High Ankle Sprains
Posted by: Dr. Samuel Carter
The University of Louisville’s Mens’ Basketball Team has announced that Chane Behanan will miss 7-10 days because of a high ankle sprain he suffered during practice. I have written extensively about different types of ankles
sprains in the past, but wanted to give a quick overview for those interested.
Ankle sprains are one of the most common injuries seen in sports, and also one of the most common that I see in my office. The typical ankle sprain occurs when the foot rolls outward (called ankle inversion) and involves the lateral, or outside, ankle ligaments. The ligaments are stretched beyond their limits and can partially or completely tear, causing pain and swelling in that part of the ankle. The medial ligaments can also be sprained by rolling the foot inward (called ankle eversion), but this is more uncommon. Treatment of ankle sprains usually consists of rest, ice, elevation, and compression to control the swelling and a gradual return to activity as pain permits. X-rays are usually normal with an ankle sprain.
A syndesmosis sprain, or a “high” ankle sprain, occurs when the ligaments just above the ankle that hold the two bones of the leg together are stretched or torn. This injury causes pain at the end of the leg just above the ankle, and can occur in conjunction with a lateral or medial sprain. This type of injury generally takes longer to heal than a typical ankle sprain. It is more difficult to diagnose and is often missed because X-rays will not show any difference between a high ankle sprain and a lateral sprain. Only a careful physical exam can diagnose a high sprain. One test used is called the squeeze test, where the examiner squeezes the two bones of the leg together to see if this reproduces ankle pain. Another test involves dorsiflexing the ankle (toes up) and then externally rotating the ankle. This maneuver stresses the syndesmosis, or the ligaments that hold the bones together. If this reproduces ankle pain then a high sprain is likely.
High ankle sprains can be very frustrating because they do not heal as well as a typical sprain and many times the diagnosis is not made right away. An early diagnosis and proper treatment can help avoid re-injury by returning to activity too soon. The treatment of high sprains is similar to other ankle sprains, but I am more likely to recommend ankle bracing when returning to sport after a high ankle sprain. As with all sprains, the severity of the initial injury determines how long it will take to heal, but on average high ankle sprains may take 2-4 weeks longer to heal than a traditional ankle sprain.
There is such a wide range of recovery times based on the severity of the individual sprain that for now, without knowing any more than I have read, I would trust the timeframe given by the treating physician.