High ankle sprain: what is it and how do we treat it?

By Justin A. McCoy, DO | Posted 6/8/2021

Ankle injuries are common in a multitude of sports. Ankle sprains are a common cause of concern and often an athlete is diagnosed with a high ankle sprain. But what is the difference between the two?

Common ankle sprains are painful and often result from “rolling” the ankle. The athlete may step funny and the foot can roll inward, stretching the ligaments on the outside of the ankle. These injuries tend to heal well and may need a brace for a few weeks or months while playing or practicing. Before returning to practice or games these injuries should be evaluated by a sports medicine physician to make sure it is safe to play but typically it is not an issue that will keep a player out for more than a week or so.

A high ankle sprain is different. The ligaments that hold the lower leg bones together are called the syndosmosis. A high ankle sprain occurs when the foot is forcefully rotated outward causing the two bones in the lower leg to be pulled apart, stretching, and sometimes tearing, the syndosmosis. This type of injury is more common in collision sports like ice hockey, rugby and…you guessed it – football.

Most high ankle sprains are associated with pain and swelling in the front of the ankle joint. Depending on physical exam findings, x-rays and maybe even an MRI may be taken. Usually, typical triage of this injury includes ice, splinting or bracing and anti-inflammatory medication. Depending on the severity of the injury and the stability of the ankle there may be a period of intense rest and non-weight bearing of up to six (6) weeks. In worse-case scenarios, the patient may need surgery to stabilize the ankle joint.

Once the ankle is feeling better, physical therapy can help the athlete begin the return to the field of play. Typically, within a 3-to-4 month period a high ankle sprain (treated non-surgically) can heal well enough to allow the athlete to return to sports.

Prevention is always preferable to any injury, so doing exercises to strengthen the ankle may be helpful in preventing both simple ankle sprains and high ankle sprains. Once an injury has occurred, re-injury is a risk and these athletes may benefit from bracing when they return to play.



Dr. Justin McCoy advances the health of athletes through SCL Health in Grand Junction, Colo. He is a member of the American Medical Society for Sports Medicine and the Performing Arts Medical Association. He also serves on the Western Colorado Concussion Alliance. Dr. McCoy provides comprehensive medical care to both non-athletes and athletes alike, spanning recreational to professional levels.