What is High Ankle Sprain?
A high ankle sprain is a condition where there is injury or damage to the syndesmotic ligaments which hold the ankle, tibia and fibula together. As the injury occurs in the upper part of the ankle, it is called as high ankle sprain. The anterior tibiofibular ligament is the commonly injured ligament. High ankle sprain can also occur with fracture of tibia or fibula.
High ankle sprain or syndesmotic ankle sprain is a more serious injury than the lateral ankle sprain and can be difficult to treat. The common causes of high ankle sprain or syndesmotic ankle sprain are twisting and inversion movements. People who are active in sports are more prone to suffering from high ankle sprain or syndesmotic ankle sprain.
Causes of High Ankle Sprain
- Outward twisting of the ankle commonly occurring in extreme physical sports such as wrestling, soccer, ice hockey and running tends to cause high ankle sprain.
- High ankle sprain is also common in individuals who lead sedentary life and become abruptly active.
Symptoms of High Ankle Sprain
- Pain upon palpation of the ankle.
- Pain upon walking and difficulty walking are common symptoms of high ankle sprain.
- One of the symptoms of high ankle sprain is swelling at the anterior and external side of the ankle.
- Bruising is present at the anterior and external side of the ankle.
- Pain upon rotation and dorsiflexion of the ankle together.
Treatment of High Ankle Sprain
- CT scan helps in confirming the diagnosis of high ankle sprain.
- RICE (Rest, Ice, Compression, Elevation) technique application is the most effective conservative treatment for high ankle sprain.
- Plenty of rest should be taken. This is vital for early recovery from high ankle sprain.
- Crutches should be used to avoid weight bearing.
- Cold therapy should be applied to the ankle immediately after sustaining an injury.
- Anti-inflammatory medications such as ibuprofen help in reducing pain, swelling and inflammation associated with high ankle sprain.
- Cast or a brace can be used for support.
- Sports massage can be done following 72 hours after the injury. This should be done by a professional. It helps in decreasing the swelling, relaxing the muscles and prevents the developing of scar tissue.
- Ultrasound treatment helps in healing of the ligaments.
- Stretching exercises can be started after the pain subsides to increase the mobility of the ankle.
- After the pain has subsided completely, the patient should start strengthening exercises to fasten the recovery period of high ankle sprain.
- Wobble board exercises help in preventing recurrence of the injury.
Recovery Time for High Ankle Sprain
When it comes to High Ankle Sprains, they are considered to be more severe than a normal ankle sprain that any person can suffer with and hence high ankle sprain takes a while longer to heal than normal ankle sprain. To facilitate expedited healing, it is essential to diagnose high ankle sprain early and adequate treatment should be started. Since recovery period or healing time of high ankle sprains is much slower hence physicians are more concerned by this condition than normal ankle sprains.
To estimate an approximate healing time, the physician or the physical therapist will first determine whether the high ankle sprain is stable or unstable. For stable high ankle sprains, the recovery period or healing time is approximately 6 weeks after treatment with a cast or a boot. The healing time has been approximated based on the severity of high ankle sprain into three grades.
Recovery Period or Healing Time for Grade I- Mild High Ankle Sprain: These types of sprains are extremely mild and take anywhere from 4-6 weeks to completely heal, but it may take a while before you can go back to normal sporting activities again, as these injuries can result in joint stiffness and muscle weakness and if it is not allowed to heal properly it may cause further injuries with passage of time.
Recovery Period or Healing Time for Grade II- Moderate High Ankle Sprain: These types of high ankle sprains occur when there is substantial injury to the ligaments where it is stretched abnormally. High ankle sprain of moderate severity can take anywhere from 10-12 weeks to heal. If the injury is quite severe then it may take more time to heal and go back to normal activities. The patient should undergo thorough rehabilitation to get back full range of motion and strength.
Recovery Period or Healing Time for Grade III- Severe High Ankle Sprain: High ankle sprain of grade III severity are caused when there is complete tear of the ligament. These types of injuries require much more time to heal, which will include a period of thorough rehabilitation. If the injury is unstable, a screw will have to be placed to treat the injury and in such cases the usual healing time for high ankle sprain is around 4 months before the patient can return to normal activities.
Exercises for High Ankle Sprain:
Below mentioned are some of the stretching exercises which are found to be useful for patients with high ankle sprains. These exercises should be started once the initial phase of the injury has passed and the pain and swelling due to high ankle sprain has calmed down. This normally takes about a week. The first goal of the therapy is to get back normal range of motion of the ankle once weight bearing can be tolerated. Once normal range of motion is achieved, then strengthening of the ankle starts. The exercises to improve range of motion after high ankle sprain should be performed at least twice a day.
- Sit straight and try and bring the ankle and foot up as much as possible, so that a stretch to the calf is felt. Hold this position for about 10 seconds and repeat this around 10 times.
- In this exercise, while seated, bring the ankle down and bend it inwards. Maintain this position for about 10 seconds and repeat it about 10 times.
- In this exercise for high ankle sprain or syndesmotic ankle sprain, from a seated position bring the ankle up in an outwards position and maintain this position for about 10 seconds. Repeat this exercise again 10 times.
- In this exercise for high ankle sprain, while in a seated position point the toes down and maintain the position for about 10 seconds and repeat this again 10 times.
The below mentioned exercises for high ankle sprain should only be done once there has been substantial improvement in the ankle pain.
- Stand on the edge of a stair, drop the ankles down and maintain this stretching position for about 10 seconds and repeat the exercise about 10 times.
- Stand about 10 inches from a wall with the toes pointing towards the wall. Now squat down and maintain this position for about 10 seconds and repeat this maneuver about 10 times.
After achieving near normal range of motion and strength following high ankle sprain then you can start with some isometric exercises by first pushing at a fixed object with the injured ankle. Once this is able to be done with minimal to no pain then the exercises can be advanced by placing resistance and then doing ankle range of motion.
- Place the ankle down and inwards against a fixed object like a couch Place your ankle in the "down and in" position against a fixed object such as a couch. Maintain this position for about 10 seconds and repeat it about 10 times.
- In this exercise for high ankle sprain, position the ankle upwards and bring it out against a stationary object. Maintain this position for about 10 seconds and repeat it about 10 times.
- This exercise for high ankle sprain makes use of a resistance band. Take a resistance band and hold the ends of the band in the hands while the band it placed around the foot. Now, try and bring the ankle down as much as possible. Do this for about 10 seconds and repeat it about 10 times. This can also be done by typing the band around a fixed object and then doing this exercise.
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