INTRODUCTION​

• A high ankle sprain is an injury to the major structure connecting the two leg bones

• This major structure is called the syndesmosis and is composed of 4 very important ligaments

• A sprain is a partial tear of the ligaments and the severity of the tear determines the grade

• Grade 1: Mild stretching of the ligaments

• Grade 2: Moderate tearing of the ligaments

• Grade 3: Full thickness complete tearing of the ligaments

• Some high ankle sprains are so high energy that they lead to a fracture in the proximal part of the fibula bone closer to the knee

• This occurs because the twisting forces tear the ankle ligaments and travel up the syndesmosis, exiting through a fracture near the knee

•  High ankle sprains are completely different entities from low ankle sprains and a correct diagnosis is essential for optimal treatment results

• 10% of ankle sprains are high ankle sprains

CAUSES 

• A high ankle sprain usually occurs when one severely twists their ankle

• It is usually an external rotation injury where the foot twists outward

SIGNS AND SYMPTOMS

• Pain and swelling in the inner and outer parts of the ankle 

• Often associated with difficulty walking or weight bearing

TREATMENT​​

• Treatment of high ankle sprains depend on one crucial factor: ankle stability

• If the ankle is stable by exam and imaging:

• Conservative management is usually sufficient. This consists of walking boot for 2-3 weeks as well as a period of rest, ice, compression, and elevation (RICE)

• This is often followed by a home exercise program focused on early functional rehabilitation with exercises focusing first on stretching and range of motion, followed by strengthening, then proprioception. Finally, activity-specific drills are added to facilitate a return to activities and sport

• Anti-inflammatories such as ibuprofen are oftentimes helpful as an adjunct to other treatments

• If the ankle is unstable by exam and imaging

• Surgery is recommended and consists of a minimally invasive procedure to realign the syndesmosis and provide stability to the leg and ankle joint. This can be done with screws, but newer techniques include suture button fixation 

PREVENTION  ​​

• There is no proven preventive strategy for high ankle sprains but maintaining strong muscles and tendons around the ankle can theoretically provide added stability to the ankle joint