High Ankle Sprain


  • High ankle sprains are less common than regular ankle sprains, but when they occur they are often more debilitating.
  • They occur from a twisting injury to the ankle when the foot is planted on the ground.
  • This results in partial tearing of the tibiofibular syndesmosis at the level of the ankle.
  • Anterolateral ankle pain and swelling are the main symptoms.

Diagnostic tips

  1. History of acute twisting injury to the ankle.
  2. Pain and swelling of anterolateral ankle.
  3. Marked limp
  4. Inability to weightbear.
  5. Squeeze test (tibia and fibula) and external rotation test reproduce or aggravate the symptoms.
  6. Ankle motion is restricted.

Tests and Imaging

Plain x-rays of the ankle rarely demonstrate any abnormalities. Occasionally, with a severe high ankle sprain, a stress view (force applied to the heel in an outward direction) will show some displacement and separation of the tibia and fibula (syndesmosis) at the level of the ankle joint, although this is uncommon.

MRI may demonstrate an injury to the anterior inferior tibiofibular ligament. This ligament is typically, partially or entirely disrupted in a high ankle sprain.

Immediate Treatment

  1. Non weightbearing immobilization using cast or cam walker and crutches (6 weeks usually)
  2. Consider taping the ankle to allow an earlier return to activities.

Possible Referral

  1. Podiatry for immobilisation
  2. Foot and ankle surgery for surgical stabilization of the ankle joint in case of unstable injury.