Many of us have experienced common lateral ankle sprains. However, there are those times when an expected typical ankle sprain is not so “typical”. For recreational and elite athletes, high ankle sprains are the most common contributor to persistent ankle pain and disability.
A high ankle sprain refers to injury of the distal tibiofibular syndesmosis. This complex is comprised of the anterior inferior tibiofibular ligament, interosseous ligament, posterior inferior tibiofibular ligament and deep transverse tibiofibular ligament. The syndesmotic complex serves as a ligamentous restraint to the fibula, resisting normal physiologic external rotation and lateral translation of the talus during the stance phase of gait.
The ankle syndesmosis injury comprises a strong complex of ligaments that require significant force to cause disruption. Syndesmosis injuries often involve forceful external rotation of the foot relative to the leg and commonly occur in court sports such as basketball. On the clinical examination, patients often present with supramalleolar swelling and ecchymosis. There are several tests and imaging studies that assist with the diagnosis.
Some recent examples of well-known professional athletes are Dirk Nowitzki, who suffered this injury in 2008 and more recently Ricky Rubio, who suffered a high ankle sprain this past November.
These injuries take much longer to heal than a typical lateral ankle sprain (typically around 6 weeks time). Again, just as previously discussed with other basketball injuries these are treated on an individual basis. Most of these injuries will heal conservatively, but based on the degree of tear and separation between the tibia and fibula in addition to the disruption of the medial ankle ligaments may determine if surgical repair is warranted. If there is lingering pain associated with and ankle injury I strongly recommended coming into the office for further evaluation and management.