Identifying and Treating High Ankle Sprains: A Comprehensive Guide

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High Ankle Sprain

A high ankle sprain is an injury to the syndesmosis (a joint at the lower leg). The syndesmotic ligaments connect the distal ends of the tibia and the fibula (two bones located at the lower leg). They are important for the stability of the ankle.

How does it happen?

Pattern of injury: This injury is often caused when the foot is forcibly turned outwards and upwards, especially when body weight is applied at the same time. Commonly, sports like ice hockey or football can cause injuries like this. For non-sportsmen, a missed step resulting in a hard step off stairs or a similar pattern of injury, may also cause this.

How do I know if I have a high ankle sprain?

Some common signs and symptoms of high ankle sprain include:

(do note that this list is not exhaustive!)

  • Pain that radiates from the ankle
  • Difficulty when walking or bearing weight
  • Tenderness or bruising at the upper ankle

What does having a high ankle sprain mean to me?

If left alone, a high ankle sprain, apart from being very painful, causes the ankle joint to become unstable. This means that the bones that make up the joint will move abnormally compared to before the injury.

This leads to a feeling of joint looseness, where the joint feels like it ‘gives way’ easily. This can lead to falls and further injury.

In the long term, an unstable ankle will result in damage to the joint cartilage, leading to cartilage being broken down. This is a condition known as ankle osteoarthritis, which can be severely debilitating.

Patients with ankle arthritis will have chronic pain, and the ankle will become stiff, making stair climbing and walking on slopes very difficult.

Assessment and Work-up

Based on your history, the doctor will perform a focused examination on the ankle. Besides checking the range of motion and feeling for pain over the ankle joint and surrounding tissues, the doctor may also perform provocative tests designed to assess the syndesmosis.

This includes turning the ankle outwards to see if the pain is reproduced (external rotation test) and squeezing the bones of the shin together to see if it causes pain (squeeze test).

Your doctor may require you to undergo imaging tests such as X-rays and MRI scans to confirm the diagnosis.

Treatment Options

In most patients with an unstable syndesmosis, surgery is strongly recommended to repair the injury.

If you are medically unfit for surgery, you may be offered casting as an alternative. You will be required to wear a cast for up to 2 months. Patients undergoing casting will not be allowed to step on the affected ankle for the duration of the casting. After cast removal, your ankle is retested for stability. If it is found to still be unstable, surgery may then be required.

Surgical repair of the syndesmosis is a surgical procedure that involves the insertion of a suture device (such as a tightrope) between the tibia and the fibula. This stabilises the syndesmosis and allows the damaged ligaments to heal. In general, any sutures placed as part of the surgery will be removed at the 2-week mark. You will be referred to physical therapy thereafter.

Rehabilitation and Recovery

Physical therapy after surgery or casting will initially focus on regaining ankle range of motion. Once you have recovered a sufficient range of ankle motion, balance exercises and strengthening will be introduced. The entire process can take 3-6 months.

For an assessment of your condition, please book an appointment with Dr Yong Ren.

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Sarah Taylor

Obstetrics & Gynaecology