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What is a High Ankle (Syndesmotic) Sprain?

An ankle sprain refers to tearing or stretching of one or more of the ligaments of the ankle. Less common than lateral and medial ankle sprains is a high ankle sprain, which occurs at the location of the “high” ankle ligaments. These ligaments connect the bones of the lower leg, the tibia (shinbone) and the fibula. It is important for this junction to be stable due to the high amount of forces that cross the tibia and fibula during every day and sport-specific activity. Another supporting structure to the two bones of the lower leg is the syndesmosis, which is a fibrous structure that adds stability to the junction of the tibia and fibula. The syndesmosis functions as a joint in its purpose of stability, but it allows very little movement. When the high ankle ligaments are injured due to rotational forces, the syndesmosis is often injured as well.

High ankle sprains occur when the foot is planted, such as during a cutting maneuver, with a simultaneous rotational force. These injuries are less common than other types of ankle sprains.


High ankle sprains occur from:

  • A twisting and rotational force on a planted foot
  • An external rotation force on an outward turned foot

They often occur during high-impact sports.

Signs and Symptoms

  • Pain over the front of the ankle, above the true ankle joint, where the tibia (shinbone) connects the fibula. (This is where the high ankle ligaments attach and support the joint.)
  • Inability to bear weight is common with high ankle sprains due to the increased force that walking puts on the junction of the tibia and fibula as well as the syndesmosis.
  • Pain going up onto the toes.


Treatment of a high ankle/syndesmotic sprain is essentially similar to normal lateral or medial ankle sprains. Unfortunately, due to the severity of high ankle sprains with possible involvement of the syndesmosis, treatment time is often much longer.

First, it is important to reduce the signs of inflammation and keep the swelling at a minimum. Utilization of ice, rest, compression and elevation are essential. If weight bearing is not possible, utilization of crutches and a walking boot are common. Once it is less painful to bear weight, aggressive physical therapy and home exercises are necessary to regain normal ankle strength and endurance to provide stability to the weakened joint. Conservative treatment normally takes about 6 or so weeks.

Once full range of motion, ankle strength and endurance are regained, it is possible to begin a progression back into sports. The inability to perform single leg hops (about 10-15) on the involved ankle may mean that the athlete needs more therapy and time before returning to impact sports. If conservative treatment fails, surgical intervention may be necessary to stabilize the two bones of the lower leg to regain native ankle mechanics.

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