Ask the Expert: What is a high ankle sprain?
Q: Two months ago, during a flag football game, I was tripped up while running to catch a pass. I fell awkwardly and ended up twisting my right foot. I was told I had an ankle sprain and given physiotherapy. My recovery has been frustratingly slow and my physiotherapist feels this is because I have a high ankle sprain. Could you please explain what they mean by a “high” ankle sprain?
A: Dear David:
Sorry to hear about your injury. Ankle sprains are very common injuries especially in sports such as flag football. While every ankle sprain is unique, they are commonly divided into two groups:
1. Low or common ankle sprains – approximately 90 per cent of sprains
2. High or syndesmotic ankle sprains – the remaining 10 per cent.
These two injuries are very different, with high ankle sprains usually causing more significant problems.
The ankle consists of three bones held together by a number of tough ligaments. These ligaments are essential to the stability of the ankle joint, and when they are injured the ankle typically becomes swollen, bruised and painful to move. When these ligaments are badly damaged, the ankle can also become unstable.
Low and high ankle sprains involve injuries to different sets of ligaments. In high ankle sprains you injure the syndesmosis – a group of strong ligaments found between the tibia and fibula. The syndesmosis functions to hold your tibia and fibula tightly together to prevent the impact forces of running and walking from spreading these bones apart. When your syndesmosis is injured walking and running can be painful.
High ankle sprains most commonly occur when your foot is forced into rapid external rotation. They can also occur when your foot is rapidly flexed up towards your shin – well beyond the normal range of motion. High ankle sprains are often missed because they typically cause minimal swelling and bruising. Regrettably, they take much longer to heal than common sprains and athletes may be unable to return to play for six months or longer. If the syndesmotic ligaments are badly damaged, they may need to be surgically repaired.
The bottom line: High ankle sprains are generally more significant injuries than common ankle sprains. They cause more pain, take longer to heal and in some cases require surgical repair. Keep working hard with your physiotherapist and stay fit doing low impact activities such as swimming and biking.
Exercise is medicine!
— Dr. Darrell Menard, MD, Diploma in Sport Medicine – email@example.com
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