High Ankle Sprain (Syndesmosis Ligament Injury)



The ankle is made up of three bones, the tibia, fibula and talus. The ligaments of the high ankle are located above the ankle. Also known as syndesmosis ligaments, these ligaments hold the tibia and fibula together at the ankle. The syndesmotic ligament may become injured by any sharp outward twisting or rotating of the foot and ankle. Most frequently, a high ankle sprain occurs when the foot externally rotates (turns outward) in relation to the leg. This may result in stretching of the ligament, causing tears and in extreme cases, ruptures.

The high ankle sprain may also occur in tandem with an ankle fracture. Sometimes, the ligament on the side of the ankle, the deltoid, is torn. The force of the trauma will then be felt in the syndesmosis, as well as upwards to the fibula- where it is likely to fracture. Patients who have a high ankle sprain without any broken bones may be able to tolerate weight/pressure in the foot; however, pain would be present above the ankle- at the point where the tibia meets the fibula. High ankle sprains can be diagnosed during a physical examination at a doctor’s office. X-rays should also be taken to rule out any broken bones.

High ankle sprains most often occur in athletes who are involved in contact sports such as football, basketball and soccer. Symptoms typically include the difficulty walking, severe pain, pain when rotating the ankle, swelling and redness, and significant bruising. Treatment options may include the use of a cast, splint or brace, rest, ice, immobilization and therapy. Severe cases in which the tibia or fibula are displaced may require surgery to reestablish stability in the ankle. Unfortunately, recovery from a high ankle sprain takes longer to heal than other ankle sprains.