Understanding High Ankle Sprains: Causes, Diagnosis, Treatment, and Rehabilitation
Introduction
High ankle sprains are less common but more severe than the typical ankle sprain most people are familiar with. Officially termed "syndesmotic sprains," these injuries involve the ligaments above the ankle joint, which connect the tibia to the fibula. High ankle sprains are particularly prevalent among athletes in sports such as football, soccer, and skiing, where rapid and forceful twisting of the ankle is common. This blog post delves into the mechanism of injury, how these sprains are diagnosed, treated, guidelines for returning to sport, and the critical role of physiotherapy in management.
Mechanism of Injury
The primary cause of a high ankle sprain is a forceful external rotation of the foot relative to the leg, or a hyperdorsiflexion where the toes are forced upwards towards the shin. These movements can occur during a tackle in football, changing direction quickly in soccer, or landing awkwardly from a jump. The injury results from excessive stretching or tearing of the syndesmosis, the fibrous tissue that connects the two bones of the lower leg, the tibia and fibula.
Diagnosis
Diagnosing a high ankle sprain involves a combination of patient history, physical examination, and imaging. Symptoms often include severe pain, often felt when pressing together the tibia and fibula or during specific rotational movements. Swelling and bruising may appear not just around the ankle, but also along the lower leg between the two bones.
Physicians may employ the "squeeze test," where compression of the calf causes pain at the syndesmosis, indicating a high ankle sprain. Imaging tests such as X-rays ensure that there are no fractures. More detailed assessments can be made with MRI or ultrasound to evaluate the extent of the damage to the ligaments.
Treatment
Immediate treatment follows the RICE protocol — rest, ice, compression, and elevation. The key is to reduce swelling and pain and protect the ankle from further injury. Depending on the severity, a brace or boot may be necessary to immobilize the ankle and allow the syndesmosis to heal. In cases where the injury is particularly severe, or if conservative treatment fails, surgical intervention may be required to stabilize the syndesmosis.
Return to Sport Guidelines
The timeline for returning to sport varies significantly based on the severity of the sprain and the individual athlete's healing process. Typically, it can take anywhere from 6 weeks to several months. A gradual return to activity is essential, starting with non-weight bearing exercises and slowly progressing to full weight-bearing.
Athletes must meet specific criteria before returning to sport, including:
Pain-free range of motion and strength comparable to the uninjured ankle.
Ability to perform sport-specific drills at full intensity without pain.
Clearance from a healthcare professional.
Physiotherapy Management
Physiotherapy plays a crucial role in the rehabilitation of a high ankle sprain. Initial treatments focus on managing pain and swelling. As healing progresses, the therapy shifts towards restoring range of motion, strength, and proprioception (the sense of joint position).
Exercises might start with gentle range-of-motion movements, progressing to resistance training and then to balance and proprioceptive drills. Advanced rehabilitation includes sport-specific activities designed to prepare the athlete for return to play, ensuring the ankle can withstand the demands of their sport.
Conclusion
High ankle sprains require careful and expert management due to their complexity and the significant impact they have on mobility and athletic performance. Understanding the nature of the injury, prompt and accurate diagnosis, appropriate treatment strategies, and a carefully planned physiotherapy regimen are key to a successful recovery and return to sport. As with any injury, prevention — through strength training, proprioceptive exercises, and wearing appropriate footwear — can significantly reduce the risk of a high ankle sprain.
References:
D'Hooghe, P., Kerkhoffs, G., Rosenbaum, D., et al. (2018). "Management of acute lateral ankle ligament injury in the athlete.
Schuh, R., Benca, E., Willegger, M., et al. (2016). "Diagnosis and treatment of acute ankle injuries: Development of an evidence-based algorithm.
Williams, G. N., Jones, M. H., & Amendola, A. (2007). "Syndesmotic ankle sprains in athletes.
Roemer, F. W., Jomaah, N., Niu, J., et al. (2014). "Ligamentous injuries and the risk of associated tissue damage in acute ankle sprains in athletes: a cross-sectional MRI study.
