you feel pain higher up on your leg, it may indicate a high ankle sprain.

  • Applying pressure on the ligament across the front of your ankle to check for pain or tenderness.

After a physical exam, your doctor will recommend an X-ray of the ankle. If the X-rays are not informative enough, then additional imaging like a CT scan (which provides more detail when compared to an X-ray) or an MRI (which gives more information about the ligaments) may be necessary.

High Ankle Sprain Treatment

Our foot and ankle physicians have many treatments available for a high ankle sprain:

Non-Surgical Treatment

Non-surgical 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 restrictions. These devices will allow the ligaments to scar down in their appropriate locations and help to restore the stability of the ankle.

Here are some other simple at-home treatment methods:

  • Rest

  • Ice

  • Compression of the ankle

  • Elevation

  • NSAIDs like Advil and Tylenol

  • Physical therapy

Surgical Treatment

The majority of high ankle sprains do not need surgical intervention. However, severe ankle sprains are often more serious than normal ankle sprains. If your case is severe, the ligaments are completely torn, or your injury is not improving with non-surgical methods, our physicians may recommend a procedure to surgically stabilize or reconstruct the ligaments that are damaged.

During a high ankle sprain surgery, a combination of plates, screws, and special suture buttons are installed to squeeze together the fibula and tibia and hold them into the correct position until the body can heal the ligaments.

If you're struggling with high ankle sprain symptoms, don't wait. Contact our foot and ankle physicians in Metro Atlanta today.

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