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The definition of a high ankle sprain, there is damage to the syndesmosis. A syndesmosis is a set of ligaments that lies between the tibia and fibula that is above the ankle joint. This particular joint holds the tibia and fibula together. Naturally when an individual is walking the fibula and the tibia want to separate due to the forces acting upon the bones.
The syndesmosis functions as a shock absorber between the tibia and fibula and inhibit the bones from splaying. When walking the syndesmosis joint is exposed to strong forces and even more, aggressive force is being applied when a person is running and cutting.
Every step that an individual takes with a sprained syndesmosis is painful. The type of injury is usually going to happen to our athletes.
Athletes and their coaches can have some difficulty trying to figure out the severity of the injury, because is typically not a great degree of swelling or bruising locally, and generally does not “look that bad.” Knowing the severity of the injury is important to assess rest and rehab time for complete healing.
If you want to learn more about ankle sprains, please watch this ankle video.
Sports that involve a lot of contacts and cutting like soccer and football are more at risk for high ankle sprains. The common complaint athletes will typically say is that the pain radiates up the leg from the ankle, and the pain worsens when they do cutting motions that mimic the original twisting injury.
When treating a high ankle sprain the individual should rest, ice, compression, and elevation. The doctor will first evaluate if the injury is stable or unstable. If the ankle is functioning normally then its considered stable, thus it will be treated in a cast for a period of 6 weeks.
Surgery may be necessary to stabilize the joint if the doctors determine it is not stable. The general procedure for surgery is to place one or two screws between the tibia and fibula to hold the bones in proper position while the syndesmotic ligament heals.
Grade 1 Ankle Sprain
There are different severity of a high ankle sprain which is categorized into grade 1, grade 2, and grade 3. Grade 1 is a mild issue which can take 6 weeks to heal, but it may take longer to return to functional sport again. A grade 1 mild high ankle sprain usually result in joint stiffness, ligament laxity, muscle weakness or tightness plus reduced proprioception (balance and joint awareness).
If this injury is not treated appropriately then the ankle and foot joints will start to compensate movement at adjacent joints, which can lead to several other injuries down the line.
Grade 2 Ankle Sprain
Grade 2 is a moderately severe injury that allows the ligament to excessively stretch. Most of the time to recovery from a grade 2 injury it requires 6 to 12 weeks. The rehabilitation process becomes more complex and extensive depending on the grade of the injury.
Physical therapy for a grade 2 ankle sprain focuses on gaining full range of motion, strength, proprioception, power, and agility, and return to sport-specific drills.
Grade 3 Ankle Sprain
In extreme cases, an individual can have a high ankle sprain and a fracture at the same time, which will be an indication of longer rehabilitation time. Grade 3 usually requires surgery in the surgery there is a "syndesmotic screw" is placed between the tibia and fibula to hold the bones in proper position while the syndesmotic ligament heals. Normally, the rehabilitation time takes 3 to 6 months but can vary and depends on the specific injury.
A high ankle sprain can take anywhere from 6 weeks to 6 months dependent upon the grade of the sprain. It also depends on what activity level you are wanting to get back to. A low ankle sprain is generally a faster healing time in comparison.
Treatment for a High Ankle Sprain
The first step is to be properly evaluated by a orthopedic physician who treats high ankle sprains. Usually, there is a period of time where the injured ankle needs to be immobilized in a walking boot or a cast. When treating patients for an ankle sprain, clinicians will commonly focus on range-of-motion with active and passive mobility exercises. Another form of therapy is strength training and improving balance. This will help with stability of the ankle. Balance position sense and preventing patients from losing their sense of balance due to ankle injuries is very important. Physical Therapy will focus on a full return to sport and to activities. This may require ankle taping or an ankle brace. Different pairs of shoes may also help with healing ankle pains.
If you want to learn more about other types of ankle sprains, go to What are the types of Ankle Sprains?JOI Rehab is now hiring! To find out about our current job openings, please follow this LINK.
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By: Joe Stubits PTA