How Is a High Ankle Sprain Different?

A high ankle sprain affects the ligaments above the ankle joint that connect the tibia and fibula bones, while a traditional sprained ankle usually affects the lateral ligaments on the outside of the ankle. Because the ligaments affected in a high ankle sprain help stabilize the ankle and lower leg, this injury causes more pain during walking and twisting movements.

At Total Orthopedics & Sports Medicine, our experienced orthopedic surgeon, Dr. Charles Ruotolo, takes a patient-focused approach to diagnosing and treating complex ankle injuries. Instead of relying on a one-size-fits-all plan, he identifies the root cause of your symptoms and creates a recovery strategy tailored to your lifestyle. Call 855-321-6784 to book your appointment in Commack.

How Does a High Ankle Sprain Differ From Other Sprains?

A high ankle sprain is often more serious than a standard ankle sprain because it damages the ligaments that stabilize the lower leg above the ankle joint. Unlike low ankle sprains, this type of syndesmotic injury can affect stability between the tibia and fibula. Damage to these stabilizing ligaments can make everyday movements more difficult and may prolong recovery time compared to a traditional ankle sprain.

In fact, a systematic review and meta-analysis published in the Journal of Orthopaedic Surgery and Research found that athletes with syndesmotic ankle sprain injuries required an average of approximately 58 days to return to sport. Researchers also noted that high ankle sprains often lead to greater functional limitations than traditional ankle sprains. This is because the injured ligaments play a key role in maintaining stability between the tibia and fibula during weight-bearing. In severe cases, ligament damage may further delay recovery and increase the risk of ongoing pain.

Which Structures Are Injured in a High Ankle Injury?

A high ankle sprain commonly affects the anterior inferior tibiofibular ligament (AITFL), but it can also involve the posterior inferior tibiofibular ligament (PITFL) and the interosseous membrane. The AITFL is typically the first structure to be injured in a high ankle sprain. As the force of the injury increases, damage may extend to the PITFL, indicating a more severe sprain.

In severe cases, the interosseous membrane between the tibia and fibula can also be disrupted. This additional damage may lead to greater instability and a longer recovery period. Recovery can be further delayed if the injured tissues are placed under premature weight-bearing or a rapid return to sports and high-impact activities.

Because severe high ankle sprains can involve multiple structures, an accurate diagnosis is essential for developing an effective treatment plan. Early identification of the injured tissues can help guide rehabilitation and reduce the risk of persistent instability or recurrent injury.

What Causes a High Ankle Sprain?

A high ankle sprain usually occurs when the foot is planted, and the leg twists forcefully outward. This force is often generated during cutting, pivoting, or collision-related movements, which cause the ankle and lower leg to rotate in opposite directions. Such movements are especially common in ice hockey and ice skating, which involve rapid directional changes and rotational forces that can stress the ankle syndesmosis.

Here are some other causes of a high ankle sprain:

• Falls that force the foot and leg to move in opposite directions
• Motor vehicle accidents involving significant twisting or rotational forces
• Awkward landings that place excessive stress on the ankle joint
• Workplace or recreational accidents that cause sudden external rotation of the lower leg
• Any traumatic event that places excessive rotational stress on the ankle syndesmosis may lead to a more severe sprain

Which Sports Increase the Risk of This Injury?

Football, soccer, basketball, and hockey carry the highest risk of a high ankle sprain because they involve frequent cutting, pivoting, and contact. These movements can place significant stress on the lower leg and ankle during competition, often resulting in prolonged recovery. In fact, professional athletes, including Patrick Mahomes and Tony Pollard, have missed playing time because of this injury.

Can a High Ankle Sprain Occur Without Contact?

Yes, a high ankle sprain can occur without contact when a sudden twisting movement places excessive stress on the stabilizing ligaments of the lower leg. Common causes include forceful pivoting, cutting, sudden changes in direction, and situations when the ankle rolls while the foot remains planted. These motions place excessive stress on the stabilizing structures of the lower leg and ankle.

According to research published in Physiopedia, non-contact mechanisms involving sudden external rotation of the foot and ankle dorsiflexion are among the most common causes of syndesmotic injuries. Here are some common non-contact activities that can trigger a high ankle sprain:

• Slipping on a wet or icy surface
• Missing a step while going up or down stairs
• Stepping into a hole or uneven ground
• Tripping while walking or running
• Twisting the ankle during a sudden turn
• Falling awkwardly and landing on the foot
• Walking on uneven terrain, such as gravel or trails
• Losing balance while carrying heavy objects
• Stepping off a curb incorrectly
• Wearing unstable footwear that increases the risk of ankle twisting

How Can You Tell If You Have a High Ankle Sprain?

Persistent pain above the ankle, difficulty walking, and discomfort when turning or twisting the leg are common signs of a high ankle sprain. You may also notice swelling, tenderness, and a feeling of ankle joint instability when putting weight on the affected leg. These symptoms often get worse during activities that involve pivoting or rotational movements.

Other symptoms of a high ankle sprain may include:

• Pain when pushing off while walking or running
• Tenderness above the ankle rather than around the ankle bone
• Reduced range of motion in the ankle and lower leg
• Discomfort when climbing stairs or walking on uneven surfaces
• Bruising around the ankle or lower leg
• High ankle sprains often involve less visible swelling or bruising than low sprains
• Trouble returning to sports or other physical activities
• A feeling that the ankle cannot support your normal length stride comfortably
• Difficulty performing activities that require rapid stops, turns, or bear weight movements

While some of these symptoms may seem mild at first, they should not be ignored, especially if they persist for more than a few days or begin to interfere with your daily activities. In some cases, untreated syndesmotic injuries may place additional stress on the surrounding joints and Achilles tendon, increasing the risk of further injury.

Dr. Charles Ruotolo’s Perspective on High Ankle Sprains

One of the most common concerns we hear from patients is: “I thought it was just a regular ankle sprain.” Many people make this assumption because they can still put weight on the ankle and continue walking. However, high ankle sprains often cause less swelling than traditional ankle sprains while causing more pain during twisting movements.

By the time patients come to us, ongoing instability and delayed healing have already made recovery more challenging. In our experience, patients achieve the best outcomes when the injury is diagnosed promptly and treated with an appropriate, individualized treatment plan.

Therefore, if you are experiencing ongoing pain above the ankle or discomfort during twisting movements, consult us immediately for proper evaluation. Getting a high ankle sprain diagnosed early can help prevent the condition from worsening and support a smooth recovery. Call 855-321-6784 now to get evaluated by our board-certified orthopedic surgeon.

How Do Orthopedic Specialists Confirm the Diagnosis?

Our orthopedic specialist, Dr. Charles Ruotolo, confirms the diagnosis through a physical examination, a review of your symptoms, and imaging studies. During a physical exam, he assesses ankle stability and evaluates the syndesmotic ligaments that connect the two bones of the lower leg. In some cases, he may order MRI scans to help identify ligament damage and determine the severity of the injury.

In addition to a thorough physical examination and MRI, our orthopedic specialist may use other diagnostic tests to confirm a high ankle sprain and rule out related injuries such as a stress fracture. For example, he orders X-rays to evaluate ankle joint alignment and identify associated fractures or widening of the tibiotalar joint space. He may also perform stress radiographs to assess ankle stability and detect injuries to the ligaments connecting the shin bones that standard X-rays may not reveal. According to a clinical study, stress radiographs have a 82% sensitivity for detecting syndesmotic injuries.

While most high ankle sprains can be diagnosed with a physical exam and imaging, doctors may use the following tests in more complex cases:

• Stress X-rays: Specialists apply gentle pressure to the ankle during these X-rays. This helps identify instability and widening between the tibia and fibula.
• Diagnostic Ankle Arthroscopy: This minimally invasive procedure allows specialists to directly view the syndesmotic ligaments. It can help determine the severity of the injury when imaging results are unclear.
• Weight-Bearing CT Scans: These advanced scans capture images while you are standing. They help detect syndesmotic instability and subtle alignment changes under normal loading conditions.
• Fluoroscopic Stress Examination: This real-time imaging technique evaluates ankle movement and stability. Specialists may use it to assess ligament damage and assist with surgical planning.

What Questions Will the Doctor Ask During the Exam?

Our doctor will ask how the injury occurred, what symptoms you are experiencing, and whether certain movements make the pain worse. He may also ask if you heard a popping sound, can bear weight on the affected leg, or have a history of previous ankle injuries. These details help guide the diagnosis and determine whether additional testing is needed.

During your consultation, the doctor may also ask the following questions:

• Can you point to the exact area where you feel the pain?
• When did you first notice your symptoms?
• Did a rolling motion or another specific movement cause the injury?
• Does your pain increase when the ankle gets flexed upward or when you change direction?
• Have you noticed swelling, bruising, or signs of chronic instability?
• Have you experienced similar ankle injuries or other injuries in the past?
• Do certain activities place more stress on the high ankle ligaments and increase your discomfort?
• Have you used an ankle brace, taken anti-inflammatory medications, or tried any other treatments?

How Do Doctors Treat High Ankle Sprains?

For Grade 1 and 2 sprains, Dr. Charles Ruotolo may recommend the RICE method (rest, ice, compression, and elevation). This method helps reduce swelling, ease discomfort, and support healing during the acute inflammatory phase. Depending on the severity of the injury, he may also prescribe an ankle brace or anti-inflammatory medications to help reduce pain and swelling. Besides that, he may recommend an exercise program that includes range-of-motion and strengthening exercises to support recovery.

In addition, Dr. Charles Ruotolo may advise temporary activity limits and a gradual return-to-movement plan. Avoiding high-impact activities during the early stages of recovery can help protect the injured tissues. As a result, many mild cases can be treated conservatively without surgery. In fact, according to a systematic review published in PubMed, 98% of patients return to sport after receiving nonoperative treatment for syndesmotic ankle sprains.

As healing progresses, our doctor will monitor your recovery and adjust your treatment plan as needed. Following the proper treatment plan can help restore function, prevent chronic instability, and reduce the risk of future ankle problems. However, not all ankle sprains heal the same way; some injuries may require more advanced treatment if symptoms persist or instability develops.

Can a Walking Boot Help the Ankle Heal?

Yes, a walking boot can help the ankle heal by limiting movement and protecting the injured tissues during recovery. Doctors often recommend a walking boot to reduce stress on the high ankle ligaments and allow them to heal more effectively. By stabilizing the ankle and protecting damaged ligaments from excessive movement, the boot can support recovery and lower the risk of complications.

However, the duration you wear a walking boot depends on the severity of the injury and your symptoms. Some patients may need it for only a few weeks, while others require longer support to protect the healing tissues. Therefore, it is essential to follow your doctor’s instructions carefully, as returning to normal activities too soon can place additional stress on the injured area and delay recovery. As healing progresses, your doctor may gradually transition you from the boot to an ankle brace to restore strength and mobility.

Which High Ankle Sprains Require Surgical Repair?

Grade 2 and Grade 3 high ankle sprains may require surgical repair if the injury causes significant instability or separation between the lower-leg bones. Because these injuries can directly affect the structures that connect bones and involve a torn ligament, doctors proceed with surgical treatment to restore stability.

Depending on the severity of the injury, our surgeon may recommend one of the following procedures:

• Syndesmotic screw fixation: The surgeon places one or more screws between the tibia and fibula to stabilize the joint while the injured ligaments heal.
• Suture button fixation: This procedure uses a strong suture-based device to hold the bones in place while allowing limited natural movement during recovery.
• Ligament repair or reconstruction: If the injury is extensive, the surgeon may repair the torn ligament directly or reconstruct it using a graft.
• Combined fixation procedures: In more complex injuries, the surgeon may combine ligament repair with screw or suture button fixation to restore stability and alignment.

How Long Does It Take to Recover From a High Ankle Sprain?

Recovery from a high ankle sprain typically takes 6 to 12 weeks for mild to moderate injuries, although severe cases may require a longer healing period. For example, regular ankle sprains may heal within 1 to 3 weeks. However, for a high ankle sprain treated with surgery, recovery can take from six weeks to four months or longer, depending on the extent of the injury and your rehabilitation progress.

While recovery timelines can vary, getting the right treatment at the right time can speed up the healing. At Total Orthopedics & Sports Medicine, our ankle specialist, Dr. Charles Ruotolo, guides patients through the following stages of recovery:

• Comprehensive evaluations to determine the severity of the injury and identify any associated damage.
• Ongoing monitoring to track healing progress and make adjustments to treatment when needed.
• Recovery guidance focused on restoring strength, mobility, balance, and ankle stability.
• Return-to-activity guidelines to help reduce the risk of reinjury and support long-term recovery.
• Addressing pain and inflammation management to help patients remain comfortable throughout recovery.
• Educating patients on injury prevention techniques to help protect the ankle from future injuries.

How Can You Speed Up Recovery and Prevent Reinjury?

Follow your treatment plan, complete rehabilitation exercises, and gradually return to activity to speed up your recovery. Consistent strengthening and mobility exercises help restore stability and mobility, while avoiding high-impact activities can help protect the healing tissues. In fact, research published in PubMed reports that structured rehabilitation may also help improve functional recovery after syndesmotic ankle injuries. In addition, use proper protective equipment during sports and physical activities to help reduce the risk of future injuries.

Which Activities Should You Avoid During Healing?

You should avoid running, jumping, pivoting, cutting, contact sports, and heavy lifting during the healing period. These activities can place excessive stress on the recovering ankle and interfere with its healing. Although pain and swelling may begin to improve as your ankle heals, returning to high-impact activities too soon can increase the risk of re-injury.

Here are some additional activities you should avoid until your doctor confirms that your ankle has healed:

• Sprinting and sudden acceleration drills
• Basketball, soccer, football, and tennis
• Hiking on uneven trails or rocky surfaces
• Climbing ladders repeatedly at work or home
• Carrying heavy objects up and down stairs
• High-impact gym exercises such as box jumps and burpees

Visit Our Commack Clinic for Advanced High Ankle Sprain Treatment and Recovery!

Recovering from a high ankle sprain can be frustrating because it is difficult to know whether your ankle is healing properly or needs additional treatment. Without expert guidance, many people spend weeks managing symptoms instead of addressing the underlying cause of their condition.

At Total Orthopedics & Sports Medicine, our fellowship-trained surgeon, Dr. Charles Ruotolo, begins with a thorough evaluation to accurately diagnose your condition. After identifying the source of your symptoms, he explains your treatment options and guides you through each step of recovery. With a personalized treatment plan focused on your recovery goals, you can resume the activities you enjoy with less pain and greater mobility. Contact us or visit our Commack clinic today to schedule your appointment.

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