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How Serious Is a High Ankle Sprain?

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Concussions, bone breaks and tendon tears tend to make the biggest sports headlines. So, just how serious is a sprain?

During a December 4 game against the Cincinnati Bengals, Jacksonville Jaguars quarterback Trevor Lawrence went down when a teammate accidentally stepped on his ankle before a sack. An X-ray showed no break, and the injury was later reported to be a high ankle sprain.

After the game, Jaguars Coach Doug Pederson told the press, “I don't think [surgery] is a necessary means at this point. Because of where it is in the ankle, it's not necessarily something that surgery would be warranted at this time.”

AdventHealth podiatrist and surgeon Geoffrey Cady, DPM, AACFAS, is here to help explain this injury, its impact on an athlete, and whether or not Coach Pederson’s assessment is correct.

What is a high ankle sprain?

The “high ankle” ligaments are a group of ligaments that attach between the fibula and the tibia just above the level of the ankle joint. These ligaments are collectively called the syndesmosis.

“The syndesmosis provides stability in rotational movement between the fibula and tibia,” says Dr. Cady. “The ligaments are injured in high-speed collisions or in rotation injuries where the foot is forcibly rotated outward and toward shin — a football player being tackled, or the ankle being stepped on from the side is a perfect scenario.”

How is a high ankle sprain diagnosed?

“As with any diagnosis, a thorough history is very important, particularly understanding how the injury happened and the location,” explains Dr. Cady.

“A physical exam is conducted to check for pain at the syndesmosis and to assess its stability. We take X-rays to rule out fractures and assess the alignment of the ankle joint and syndesmosis. If there is a strong suspicion for a high ankle sprain based on the history, physical exam and X-rays, an MRI is then ordered to assess the extent of the injury.”

What’s a typical treatment plan for a high ankle sprain?

Dr. Cady explains that high ankle sprains are mostly treated without surgery if there is no instability to the syndesmosis on imaging, but instability or visible separation of the tibia and fibula would be a cause for surgery.

“A CAM boot is worn until the injury is no longer tender, and therapeutic exercise and functional rehabilitation is begun under the supervision of an athletic trainer or physical therapist. These rehab exercises include range of motion and strengthening. The patient is gradually allowed to return to sport-specific activities, like running, jumping, cutting and pivoting.”

What’s the recovery period for a high ankle sprain?

“Recovery from high ankle sprains is typically longer than lateral ankle sprains,” says Dr. Cady. “Full recovery can take anywhere from four to six weeks, depending on the severity of the injury. For athletes, the player’s position may also determine the length of recovery — positions that require cutting or quickly changing direction are most affected by this injury and may take the full four to six weeks to return to play.”

We’ll likely see Lawrence back on the field with some extra support.

“Once an athlete sustains a high ankle sprain, they are more prone to further injury,” says Dr. Cady. “These athletes have their ankles taped or braced during competition.”

How can athletes and non-athletes prevent high ankle sprains?

Dr. Cady says activity type is a big factor in your risk: “High ankle sprains occur most frequently in collision sports like football (most common), lacrosse and soccer. They represent 10% of all ankle sprains.”

Strength and balance can help everyone avoid this kind of injury. “High ankle sprains are relatively uncommon in non-athletes; however, exercises that strengthen muscle control around the ankle, correct warm-up, stretching, and balance-training exercises before physical activity can help resist the forces that lead to a high ankle sprain.”

Leading Care to Help Heal (and Prevent) Orthopedic Injuries

If you find yourself in need of foot and ankle care, Dr. Cady and our expert team are always here to help our West Florida communities. To learn more about our comprehensive foot and ankle care and make an appointment, visit our website.

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