A slip on the sidewalk, a fall while playing sports… almost everyone experiences an ankle sprain at some point. It is often the classic form: the ankle swells and hurts, but you can still lean on it. With some rest and good rehabilitation, you are usually mobile again after a few weeks.
However, you can suffer another type of injury that requires a different approach: the high ankle sprain.
What makes a high ankle sprain different?
Characteristic of a classic sprain is that mainly the ligaments on the outside of the ankle stretch. With a high ankle sprain, the problem is higher up: the sturdy ligaments that hold your shin and fibula together just above the ankle are damaged: a syndesmosis injury. This type of injury is less common than the classic sprain, but we see it regularly in athletes. It usually occurs during an outward rotation of the foot – typically during soccer, skiing or a hard collision.
“A high ankle sprain is less known and also not always easy to recognize.” Explains Dr. Schenkels, foot and ankle specialist at Orthoca. “Even on medical imaging, a syndesmosis injury is sometimes difficult to see, which is why it is sometimes missed. Nevertheless, it is important to recognize it quickly, because a late diagnosis can significantly delay recovery.
How do you recognize the difference?
You notice the difference mainly in the location and intensity of the pain. In a classic sprain, it is usually around the outer ankle (lateral). With a high ankle sprain, you feel the pain higher or more in front of the ankle. Moreover, it often feels more severe than you would expect based on the swelling. Even weeks later, walking remains difficult and sports impossible.
Yet it is not easy for patients to distinguish between the two. After a sprain, pain is normal, but it is not always clear whether it is part of the recovery or indicates a more serious injury. That’s why follow-up is important.
If you sprain your ankle and are still bothered after seven to ten days, it is best to visit your doctor. If in doubt, he or she can refer them to a physical therapist, who can use targeted tests to determine whether a high ankle sprain is possible and, if necessary, refer them further to a specialist. “The sooner the injury is recognized, the smoother the rehabilitation will be,” he says.
Treatment and recovery
Treatment depends on the severity of the high ankle sprain. In milder forms, a firm brace or walking boot helps, allowing the ankle to heal gently. For more severe injuries, surgery is needed to make the ankle stable again.
Only in a second phase will rehabilitation with the chinist follow to build up strength, balance and stability step by step.
Keep in mind that a high ankle sprain usually requires more time than a common sprain, but with the right approach, you can make a full recovery.
Even with a classic sprain, it is important not to underestimate the injury. Always follow up with a physical therapist: targeted exercises help restore stability and muscle control. Those who fail to do so run a greater risk of a new sprain in the first three months – and in the longer term, chronic ankle instability. So physical therapy really is the key to a full recovery.
Some more tips from Dr. Schenkels for patients after ankle trauma
- Stay alert to the signs: pain that is higher on the ankle and does not subside may indicate more than a classic sprain.
- Take it seriously: even an ordinary ankle sprain requires attention and follow-up. Get your ankle checked with your doctor in a timely manner, especially if the pain does not improve markedly after seven to 10 days.
- Feel free to ask for a physical therapy referral: a rest period of 7 to 10 days is recommended. Afterwards, targeted rehabilitation exercises are crucial to regain strength and stability and prevent repeated injury.
- Do not force a return to sport too soon: discuss this with the specialist or physical therapist first. Resuming too soon increases the risk of permanent symptoms or chronic instability.
- Ice is allowed but use it purposefully: for example, after exercise or physical therapy, to relieve pain and swelling. Always combine this with active rehabilitation: cooling is not a substitute for exercise.