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HIGH ANKLE SPRAIN                                                     KANDILNOTES


  • 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


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

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


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

  • Often associated with difficulty walking or weight bearing


  • 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 


  • 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

High ankle sprain capture 1.PNG
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