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High Ankle Sprain

October 24, 2019

By Stephanie Davey, MEd, ATC, PES
Athletic Trainer

You may have heard about athletes, like Tua Tagovailoa, who have suffered a high ankle sprain and wondered why they seemed so much more serious than a normal ankle sprain. A high ankle sprain, or Syndesmotic ankle sprain, involves the ligaments that bridge the tibia and fibula at the Distal Tibiofibular Syndesmosis. When those ligaments are damaged they can cause a gap between the fibula and tibia which causes significant pain and difficultly with weight bearing. The more common lateral ankle sprain usually involves the ligaments that connect the fibula to the talus or the calcaneus. There is not as much pressure placed on those lateral ligaments during normal weight bearing.

The mechanism for a high ankle usually involves extreme external rotation or dorsiflexion of the talus and most commonly occurs in high impact running sports like football or soccer. There are three grades of high ankle sprains. Grade 1 involves mild stretching of the ligaments. Grade 2 involves ligaments that have been partially torn. Grade 3 involves a complete rupture of the ligaments and can result in the separation of the joint. A grade 3 injury can also include fractures of the distal tibia and/or fibula.

Treatment and recovery time depend on the severity of the injury but generally take longer than a lateral ankle sprain. Grade 1 and 2 injuries can usually be treated conservatively with restricted activity and rehabilitation. The athlete may also be instructed to wear a walking boot to decrease the pressure while weight bearing. Surgery is usually indicated for a Grade 3 injury. The standard surgery involves an orthopedic surgeon inserting a screw between the tibia and fibula to hold the two bones together while the ligaments are able to heal. A procedure called the tightrope procedure gained national recognition when Tagovailoa had the surgery and was able to return to practice two weeks after the injury. This surgery involves drilling across the two bones and implanting a non-absorbable suture that serves as a replacement ligament.

Whatever the severity of your high ankle injury, it should be taken seriously and monitored by a qualified Sports Medicine professional or orthopedic doctor. Correctly diagnosing and treating your injury significantly increases your chances of a successful return to your sport.