high ankle sprain
Treatment for a high ankle sprain typically follows the standard “RICE” protocol, which stands for rest, ice, compression, and elevation.

A high ankle sprain requires a longer time to heal than a low ankle injury. The focus of treatment is to move the tibia and fibula with respect to each other and facilitate healing in those positions, which would be performed by a doctor.

The treatment of a high ankle sprain uses the standard "RICE" protocol, which includes:

  • Rest: The weight is kept off the affected leg to provide the time required for healing.
  • Ice: Application of ice for about 15 minutes every few hours to reduce inflammation and swelling.
  • Compression: Wrap the affected area with an elastic bandage to minimize swelling.
  • Elevation: Sit or lie down with the foot elevated above the level of the heart to reduce swelling and pain.

Surgery, taping, or braces

For severe high ankle sprains or in cases of ligament tear, surgery (high ankle sprain taping) or braces may be required. The doctor will advise appropriate treatment based on the extent of the surgery. Depending on the recovery progress, the doctor will advise physical therapy and exercises.

What causes a high ankle sprain?

A high ankle sprain or syndesmotic sprain is an injury that involves the set of ligaments that are located above the ankle joint, between the tibia and fibula (the two bones of the lower leg). These ligaments together form a fibrous joint called syndesmosis. The primary function of the ligaments of syndesmosis is to serve as shock absorbers, preventing the tibia and fibula from getting separated from each other.

A high ankle sprain is caused mainly by activities, such as running, jumping, or during a quick change in direction (for example, a sudden twisting, turning, or cutting motion). During the quick change in direction, these ligaments experience very high forces, and the sudden inversion or dorsiflexion of the foot can cause trauma to the syndesmosis. These injuries are mostly noticed in athletes who play high-impact running sports, such as football, soccer, basketball, and lacrosse.

What are the symptoms of a high ankle sprain?

A high ankle sprain can impair the activity of individuals, especially an athlete, for much longer than a typical ankle sprain. These injuries are often associated with severe lateral or medial ankle sprains or fibular fractures. They form approximately 10 percent of all acute injuries that are treated by physicians in clinics.

The main site for a high ankle sprain to occur is on the lateral side (outer side) of the ankle. An individual affected may experience the following symptoms:

  • Tenderness over the ankle joint
  • Pain while weight-bearing
  • Pain with passive and active movements of the joint
  • Pain while rotating the joint
  • Mild to moderate swelling above the ankle in the lower leg

When a high ankle injury is suspected, the individual’s lower leg, ankle, and foot must be immobilized and the person should be transported for immediate emergency medical investigation.

How is a high ankle sprain diagnosed?

The orthopedic will diagnose the high ankle sprain after assessing the symptoms and conducting a physical exam. Two main tests are performed: the squeeze and external rotation test.

  • Fibular compression test: also called a high ankle sprain or squeeze test, is performed by squeezing the leg just below the knee to see if the pain radiates to the ankle area. If the test is positive, it suggests a high ankle sprain.
  • External rotation test: is performed by bending the knee and placing the ankle in neutral or 90 degrees with the foot in relation to the leg. Then, the foot is turned to the outside. If the patient experiences pain at the ankle area on bending the knee, this suggests a high ankle sprain.

Additional tests such as X-rays and magnetic resonance imaging may be conducted to exclude fractured fibula or other complications.


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Medically Reviewed on 9/29/2021
American Orthopaedic Foot & Ankle Society. High Ankle Sprain (Syndesmotic Injury). https://www.footcaremd.org/conditions-treatments/ankle/high-ankle-sprain

de-Las-Heras Romero J, Alvarez AML, Sanchez FM, et al. Management of Syndesmotic Injuries of the Ankle. EFORT Open Rev. 2017;2(9):403-409. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5644422/

WebMD. Picture of the Ankle. https://www.webmd.com/pain-management/picture-of-the-ankle