The San Francisco 49ers recently placed running back Tyrion Davis-Price on the injured list with the dreaded “high ankle sprain.” What is a high ankle sprain, and how is it different than a typical low ankle sprain?

Ankle anatomy

You might not know it, but each ankle joint is composed of a complex array of three main bones, several ligaments, and membranes. Ankles are arranged like a ball-and-socket joint that allows feet to move mainly up and down like a hinge. But ankles also feature some side-to-side and rotational movements.

The flat end of the long tibia bone makes up the weight-bearing surface of the ankle socket. Meanwhile, the distal ends of the tibia and fibula bones form the socket itself.

A strong ligament connects the tibia and fibula (“tib-fib”) together and enables them to develop a tight glove around the talus bone. Other ligaments connect the tib-fib to the talus on either side.

What happens when your ankle is sprained

Sprains cause an injury to the ligaments. The sprain can either stretch ligaments or tear through them. With partial tears, a portion of the ligament still holds the bones together. But when a full tear occurs, the ligaments can no longer hold the bones. Sprains cause excessive motion between the tib-fib, and that is when problems begin.

Low ankle sprains

Most ankle sprains (85%) happen to the lateral side when you roll your foot inward. One of the three lateral ligaments is injured and causes a lot of bruising and swelling. It’s considered a low ankle sprain because of its location below the weight-bearing part of the socket. Lateral ankle sprains can cause instability. Reoccurrence can occur when not treated properly. (Ask Steph Curry about his early NBA career.) Luckily, most heal with rest and ankle support.

A medial ankle sprain occurs when the deltoid ligament on the other side is injured. Medial ankle sprains are also considered a low sprain, but they are less common. Again, rest and ankle support usually heal medial ankle sprains.

High ankle sprains

High ankle sprains happen when a twisting foot injury damages the distal tib-fib ligament. They are most commonly seen during high-impact or contact sports. Typically, the injury is caused by planting the foot while the body is rotating over the leg. This motion can tear the ligament and might cause a fracture to the fibula. A high ankle sprain is more serious because, without a tight socket, the ball can roll around in any direction.

Symptoms of a high ankle sprain include:

  • Pain above the ankle that increases with outward rotation of the foot
  • Pain with walking
  • Bruising and swelling across the high ankle
  • Inability to do a single-leg calk raise

Treatment of a high ankle sprain requires an orthopedic surgeon’s careful examination, which will determine the injury’s stability. Stable high ankle sprains can be treated with rest and the support of a cast or boot. The goal is to hold the tibia and fibula close together so they can heal. Patients may need to wear a supportive brace after a stable high ankle sprain is healed.

But with unstable high ankle sprains, surgery is often required to hold the bones together. In previous medical eras, screws were used for three months. They were removed when the patient resumed walking, or if the screws broke.

Contemporary surgical techniques now use metal and suture devices that can replicate the strength of the tib-fib ligament. These newer techniques allow patients to resume physical activities while the ligament heals. Therefore, a cast or brace may not be needed in modern surgical cases.

Wrapping up

Approximately 25,000 people sprain their ankles every day in the United States. Over half of those don’t see a doctor. Fortunately, most ankle sprains are low and lateral, and they heal with rest and support.

On the other hand, high ankle sprains cause more serious instability and need specialized treatment. If you are concerned about an ankle injury, don’t hesitate to seek evaluation from a sports medicine specialist or orthopedic surgeon.

Dr. Jerome Enad is an accomplished, board-certified orthopedic surgeon specializing in sports medicine. He grew up in Stockton and graduated from Lincoln High School before obtaining his bachelor degree at UCLA and medical degree in Bethesda, Md. He has been practicing medicine for over 30 years and lives in Florida with his wife and three dogs. His health and fitness column appears monthly.

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