Apex Performance Centre

High Ankle Sprain: Causes Symptoms and Treatment

Syndesmotic Ligaments

A high ankle sprain, also known as a syndesmotic sprain,  is an injury to the ligaments above the ankle which connect the tibia and fibula. The syndesmosis is a joint where the tibia and fibula are connected together by ligaments and fibrous tissue.

The purpose of these ligaments is to improve stability in the ankle joint as well as between the tibia and fibula to minimize forces associated with walking, running and jumping.

This injury is less common than  typical ankle sprains which injure the ligaments on the outer part of the foot when the ankle rolls inwards, and requires greater recovery time.

Syndesmotic Ligaments

In high ankle sprains the syndesmosis (connective tissue between the tibia and the fibula) is torn or damaged. In some cases, the tibia or fibula can also be fractured.

Causes Of High Ankle Sprains

These sprains typically occur in impact sports such as hockey and football where the athlete’s foot and ankle joint is either loaded or restricted in a skate or brace.  Because the ankle has no room to ‘give’, or accommodate the impact,  the force is transmitted higher up the leg.

The force that causes the high ankle sprain is usually a rotational movement where the foot is forcefully out turned relative to the lower leg.


Symptoms are usually limited to pain just above the ankle joint when the foot is turned outwards or the foot is planted and the leg is turned inwards relative to the foot.

The person suffering from this injury may or may not be able to bear weight, depending on whether or not there was an ankle fracture associated with it. Pain will be worse with walking, running, jumping and rotating the ankle and there can be significant bruising.


High Ankle Sprain X-Ray

Diagnosis involves checking the structural integrity of the syndesmotic ligaments. If a high ankle sprain is suspected an x-ray may be indicated to confirm the diagnosis. Often a trained physiotherapist or athletic therapist can accurately diagnose a high ankle sprain without the need for x-rays.

High ankle sprains are more serious and heal slower than lower ankle sprains. Because of this, accurate early diagnosis and treatment are important. Isolated high ankle sprains usually take about 6-8 weeks to return to sport, with proper management. If there is an associated fracture the person would likely be in a plaster cast for a couple of weeks followed by a walking boot until bone unison is shown on an x-ray. Stiffness after high ankle sprains usually lingers more than with lower ankle sprains.


Treatment begins with rest, ice for 10 minutes every 2-3 hours, elevation above the level of the heart and compression using a tensor bandage. Once pain and swelling are limited than you can begin seeing a physiotherapist for range of motion, modalities, and gentle strengthening.

How Apex Can Help

The Apex Centre offers advanced treatment modalities and hands on manual therapy techniques to release the muscles and restore joint mobility. As movement improves, our talented team of individuals will progress you to doing higher intensity balance, agility and strength training aimed at the whole lower extremity.

Therapies involved may include:


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