Sep 22, 2021

Less commonly seen is the high ankle sprain. It involves separation of the ligaments that bind the 2 long shin bones (tibia and fibula). The area of the ankle where this separation occurs is called the syndesmosis. The syndesmosis consists of the interosseous membrane (IM), anterior inferior tibiofibular ligament (AITFL), posterior inferior tibiofibular ligament (PITFL), and the transverse tibiofibular ligament and interosseous ligament which are not pictured in the video. The IM spans the entire length between the tibia and fibula, while the AITFL and PITFL are the primary stabilizers of the distal shin joint, limiting external rotation of the foot. 🦶

As such, a high ankle sprain usually occurs from a twisting or rotational injury. For example, pivoting inwards with the foot planted, OR experiencing an external blow to the outside of the knee while the foot is planted and flexed. This position creates shearing forces within the ligaments and interosseus membrane, causing them to split apart. In more serious cases, it can be accompanied with fracture. Common sports involved include basketball🏀, soccer⚽, rugby (or American football)🏈, and lacrosse🥍.

There is normally point tenderness over the syndesmosis, with perhaps less swelling than common ankle sprain, but difficulty to weight bear. Thus, the initial management is to offload weight, and surgery if there is frank instability, confirmed via imaging. 🦴

For physiotherapy, the primary goal of the initial phase is to protect the joint while managing the swelling, inflammation, and pain. This is done through modalities such as current therapy, manual therapy, and cryotherapy. Appropriate exercises and gait retraining are slowly introduced to regain motion, function and strength. The recovery time for a high ankle sprain typically takes longer than a common ankle sprain, and can take several months. Eventually, return to sports and activities are introduced. ⛹️🤾

Send us a DM or contact us at 82182905 / 62620970 to learn how to manage a high ankle sprain! 📱

📝1. Williams, G. N., & Allen, E. J. (2010). Rehabilitation of Syndesmotic (High) Ankle Sprains. Sports Health: A Multidisciplinary Approach, 2(6), 460–470. doi:10.1177/1941738110384573
📝2. Syndesmotic Ankle Sprains. (n.d.). Physiopedia. Retrieved September 20, 2021, from
📝3. Porter, D. (n.d.). High Ankle Sprain (Syndesmotic Injury). AOFAS FootCareMD. Foot Care MD. Retrieved September 20, 2021, from
📝4. Lee, E. (n.d.). High Ankle Sprain: A Difficult Athletic Injury | OAK Orthopedics. OAK Orthopedics. Retrieved September 20, 2021, from

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