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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.
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. Proper stretching and training may help prevent some
"high" (syndesmotic) ankle sprains.
Symptoms
Considerations
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
An 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.
An
inversion injury, the most common cause of ankle sprains,
occurs when the ankle rolls outward and the foot turns
inward. It results in stretching and tearing of the
ligaments on the outside of the ankle. In a "high"
ankle sprain, a less common type of inversion injury, the
ligaments at the top and outside of the ankle are also torn,
increasing the sprain's severity and healing time. The high
ankle sprain is
different from a typical sprain because it is more severe and may,
though rarely, require surgery
early in the treatment course.
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.
Damage to the ligament varies
from simply stretched or slightly torn to completely torn. Your doctor will
grade your sprain accordingly.
-
Grade I is stretching
or slight tearing of the ligament with mild tenderness, swelling, and
stiffness. It is usually possible to walk with minimal pain.
-
Grade II is a larger
but not complete tear with moderate pain, swelling, and bruising. The
damaged areas are tender to the touch, and there is pain with walking.
-
Grade III is a complete
tear of the affected ligament with severe swelling and bruising Walking is
usually not possible because of the ankle gives out, and there is intense
pain, although initial pain may quickly subside.
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 (see sprained
ankles). 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.
Call
Immediately For Emergency Medical Assistance if
a) a broken bone is suspected or if
there has been a serious injury or persistent pain.
b) there is an audible popping sound and immediate difficulty in
using the joint.
How
to Rehabilitate
Rehabilitation can begin a few days after the
injury, when the swelling starts to go down. There are three goals to aim
for in rehabilitation.
1. Restore motion and
flexibility.
Gently move
the ankle up and down. After 5 to 7 days, start restoring motion to
the hindfoot by turning the heel in and out.
You should also begin to restore flexibility to the calf muscles. One
way to do this is to face a wall with one foot in front of the other
and lean forward with your hands on the wall, bend the front leg while
keeping the back leg straight and both heels on the floor. Lean
forward until you feel a gentle stretch, and hold for ten seconds.
Switch legs and repeat.
2.
Restore strength.
After 60 to 70% of the ankle’s normal motion has returned, you can
begin strengthening exercises using a rubber tube for resistance. Fix
one end of the tube to an immovable object like a table leg, and loop
the other end around the forefoot. Sit with your knees bent and heels
on the floor. Pull your foot inward against the tubing, moving your
knee as little as possible. Return slowly to the starting position.
Repeat with the other foot.
You can also sit on the floor with your knees bent and the tube looped
around both feet. Slowly pull outward against the tube, moving your
knee as little as possible. Return slowly to the starting position.
Repeat with the other foot.
3.
Restore balance.
As strength returns, balance is restored by standing on the injured
leg, hands out to the sides. You may want to warm the ankle
before doing these exercises by soaking it in warm water. Warmed tissue is
more flexible and less prone to injury. Use ice when finished with the
exercises to minimize any irritation to the tissue caused by the exercise.
When Can I Return To Sports?
Return to sports only after you have met these goals:
1. You have full range of motion in all directions (up and down, side to side, and in and out).
2. You have good strength in all muscles around the ankle.
3. You have good balance.
4. You have no pain or swelling with exercise or activity.
How to bandage a sprain
1. Wrap a sprained ankles with a
compression bandage in a figure 8 pattern. Make two loops around the
instep, then stretch bandage diagonally across the foot.
2. Bring the bandage around the ankle to the front of the foot. Then wrap
it diagonally across the foot.
3. Continue wrapping the bandage in figure 8 turns. Each turn should
overlap the previous turn by about three fourths of the bandage’s width.
4. When the foot and ankle are wrapped, secure the bandage with a pin.
Leave toes bare. If they become numb or discolored, the bandage is too
tight.
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