High Ankle Sprain


High Ankle Sprain: Symptoms

Having a high ankle sprain can seriously hinder your mobility and daily activities. This type of injury is more than just an ordinary ankle sprain; it involves the ligaments above the ankle joint.

High ankle sprains have distinct symptoms, such as pain above the ankle, bruising, difficulty bearing weight or walking, and tenderness.

Pain Above the Ankle

In the wake of a high ankle sprain, one might notice an escalating discomfort above the ankle. This pain typically arises from damaged ligaments positioned higher than those affected in a regular sprain.

A picture of a man's feet labeling the locations of a high ankle sprain and a common inversion ankle sprain with red markers.
Photo Credit: Foot Ankle & Rehabilitation Clinics

Consequently, it encompasses the ankle and the lower part of the leg towards the shin. The severity varies; some people can still walk even with this condition, while others find weight-bearing unbearable.


Bruising is a common symptom of a high ankle sprain. When the ligaments in the ankle are stretched or torn, it can cause small blood vessels to break and result in bruising. The area around the ankle may appear discoloured, with shades of blue, purple, or yellow. This discolouration indicates internal bleeding due to the injury.

Bruising associated with a high ankle sprain usually occurs along the foot’s outer side and may extend upwards towards the leg. It typically develops within a few hours or days after sustaining an ankle sprain.

The severity of bruising can vary depending on how severe and extensive the ligament damage is.

Difficulty Bearing Weight or Walking

Difficulty bearing weight or walking is a common symptom of a high ankle sprain, caused by the injury to the ligaments above the ankle joint. When you have a high ankle sprain, putting pressure on your foot can be extremely painful and may result in instability.

Walking becomes challenging as you struggle to support your body weight on the affected leg. The ankle pain and discomfort experienced during weight-bearing activities make performing everyday tasks or engaging in physical activities difficult.


Tenderness is a common symptom experienced with high ankle sprains. When the ligaments above the ankle joint are stretched or torn, it can result in pain and tenderness in that area.

This tenderness is often noticed when touching or pressing on the affected area, making it sensitive to pressure. It’s important to be cautious and avoid putting excessive force on the ankle as this can exacerbate the tenderness and delay the healing process.

High Ankle Sprain: Causes and Treatment

High ankle sprains are commonly caused by syndesmotic injuries involving the ligaments above the ankle joint. Treatment options include non-operative methods such as R.I.C.E., rehabilitation exercises, ankle taping or braces.

In severe cases, surgery may be necessary. Learn more about high ankle sprains and how to prevent them.

Syndesmotic Injury

A syndesmotic injury, or a high ankle sprain, occurs when the ligaments connecting the tibia (shinbone) and fibula (calf bone) are stretched or torn. Unlike a typical ankle sprain that affects the ligaments on the outside of the ankle joint, a syndesmotic injury involves the ligaments above the ankle joint.

Commonly caused by sudden twisting or rotational movements of the foot during sports activities or falls, syndesmotic injuries can lead to significant pain and discomfort. In addition to pain above the ankle, other symptoms may include bruising, difficulty bearing weight or walking, and tenderness.

AUGUST 13, 2018 - KHARKIV, UKRAINE: Terrible sprained ankle ligament rupture injury of defender trying to block ball during powerful shot on goal. Women's Champions League. WFC Kharkiv - Olimpia
Photo Credit: Oleksandr Osipov, Shutterstock

Diagnosing a syndesmotic injury requires careful examination by a healthcare professional. They may perform specific tests, such as the squeeze test, to determine if there is any instability in that area.

Treatment options for high ankle sprains typically start with non-operative approaches like rest, ice therapy, compression bandages, and elevation (R.I.C.E.).

Rehabilitation exercises are essential in restoring strength and stability to the injured joints after initial healing. Surgery may be necessary in more severe cases where there is significant instability or failure to respond to conservative treatment methods.

To prevent syndesmotic injuries from occurring or recurring in athletes and active individuals alike:

– Ensure proper warm-up before engaging in physical activities.

– Wear properly fitting shoes for adequate support.


Diagnosing a high ankle sprain typically involves a thorough physical examination and possibly some imaging tests. The healthcare provider will carefully assess the area above the ankle for tenderness, swelling, or bruising.

They may also perform specific tests like the squeeze test or external rotation stress test to evaluate the stability of the syndesmosis (the ligaments connecting the tibia and fibula).

X-rays are commonly used to rule out any fractures or dislocations in the ankle joint. In some cases, additional imaging studies such as magnetic resonance imaging (MRI) or ultrasound scans may be recommended to provide more detailed information about soft tissue damage.

Non-Operative Treatment Options

Non-operative treatment options for high ankle sprains focus on reducing pain and inflammation and promoting the healing process. Rest plays a vital role in allowing the injured ligaments to repair themselves.

The R.I.C.E. method – Rest, Ice, Compression, and Elevation – is commonly recommended during the initial stages of treatment. Applying ice packs for 15-20 minutes every few hours can help reduce swelling and relieve pain.

A close-up of the ankle area in the process of being bandaged.
Photo Credit: Tetra Images, Alamy

Compression with an elastic bandage or brace helps support and stability the ankle joint while minimising swelling. Elevating the affected leg above heart level can also aid in decreasing swelling by improving blood flow.

Additionally, physiotherapy exercises are crucial for strengthening the muscles around the ankle joint and restoring its full functionality. These exercises may include a range of motion exercises, balance training, stretching, and strengthening exercises tailored to individual needs.

Rehabilitation and Recovery Process

The rehabilitation and recovery process for a high ankle sprain involves several stages to regain strength, stability, and mobility in the ankle joint:

  • Rest: Initially, rest is necessary to allow the ligaments to heal properly.
  • Range of Motion Exercises: Once cleared by a healthcare professional, gentle exercises can reduce stiffness and improve flexibility.
  • Weight-Bearing Activities: Gradually, under a physiotherapist’s guidance, weight-bearing activities are introduced.
  • Physical Therapy: This plays a crucial role in healing and preventing future injuries. It includes balance training, strengthening exercises, and proprioceptive drills to restore stability and function to the ankle joint.
  • Muscle Strengthening: Therapeutic exercises improve muscle strength around the ankle and enhance coordination.
  • Pain and Inflammation Management: Techniques like ultrasound or electrical stimulation may be used to manage pain and inflammation during physical therapy sessions.
  • Manual Therapy: Treatment options like massage or joint mobilisation may assist in reducing pain and restoring normal joint mechanics.

Surgery As a Treatment Option (If Necessary)

In certain cases, surgery may be recommended as a treatment option for high ankle sprains that do not respond to conservative measures. Surgical intervention is generally considered if there is significant ligament damage or if the joint remains unstable after initial non-operative treatments.

During surgery, the damaged ligaments are repaired or reconstructed to restore stability to the ankle joint.

It’s important to note that surgical treatment for high ankle sprains is not always necessary and is typically reserved for severe cases. The decision to undergo surgery will depend on various factors, including the severity of the injury, individual patient characteristics, and professional recommendations from healthcare providers specialising in orthopedics or sports medicine.

Prevention Measures

A close-up of a person putting ankle foot orthosis on a patient.
Photo Credit: This Is Engineering, Pexels

Preventing high ankle sprains involves several key measures:

  • Proper Footwear: Wear shoes that provide adequate support and cushioning for your ankles. Ill-fitting shoes can increase the risk of injury.
  • Regular Exercise: Engage in regular exercises to improve ankle strength and flexibility. Activities such as calf raises, and ankle rotations can help stabilise the joint and reduce the chances of spraining.
  • Use of Ankle Braces or Taping: Consider using ankle braces or taping techniques for added stability and protection, especially when participating in sports or physical activities.
  • Appropriate Rest and Recovery Periods: Ensure adequate rest periods between strenuous activities to prevent overuse injuries.
  • Good Posture and Movement Techniques: Practice good posture and proper movement techniques during activities to reduce unnecessary strain on the ankles.

These preventive measures can significantly reduce the risk of high ankle sprains and other injuries.

Frequently Asked Questions (FAQs) About High Ankle Sprain

How do you tell if it’s a high ankle sprain?

A high ankle sprain often presents with pain above the ankle, difficulty bearing weight, and tenderness. A healthcare professional can confirm the diagnosis with specific tests and examinations.

Can you walk on a high ankle sprain?

Walking on a high ankle sprain depends on its severity. While minor sprains may allow some walking, severe sprains can make weight-bearing very painful and can delay recovery.

How do you treat a high ankle sprain?

Treatment for a high ankle sprain starts with non-operative approaches like rest, ice, compression, and elevation (R.I.C.E.). Physical therapy exercises are introduced gradually. Severe cases may require surgical intervention.