What is a HIGH Ankle Sprain?

We are glued to the TV watching the big game and there goes a key player. Out with a High Ankle Sprain!!! So….what is a high ankle sprain? Can you have a low ankle sprain? The Vikings have been struggling, and now that Adrian Peterson, their star running back, has a high ankle sprain, do they even have a chance? The answer is no, but Peterson will be just fine and back in the game soon.

A high ankle sprain is a tear in the syndesmotic ligament. This ligament lies between the tibia and fibula and connects the bones throughout the lower leg. A typical ankle sprain involves the ligaments that surround the ankle joint. As the name suggest, the Syndesmosis is above the ankle joint and thus a tear in this ligament is called a “high ankle sprain.” Syndesmotic tears occur more commonly with an ankle fracture but isolated syndesmotic tears are also reported. The typical mechanism of injury is external rotation of the foot on the tibia and fibula, as seen on the photo below, on the right.



Syndesmosis injuries are more common than classic ankle sprains. They frequently occur in collision sports or those sports that have rigid ankle immobilizing gear such as skiing. Nearly 74% of ankle injuries reported in hockey are syndesmotic sprains. In the general population syndesmotic sprains make up only 10-20% of all ankle sprains. Typically, the athlete will present with a sore sometimes sharp pain over their leg between the tibia and fibula. The pain is worse when bearing weight and often the athlete cannot bear any weight on the extremity. The diagnosis of a syndesmotic tear is not difficult on physical exam but further studies are performed to identify any associated injuries or the extent of the injury. It is standard to take x-rays and to examine for any fractures, typically seen in the fibula or tibia. Often, an MRI is also ordered to identify the extent of the tear. Very rarely, surgery to repair the torn ligament is necessary.

The degree of severity can vary greatly. Due to the high incidence of associated injuries, it is difficult to outline the recovery time. Multiple studies have been done to determine the average recovery time. This can range from as low as 1 week to as high as 6 months. Studies have consistently showed that stage I and II ankle sprains on average have a faster recovery time than a syndesmotic sprain.

If an isolated syndesmotic sprain is identified with no other associated injuries than recovery time is very short. I feel comfortable saying that Peterson will be back on the field with the rest of the Vikings to finish the season. Unfortunately, with or without and injured Peterson, I don’t see them making it to the play offs.