What Is A High Ankle Sprain? | A Physical Therapist Explains

Written by on May 20, 2022 — Medically reviewed by Mich Torres (PT)

Among the 3 typical ankle sprains, a high ankle sprain is probably the most disabling. (1) But first, what is a high ankle sprain?

Also known as a syndesmotic ankle injury, this type of sprain accounts for 10% of all sprains. It affects the ligaments that are crucial for ankle stability. (1, 2)

Below, you’ll learn all you need to know about this injury. Here’s what’s in store for you – tap any of the links to go straight to that section:

What are high ankle sprains?

Your talofibular ligaments keep your lower tibia and fibula (shin and calf bone) in place whenever you move your foot. They are the ones injured in a high ankle sprain. (3)

Much like a common ankle sprain, excessive external rotation (foot going outwards) and/or severe dorsiflexion (foot pointing up) on a planted foot can sprain these ligaments. (4)

This mechanism of injury usually happens in (3, 4):

  • Football players, when pivoting to the inside using their outer foot.
  • Skiers with momentum, getting their ski boot stuck in the snow.
  • Ice hockey players, when their skating shoe is forced to hit the sideboard.

What is the difference between high and low ankle sprains?

Both types of sprain are named after the part of your ankle joint that’s injured.

High ankle sprains affect the talofibular ligaments, which are located on the “higher” part of your ankle.

Meanwhile, a low ankle sprain means the injury occurred below your ankle joint. There are two types:

  • Lateral sprain. This is a typical ankle sprain. It affects the anterior talofibular ligament, found on the outer side of your ankle.
  • Medial or eversion sprain. Not as common, it’s the injury of the deltoid ligament on your inner ankle.

Learn more: What type of ankle sprain is the most common?

What does a high ankle sprain feel like?

A high ankle sprain causes pain and swelling at the top of your ankle joint – that’s where the damaged ligaments are.

Additionally, you may also notice bony tenderness on your ankle bones to anywhere up your calf bone. The larger the area that you feel is tender, the more severe a sprain you likely have. (3)

Finally, this injury may also affect your walking pattern, from a normal heel-toe to a heel-raised manner. This is your body’s way to avoid pain-provoking motions like pushing off and pointing your foot upward. (2)

Now, these symptoms will vary depending on the severity of the sprain.

We classify the severity of your ankle injury with a grading system, from I to III.

Grade I ligament injuries are considered mild and work well with conservative care. On the contrary, grade III are severe high ankle sprains where surgery should be considered. (3)

Further reading: The 5 unmistakable symptoms of high ankle sprains.

Treatments for a high ankle sprain

Keeping your ankle joint immobile

Immobilization and crutches are initially needed to allow proper ligament healing for your sprained ankle. (3)

The length of immobilization may vary depending on the severity of your sprain. You will probably have to use a removable walking boot.

Meanwhile, crutches are used for 1 or 2 weeks before slowly progressing with weight-bearing activities. (5)

Home remedies

For pain and swelling, use RICE therapy. It stands for rest, ice, compression, and elevation. This home remedy is especially effective for the first 4-5 days from your initial injury. (6)

If you need more support, you can try wrapping your ankle or using an ankle brace. The former gives you a more personalized fit, while the latter has less risk for skin irritation and is more user-friendly. (7)

This will help: 7 effective home treatments for ankle sprains.

Ankle exercises

Even after a brief immobilization, your injured ankle might not be strong enough to handle your previous level of activities. This means you might be prone to another injury.

This is why doing exercises are important after a high ankle sprain.

If done right, you can boost the recovery of your ligaments and surrounding muscles without the risk of overstressing them. (8)

Doing your exercise daily, but just to the point of tolerable pain, is a good way of regaining your ankle function.

Try this: 12 Physio-approved exercises to heal your ankle sprain.

Physical therapy

A personalized assessment and treatment plan is what physical therapy can offer you.

A physical therapist will look for any imbalances in and around your ankle joint that may have led to your injury. Once identified, your therapist will guide you through various manual and exercise approaches to help fix them.

This means that aside from recovering from a sprain, physical therapy can also prevent re-injuries in the future.

Further reading: 7 treatments for high ankle sprains.

Do high ankle sprains require surgery?

You may need to undergo surgery to restabilize the ankle if you have (2, 5) :

  • A grade II or grade III high ankle sprain.
  • Presence of fractures.
  • Involvement of your inner, deltoid ligament.

There are different approaches in regards to surgery for a high ankle sprain. But their goals are essentially the same – reducing the gap and securing your ankle in place. Most surgical approaches do this by using a surgical screw or rod. (5)

How long does it take to recover from a high ankle sprain?

Full rehabilitation typically requires 2 to 6 months to allow adequate time for healing. (5)

This long period may be due to the limited blood supply of the area and reliance on immobilization for the injured ligament to heal. (9)

How is a high ankle sprain diagnosed?

Your doctor may ask you if any preceding events may have caused your injury. A wrong pivot or a sudden stop after a jump are two typical mechanisms of injury.

Next is the physical examination. The following can indicate your doctor you have a high ankle sprain (2):

  • Pain and swelling at the top of your ankle.
  • Lack of ankle motion when turning your foot upwards and out.
  • Heel-raised walking pattern.

Finally, x-rays may also be used to rule out possible ankle fractures, complete ligament tear, or structural instability. (3)


Can I walk on a high ankle sprain?

Yes, but this injury may lead to a heel-raised walking pattern. If you have that, it may be best to let your symptoms subside to avoid this abnormal movement.

Is a high ankle sprain worse than a break?

This depends on what type of sprain and fracture you have. For example, a grade I high ankle sprain might be easier to treat than a broken ankle.

Do high ankle sprains recur?

9.8% of high ankle sprains do happen again. (10)

Conclusion: What does a high ankle sprain look like?

A high ankle sprain is a tear or rupture to the ligaments on top of your ankle joint. These damaged ligaments are vital to keeping your ankle stable.

This injury may take a longer time to heal compared to other ankle sprains due to poor blood supply and immobilization.

Thus for it to get better faster, you may need to undergo physical therapy or surgery.


  1. Wolfe, Michael et al. “Management of Ankle Sprains”. Am Fam Physician. 2001 Jan 1;63(1):93-105. https://www.aafp.org/afp/2001/0101/p93.html
  2. McGovern, Ryan P, and RobRoy L Martin. “Managing ankle ligament sprains and tears: current opinion.” Open access journal of sports medicine vol. 7 33-42. 2 Mar. 2016, doi: 10.2147/OAJSM.S72334
  3. Wells, Bradley et al. “MANAGEMENT OF ACUTE GRADE II LATERAL ANKLE SPRAINS WITH AN EMPHASIS ON LIGAMENT PROTECTION: A DESCRIPTIVE CASE SERIES.” International journal of sports physical therapy vol. 14,3 (2019): 445-458. doi: 10.26603/ijspt20190445
  4. Tully, Mark A et al. “Functional management of ankle sprains: what volume and intensity of walking is undertaken in the first week postinjury.” British journal of sports medicine vol. 46,12 (2012): 877-82. doi:10.1136/bjsports-2011-090692
  5. Petersen, Evi et al. “Walking barefoot vs. with minimalist footwear – influence on gait in younger and older adults.” BMC geriatrics vol. 20,1 88. 4 Mar. 2020, doi:10.1186/s12877-020-1486-3
  6. Beynnon, Bruce D et al. “Predictive Factors for Lateral Ankle Sprains: A Literature Review.” Journal of athletic training vol. 37,4 (2002): 376-380.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC164368/
  7. Foster, Alicia et al. “The influence of heel height on frontal plane ankle biomechanics: implications for lateral ankle sprains.” Foot & ankle international vol. 33,1 (2012): 64-9. DOI: 10.3113/FAI.2012.0064
  8. Tiemstra, Jeffrey D. “Update on acute ankle sprains.” American family physician vol. 85,12 (2012): 1170-6. https://pubmed.ncbi.nlm.nih.gov/22962897/
  9. Maeda, Noriaki et al. “Effect of Semi-Rigid and Soft Ankle Braces on Static and Dynamic Postural Stability in Young Male Adults.” Journal of sports science & medicine vol. 15,2 352-7. 23 May. 2016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4879451/
  10. Al-Mohrej, Omar A, and Nader S Al-Kenani. “Acute ankle sprain: conservative or surgical approach?.” EFORT open reviews vol. 1,2 34-44. 13 Mar. 2017, doi: 10.1302/2058-5241.1.000010

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