Understanding High Ankle Sprains
If you closely follow sports and are actively involved in fantasy sports leagues, you are all too familiar with players being sidelined by ankle sprains – especially those described as high-ankle sprains. Though people often hear of ankle sprains on a graded severity scale (Grade 1 to Grade 3), many aren’t aware that the location of the sprain is an essential factor in both the treatment of the injury and the recovery timeline. So let’s dig a little deeper into this topic.
Generally speaking, there are three ankle sprain “types.” The most common type is lateral ankle sprains, and these occur on the outer or lateral ligaments of the ankle. Medial ankle sprains occur on the ligaments of the inner side of the ankle. High ankle or syndesmotic ankle sprains injure ligaments between the two bones of the lower leg and can cause a separation of the 2 bones if severe. If a high-ankle sprain sounds more complicated than other ankle sprain types, it is. So it’s essential to understand the approach taken to treat them, as well as what to do if you think you’ve sprained your ankle.
As mentioned above, with a high-ankle sprain, there is more extensive damage to more structures. In the lower part of the leg, there are two bones: the tibia and the fibula. Between the tibia and fibula is a membrane of connective tissue that keeps the bones together. When a high-ankle sprain occurs, enough force or damage is placed through the foot and ankle that causes injury not only to the ankle ligaments, but it also creates a forceful separation between the tibia and fibula in the lower leg. High-ankle sprains often occur when an athlete plants their foot and then tries to push off or change directions quickly or is unsuspectedly rolled up on by another player who has been blocked or tackled to the ground. During this time of year, high-ankle sprains occur in many athletes who play football – most notably University of Alabama quarterback and Heisman Trophy candidate Tua Tagovailoa, who recently sustained his second high-ankle sprain in the past two seasons.
The chief symptom of a high-ankle sprain is pain that radiates up the leg from the ankle. Every step taken on this type of sprain can be very painful, and the severity may increase when moving the foot in the direction in which the sprain occurred. Although high-ankle sprains are a severe injury, you may be surprised to learn that they do not often cause significant swelling or bruising. Due to the lack of outward or visible “signs” of injury, this type of sprain can be frustrating for the athlete who has sustained it because the ankle “looks fine.” When this is the case, there is danger in carrying on as usual and playing through pain, as many people who have a high-ankle sprain may not realize the extent of the injury.
During a doctor’s examination and diagnostic process, ankle sprains can be “graded” between 1 and 3 based on the severity of the injury. A Grade 1 ankle sprain, or mild sprain means that there is some minor stretching or tearing of the ligaments, but they are still entirely intact. A Grade 2, or moderate sprain, involves partial tearing of the ligament. A Grade 3, or severe sprain, means that the ligament is completely ruptured, and all of the fibers are torn. Typically, the higher the grade for any ligament sprain, the longer the recovery process. Also, the higher the grade, the more potential that it may require surgical correction depending on the level of sport or activity that the injured person wants to return to.
The standard treatment for high-ankle sprains, especially in the acute period after the injury, is something called the R.I.C.E. protocol. R stands for rest, keeping weight off of the injured ankle. I stands for ice, applying every 20-30 minutes for the first couple of days after injury. C stands for compression, wrapping of the ankle to minimize swelling. E stands for elevation, keeping the affected leg elevated to reduce pain and swelling. Physical therapy is also crucial after an ankle sprain to restore range of motion and to strengthen the ankles and leg muscles as well as regain balance to help prevent re-injury.
Though most cases of high-ankle sprains will begin with a non-surgical course of treatment, sometimes surgery is needed to correct the problem adequately. If surgery is necessary for the sprain, it may involve the placement of a screw or strong suture material between the tibia and fibula to hold the bones together. This procedure helps to relieve ligament pressure while healing continues. Tagovailoa is a prime example of someone electing to have surgery to repair the high-ankle sprain, his second in two seasons, in hopes of returning to the field sooner.
Recovery timelines for a high ankle sprain vary greatly from athlete to athlete. In some cases, an athlete can return to the sport in 4 to 6 weeks, but in cases where the injury is more extensive, or surgery was required, that timeline can be pushed out to at least 6-12 months for a full recovery. Following surgery, and once the surgeon determines there are no longer any activity restrictions, post-surgical rehab will begin again with the same focus as non-operative rehab treatment.
The best way to prevent ankle sprains is to be proactive about working on balance, hip and core, and ankle strengthening. A number of athletes also choose to wear ankle braces or tape while they play, which may help, but it is also critical to work on strengthening the muscles rather than relying upon bracing or taping alone to prevent a sprain. Remember, not all sprains are suffered equally and not all can be prevented, but with the help of a certified medical specialist and/or physical therapist, you can help minimize your risk.