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High Ankle Sprains

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For the last two weeks, a large portion of the Super Bowl media coverage has focused on Patriots TE Rob Gronkowski’s ankle injury.  He sustained a high ankle sprain in the AFC championship game two weeks ago, and there has been much speculation on whether he will be healed enough to play in the big game.  If you follow sports at all, I’m sure you’ve heard of a high ankle sprain and you know that it usually takes longer to heal than a typical ankle sprain.  But what exactly is a high ankle sprain and why does it take so long to heal?

A high ankle sprain is an ankle sprain that also involves the syndesmosis of the ankle.  The syndesmotic ligaments hold the bones of the lower leg, the tibia and fibula, together.  Typical ankle sprains most commonly involve the lateral ankle ligaments that attach to the tip of the distal fibula, or less commonly the medial ankle ligaments that attach to the tip of the medial malleolus.  Both of these injuries cause pain low in the ankle joint, usually just below the tips of the malleoli – the large bony bumps that you feel on each side of the ankle.   A syndesmosis sprain usually causes pain slightly above the ankle joint where the tibia and fibula are held together, which is higher than the common sprains giving rise to the term “high” ankle sprain.  The pain usually occurs with weight bearing, and can be elicited on physical exam by several methods including the “squeeze test” in which the bones in the end of the leg are squeezed together by the examiner.

While the treatment of high ankle sprains is similar to other ankle sprains they generally take several weeks longer to heal because of the added injury.  On average, high ankle sprains take four to six weeks to heal before pain free athletic activity can occur.  It is important to correctly diagnose syndesmosis sprains early so that reasonable expectations regarding healing time and return to play can be established.

I’m sure Gronkowski will tough it out for the Super Bowl and be on the field much of the game with the aid of taping and bracing.  You never really know because the Patriots are notorious for not releasing details on their players’ injuries, but if he truly has a high ankle sprain he will almost certainly be limited by pain during the game.

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