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UNDERSTANDING HIGH ANKLE SPRAIN

high ankle sprain physiotherapy in Ryde

When speaking regarding ankle injuries, Syndesmotic ankle sprains are less common than other ankle pathologies such as a lateral ankle ligament sprain,  however, are an important part of the examination of leg/foot pain. The main mechanism for this injury is forced external rotation and dorsiflexion of the foot. While surgery is rarely indicated for the general population in the absence of fractures, conservative physiotherapy management can help aid in a faster recovery.

Syndesmotic ankle injuries generally occur during sporting activity and are more of an acute trauma type of injury rather than an overuse injury. It is one that is commonly seen in contact sports such as NRL and Soccer, or sports where the foot is in a fixed position (Skiing, Ice Hockey)

The higher ankle ligaments aid in stability of the long bones of your lower leg (tibia and fibula). Their primary job is to keep the bones together at ankle joint, helping to prevent them from splitting apart whilst walking, running or jogging.

Clinical Presentation of High Ankle Sprain:

Physiotherapy for Swollen high ankle sprain

  1. Pain slightly higher than the ankle joint

  2. Loss of full plantarflexion

  3. Inability to weight bear

  4. Less swelling than a regular ankle sprain

  5. Ankle swelling that gradually increases over the next two days on the outside part of the ankle

As physiotherapists, how do we  assess this injury?

  • Gather a thorough history. Specifically, gathering information regarding location of injury, mechanism of injury, type of sport played whilst injured, position of the foot when injured, ability to weight bear after the injury.

  • If we suspect a syndesmotic injury, we will refer for scans weight bearing X-ray to see for any separation of the tibia and fibula, or MRI to get a better understanding of the ligamentous structures around the whole ankle joint.

    3 Types of Syndesmotic Ankle Injuries

  1. Grade 1 – High ankle sprains without diastasis (separation of tibia or fibula) are stable and are treated conservatively. They are allowed to weight bear as tolerated.

  2. Grade 2 – High ankle sprains with latent diastasis confirmed on X-ray/MRI – do not need surgery but may need to be in a boot for 4-6 weeks to allow healing prior to rehab.

  3. Grade 3 – High ankle sprain with a diastasis of the syndesmosis without a fibula fracture require surgery immediately.

How can Physiotherapy help a High Ankle Sprain?

Depending on the severity of your syndesmotic injury, we will be able to:

  1. Phase 1 – Help protect the area (Cam boot, Crutches etc) and gentle ROM exercises as able.

  2. Phase 2 – Regain normal ankle ROM, regain normal gait, regain basic balance, and start ankle and lower leg strengthening program.

  3. Phase 3 – Start agility drills, Running drills, Improve capacity and strength of the muscles around the ankle joint and return to sport specific drills.

Written by

Neeraj Sampelly

Physiotherapist

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