High, Ankle Sprain!

Posted by on Tuesday, May 1st, 2012

An ankle sprain is bad. A high ankle sprain is really bad. If you have a fantasy sports team, and you read an injury update that says one of your players has a regular ankle sprain, you’re not worried. He’ll get it taped up and be on the practice field in a day or two. However, if that report says he has gone down with a high ankle sprain, you know that you are going to need to find a replacement quick because that player is going to be gone for a long time. A really, really long time. An amount of time that makes you curse the day you drafted said player.

Okay, let’s skip the melodrama about fantasy seasons gone bad and learn the basics about high ankle sprains: what it means to have one and, of course, what it means to your fantasy lineup when one of your players has one.

What is an ankle? Can you give me a quick anatomy lesson? Yes! I was hoping you would ask that. The ankle joint connects your foot to your ankle, and allows your foot to bend and move. Three bones make up the ankle joint: the tibia and the fibula, which are the two lower leg bones, and the talus, which is the bone at the connection point between the foot and lower leg; the tibia and fibula meet at the top of the talus. Ligaments hold the whole operation together.

Glad we got that cleared up! So what is the difference between a regular ankle sprain and a high ankle sprain? Did you ever “roll your ankle?” You know, take a bad step, maybe off a curb, and feel your ankle bend down while your foot rolls inward? That’s kind of the classic regular sprained ankle. In that case, the ligament that connects the fibula to the talus is injured.  The ligament in question is essentially located below the ankle joint.

A high ankle sprain, on the other hand, involves ligaments located above the ankle joint that hold the tibia and fibula together (yes, feel free to apply to medical school after reading this). These ligaments, the syndesmosis ligaments, help protect the positioning of the bones when you walk, and more importantly, when extreme force is put on the lower leg, such as during running and making quick cuts from one direction to another. Since they ‘re located above the talus, they win the name “high” ankle sprain. They’re higher than the other ligaments. Get it? High ankle sprains are more likely to come from twisting motions–that is, your cleat gets caught in the turf, facing one direction, while your knee has already turned in another direction.

How do I know which kind of sprain I have?! With a regular ankle sprain, you’ll most likely feel the pain just below the ankle sprain, and it will feel pretty concentrated in one area. There will be swelling and sometimes bruising in a severe ankle sprain.

A high ankle sprain is often difficult to manage because there may not be swelling or bruising, so it’s hard to really define the exact spot of the injury. Good news, though–every step you take will cause pain, with the pain typically radiating up the leg from an area above the ankle joint, so you will know you have a high ankle sprain. Okay, maybe that’s not good news, but it’s, well, news. And unlike that regular ankle sprain that you can walk or even run on in a few days, a high ankle sprain pretty much puts a stop to normal walking, let alone running. You can try, but you won’t be very effective.

How do we treat these? For both kinds of sprains, start with the classic RICE–rest, ice, compression, elevation treatment. And do this as soon as possible. I have twice had incidents where I had the classic, rolled ankle type of ankle sprain, didn’t do anything about them for a few hours (in one case, I even went to the gym and took a spin class before even icing the ankle), and ended up with injuries that lingered for weeks; in one case, it took years for me to get full mobility back in the ankle (in a perfect world, I would have had physical therapy for it, but alas, the world is not perfect). So yeah, I would advise treating these right away.

With a regular ankle sprain, you can be back walking on it pretty quickly. If you’re a highly paid pro athlete, you can have your ankle taped up by the trainer and return to the game, and you may wear a brace afterwards to protect it from re-injury.

If, however, you have a high ankle sprain, you can expect the healing process to take twice as long as that of a regular ankle sprain; it probably will take about six weeks for the injury to really heal. In severe cases, a podiatric surgeon at The Center for Podiatric Care and Sports Medicine (212.996.1900) may find that you need to have surgery to have a screw put in to hold the tibia and fibula in place while the ligaments heal. And after all that, many people will find that symptoms (pain, stiffness) linger for up to six months. Unfortunately, there is no magic cure to make that high ankle sprain go away faster. You just have to let it heal up the old-fashioned way.

So, there you go–high ankle sprain! Avoid it all costs! Not like you want a regular one, but if you have to injure your ankle, you would definitely do better with a roll rather than a twist. Next time you jump into that pickup game of football with your friends, think twice before you start doing your Barry Sanders imitation.

If you have an ankle problem that isn’t healing, or any other foot issue, contact The Center for Podiatric Care and Sports Medicine to find out if PRP is right for you. Dr. Josef J. GeldwertDr. Katherine Lai, and Dr. Ryan Minara have helped thousands of people get back on their feet.

If you have any foot problems or pain, contact The Center for Podiatric Care and Sports MedicineDr. Josef J. GeldwertDr. Katherine Lai, and Dr. Ryan Minara have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.