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 Definition A "high" ankle sprain is an injury to the ligaments between the two major bones of the lower leg (Tibia and Fibula) at the level of the ankle.
Details A "high" ankle sprain is named because the injury is above the level of the joint. It is a tearing of the syndesmotic ligaments of the tibia and fibula bones. It is different from a typical sprain because it is more severe, takes much longer to heal and may rarely require surgery early in the treatment course.
Causes A "high" (syndesmotic) ankle sprain is caused by an outward twisting of the foot and ankle. This is opposite of a typical ankle sprain where the foot and ankle are twisted inward. Football, soccer and basketball are the most common sports associated with a high ankle sprain.
Diagnosis A "high" (syndesmotic) ankle sprain is diagnosed when a patient has a history of an outward twisting motion to the ankle and pain just above the ankle joint. The patient initially may not be able to walk on injured leg. Squeezing the leg at the midpoint of the calf or gently moving the foot outward may reproduce the patient's pain. X-rays are taken to rule out fractures that can be associated with this injury. Occasionally, an MRI may be needed to confirm the diagnosis.
Treatment Nonoperative: Most "high" (syndesmotic) ankle sprains can be treated in a manor similar to typical ankle sprains with PRICE. P: Protection from further injury via a splint, R: Rest, I: Icing, C: Compression wrapping, E: Elevation. Syndesmotic sprains, however, will require much longer to heal and will also need more physical therapy to strengthen the muscles around the ankle.

Operative: Severe "high" (syndesmotic) ankle sprains with significant displacement of the bones (Tibia and Fibula) require surgical stabilization.

Proper stretching and training may help prevent some "high" (syndesmotic) ankle sprains.