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High Ankle Sprain: Symptoms, Causes and How to Treat It

A person sitting on a white surface holding their right ankle, highlighting an area of pain on the side of their foot, depicted by a red overlay.


A twisted ankle is common for athletes and non-athletes alike. But what happens when the pain goes beyond a simple sprain? A high ankle sprain, also known as a syndesmotic injury, can be a more complex issue affecting the upper part of your ankle joint. This blog explains high ankle sprains, exploring their symptoms, causes, and effective treatment options.

What is a High Ankle Sprain?

A high ankle sprain occurs when the ligaments connecting the tibia (shinbone) and fibula (smaller bone outside your shin) are stretched or torn. These ligaments, known as the syndesmosis, help stabilize the ankle joint and prevent excessive separation between these two leg bones. While not as common as the typical ankle sprain affecting the outer side of the ankle joint (lateral ankle sprain), high ankle sprains can be significantly more serious.

Studies using clinical diagnostic criteria suggest they make up only about 6% of all acute ankle sprains without a fracture. In the United States, the incidence is estimated to be around 2.09 injuries per 100,000 people per year.

What Are The Differences Between A High Ankle Sprain And A Low Ankle Sprain?

The distinction between high and low ankle sprains goes beyond just location.

  • Mechanism of Injury: A key difference lies in the movement that causes the sprain. High ankle sprains typically occur due to forceful twisting motions, often with the foot planted and the ankle in a flexed (pointed upwards) position. In contrast, low ankle sprains most commonly happen when the foot rolls inwards, although outward rolling can also cause them.
  • Ligaments Affected: Low ankle sprains primarily affect the ankle ligaments on the outer side of the ankle joint. On the other hand, high ankle sprains involve the ligaments connecting the shinbone and fibula higher up near the shin, not the ligaments typically associated with a low ankle sprain.
  • Severity: While both common types of sprain can be painful, high ankle sprains or syndesmotic sprains often involve deeper structures and can be more severe than typical ankle sprains, leading to greater instability and a longer recovery time.

The Ligaments Involved In A High Ankle Sprain

High Ankle Sprain: Symptoms, Causes and How to Treat It

Several ligaments make up the syndesmosis, each important in ankle stability. Here’s a closer look at the key ligaments affected by a high ankle sprain:

Anterior Inferior Tibiofibular Ligament (AITFL): The AITFL is one of the most commonly affected ligaments in high ankle sprains. It stretches between the tibia and fibula, providing stability to the ankle joint.

Posterior Inferior Tibiofibular Ligament (PITFL): The PITFL works with the AITFL to stabilize the ankle and lower leg. It is located at the back of the ankle and is less frequently injured than the AITFL.

Interosseous Membrane (IOM): The IOM is a fibrous sheet connecting the tibia and fibula along their lengths. In high ankle sprains, this membrane can also be strained, contributing to the severity of the injury.

Common Causes of High Ankle Sprains

High ankle sprains can occur due to various forceful movements that stress the ligaments above the ankle joint. Here are some common causes:

  • Twisting Motions: Sudden twisting of the ankle, especially when the foot is planted, can stretch or tear the syndesmotic ligaments. This can happen during falls, missteps on uneven terrain, or during sports involving quick direction changes.
  • Impact: A direct blow to the outside of the ankle joint can damage the syndesmotic ligaments. This can occur during contact sports or falls from a height.
  • Overextension: Forcing the ankle joint beyond its normal range of motion, particularly external rotation or dorsiflexion (bending the foot upwards), can stress the ligaments and lead to a sprain.

Activities and Sports That Increase the Risk

Studies show the prevalence of sports-related ankle injuries can range anywhere from 20% to 50%. According to the American Academy of Orthopedic Surgeons, a significant portion (25%) of all athletic injuries involve the foot and ankle. Given this high prevalence, it’s no surprise that certain activities and sports put you at a higher risk of experiencing a high ankle sprain:

  • Football: Football players are prone to high ankle sprains due to frequent direction changes and tackles.
  • Skiing and Snowboarding: Falls on uneven terrain and twisting movements while skiing or snowboarding can lead to high ankle sprains.
  • Basketball and Soccer: These sports involve quick cuts, jumps, and landings, increasing the risk of ankle injuries.
  • Ice Hockey: Similar to other collision sports, ice hockey players are susceptible to high ankle sprains from collisions and falls on the ice.
  • Wrestling and Other Combat Sports: The grappling nature of these sports can lead to forceful twisting or rotation of the ankle, causing high ankle sprains.

Common Symptoms of a High Ankle Sprain

Several ankle sprain symptoms can indicate a high ankle sprain. Here are some key signs to watch for:

  • Pain and tenderness: Pain and tenderness are usually present just above the ankle joint on the outer side.
  • Swelling and bruising: Swelling and bruising can extend higher up the leg compared to a low ankle sprain.
  • Pain when twisting or rotating the foot: Any movement involving twisting or rotating the ankle can cause significant pain.
  • Difficulty bearing weight: Putting weight on the injured ankle can be challenging or even impossible in some cases.
  • Instability of the ankle: The ankle joint might feel loose or unstable, impacting balance and coordination.

How These Symptoms Differ From Those of a Low Ankle Sprain

A person sitting on the ground next to a path, holding their ankle in pain, wearing a pink and blue running shoe.

As mentioned earlier, some key differences exist between low ankle sprain and high ankle sprain symptoms:

  • Location of pain: High ankle sprains cause pain higher up on the outside of the ankle, whereas low ankle sprains manifest pain on the outer side of the ankle joint.
  • Type of pain: Low ankle sprains often present with sharp, burning pain, while high ankle sprains might cause a deeper, duller ache.
  • Swelling and bruising patterns: Swelling and bruising in a low ankle sprain is usually localized around the outer ankle joint. In high ankle sprains, swelling and bruising might extend higher up the leg.
  • Impact on mobility: A low ankle sprain might allow you to bear some weight, while a high ankle sprain can make putting weight on the injured ankle quite difficult.

Treatment for High Ankle Sprain

Treating a high ankle sprain effectively requires numerous approaches. Here are some common high ankle sprain treatment methods:

  • R.I.C.E.: This stands for Rest, Ice, Compression, and Elevation. These are crucial steps to promote healing in the initial injury phase. Resting the ankle for several days, applying ice packs to reduce swelling, using compression bandages to minimize further swelling, and elevating the injured leg above the heart level will all help with initial recovery.
  • Physical Therapy: Physical therapy is important in regaining strength, flexibility, and range of motion in the injured ankle. A physical therapist will design a personalized exercise program to improve stability, balance, and proprioception (your body’s awareness of joint position).
  • Immobilization: In some cases of severe injury, a walking boot or cast might be necessary to immobilize the ankle joint and promote healing. The duration of immobilization will depend on the severity of the sprain.
  • Pain Relief Medications: Over-the-counter pain relievers like ibuprofen or acetaminophen can help manage pain and inflammation.
  • Surgery: Surgical intervention to repair the damaged ligaments might be an option, especially in rare cases of torn ligaments or instability that persists despite conservative treatment. This can also reduce the risk of additional injury.

Recovery Time and Prognosis

The recovery time for a high ankle sprain can vary depending on the severity of the sprain.

  • Mild Sprains: With proper care and physical therapy, mild sprains might take 2-4 weeks to heal.
  • Moderate to Severe Sprains: Moderate to severe ankle sprains can take 6-12 weeks or even longer to recover fully or return to full sports participation. Regaining full strength, stability, and confidence in the ankle joint might take additional time.
  • Surgery: If surgery is necessary, recovery time can be longer, often requiring several months of physical therapy to regain full function.

Prevention Tips

Preventing a high ankle sprain is always better than dealing with the pain and limitations it can cause. Here are some tips to keep your ankles strong and healthy:

  • Wear Appropriate Footwear: Wear shoes that provide good ankle support, especially for activities that increase the risk of ankle sprains.
  • Strengthen Ankles: Regularly perform exercises that target the ankle muscles to improve strength and stability. Calf raises, ankle circles, and balance exercises can be beneficial.
  • Improve Balance and Proprioception: Balance exercises and activities like wobble boards or single-leg squats can enhance your body’s awareness of joint position and improve balance, reducing the risk of falls and sprained ankles.
  • Warm Up Properly: Before engaging in any physical activity, always perform a proper warm-up routine to increase blood flow and prepare your muscles for movement.
  • Be Mindful of Surfaces: Pay attention to uneven terrain or slippery surfaces that can increase the risk of ankle sprains.

Exercises for Prevention

Here are some exercises you can incorporate into your routine to strengthen your ankles and improve balance:

  • Calf Raises: These exercises strengthen the calf muscles, which is important in ankle stability. Perform them on both flat ground and with your toes elevated on a step for an added challenge.
  • Ankle Circles: Slowly rotate your ankles in both clockwise and counter-clockwise directions to improve range of motion and flexibility.
  • Balance Exercises: Single-leg stance exercises on a stable surface, or wobble board challenge your balance and proprioception. Aim to hold the position for 30 seconds to 1 minute per leg.
  • Elastic Band Exercises: Wrap an elastic resistance band around the forefoot and perform various exercises like foot eversion and inversion to strengthen the muscles responsible for ankle stability.
  • Hopping and Plyometrics: Once your ankle has healed sufficiently, incorporate low-impact hopping exercises and plyometrics into your routine to enhance agility and stability.


A high ankle sprain can be a debilitating injury, but with prompt diagnosis, proper treatment, and a focus on rehabilitation, you can recover fully and regain strength and stability in your ankle. By incorporating preventive measures like proper footwear, strengthening exercises, and good balance training, you can significantly reduce your risk of experiencing a high ankle sprain. If you suspect a high ankle sprain, consult a healthcare provider for a proper diagnosis and treatment plan to ensure a smooth and successful recovery.

Want to keep your ankles strong and stable to avoid sprains? Integrative Physical Therapy can design a personalized program to improve your ankle strength, balance, and proprioception. We also offer a variety of services to address other foot and ankle conditions, including Dry Needling for Plantar Fasciitis. Consult with a qualified physical therapist in Jacksonville, FL to learn more and schedule a consultation today!


What does a high ankle sprain feel like?

A high ankle sprain typically causes pain and tenderness just above the ankle joint on the outer side. You might also experience swelling and bruising that extends higher up the leg. Twisting or rotating the ankle can be quite painful, and putting weight on the injured ankle can be difficult or even impossible in some cases.

What happens if you don’t treat a high ankle sprain?

Neglecting proper treatment for a high ankle sprain can lead to complications like chronic ankle instability, weakness, and pain. It can also increase your risk of developing arthritis in the ankle joint in the long run.

Is a high ankle sprain serious?

While a high ankle sprain can be quite painful and debilitating, it’s usually not considered a serious type of injury. However, seeking medical attention for proper diagnosis and high ankle sprain treatment is important to ensure a full recovery and prevent potential complications.

A man in a blue shirt smiling in front of a wall.

Dr. Scott Dixon

PT, DPT, CSCS, MDNC, Cert DN, FMT, Owner and Founder

We help athletes of all levels continue to perform pain free and we help those who have tried very thing else and are hoping to avoid surgery

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