This type of ankle sprain is damage just above the ankle joint, unlike typical ankle sprains which affect the ligaments that attach the ankle bone into the foot. In the case of this type of sprain, there is damage to the ligaments (syndesmotic ligaments) that connects the two leg bones together, the tibia and fibula bones, that together form the top of the ankle joint. The specific ligament is called the anterior inferior tibio-fibula ligament.
The purpose of this ligaments is two fold. One is to keep the fibula bone attached to the lower leg in an effort to form the ankle joint. Additionally, this ligament has some "give" to it so that it expands when the foot is dorsiflexed (lifted upward) in an effort to allow the talus bone of the foot to go through its full range of motion (ankle joint motion). A high ankle sprain is generally a more serious injury then the typical ankle sprain and in most cases takes longer to heal.
HOW DOES THIS TYPE OF SPRAIN OCCUR
The mechanism that creates this injury is the twisting of the foot outward while the lower leg is twisting inward. This causes a torquing of the tibia and fibula bones putting tremendous stress on the syndesmotic ligament to the point where the ligament is damaged or even torn.
Any one may suffer this type of sprain but it is more often than not seen in athletes who have their foot planted in the ground and the impact of someone hitting them like in football or soccer causes the excessive twisting motion. Typically, there will be pain, swelling and eccymosis (black and blue) on the outside of the ankle as well as the front of ankle just above the foot. Rarely do we see pain on the front of the ankle in simple ankle sprains.
DIAGNOSING A HIGH ANKLE SPRAIN
X-rays are taken but it can be difficult to see any change in the position of the tibia and fibula bones.
Stress view x-ray- If a high ankle fracture is suspected a "stress view" may be taken where the mechanism of injury is re-created in an effort to see if there is any widening between the two bones.
MRI- In cases where it is still difficult to make a diagnosis, an MRI may be indicated to determine if there is damage to the syndesmotic ligament.
CT scan (computed tomography) is also helpful as it can demonstrate a widening between the tibia and fibula bones indicating damage to the syndesmotic ligament.
The Squeeze Test is a classic test for this type of sprain, whereby you squeeze the middle of the lower leg from side to side. If there is damage to the syndesmotic ligament then there will be pain.
Klieger's maneuver involves externally rotating the foot relative to the leg. In a high ankle sprain, this too should cause discomfort.
TREATMENT OF HIGH ANKLE SPRAIN
Conservative- Treatment of this type of sprain is along the same lines as treatment for a simple ankle sprain, however, it is not uncommon for this type of sprain to take much longer to heal. The standard treatment of R.I.C.E. (rest, ice, compression and elevation) is in order, but the compression component usually requires a walking boot or cast to better stabilize the tibia and fibula bones.
In more severe cases the patient may have to be non-weightbearing on the affected foot. One of the reasons healing may take longer is due to the chance of misdiagnosis where the diagnosis of lateral or medial ankle sprain is made while in actuality it is a high ankle sprain.
In severe injuries it may take upwards to 8-12 weeks for complete healing and a return to sports. Less time will be required to just return to normal walking activities.
Physical therapy is also very useful for two reasons:1. to facilitate healing and 2. to prevent muscle atrophy.
Surgery- In those cases where pain remains unresolved after a legitimate period of time, surgical intervention is considered where in some cases the ligament is surgically repaired and in other cases a screw may be placed between the tibia and fibula bone to stabilize the stress that it being created during gait.
ORTHOTICS for heel and arch pain for those who must wear dress shoes
click link below
Topical pain reliever
click link below
Relief for nail fungus
click link below
I've been doing some aggressive research lately (it's how I found your incredible website) and realize now that my symptoms are not consistant with the diagnosis.
….after reviewing your amazing site (great for the avg. jill). So thank you very much!!!
I am really, really impressed with your plain-speak explanations for the various conditions.
This was an extremely helpful site. I have an appointment on the 18th and your info. Was right on target…..
A well organized site containing much information written in a manner that the average reader can comprehend.
I found your website and articles most interesting.
Thank you for a quick response. I think your site is the best information site on foot pain and I have viewed many.
I came to your website, footspecialist.net via www.foot-pain explained .com which I think is also your website? I thought explanations for different types of problems were well addressed and thoughtfully stated for the patient in mind.
You have an amazing and extremely informative site. I enjoyed looking through all of the data and stats.
Thanks again so much for the information in the article. Very interesting.
Great article. I have had plantar fasciitis since I was in high school……..
Dear Dr. Mitnick,
The orthotics arrived four days ago and I slipped them into my shoes immediately. I was skeptical as to the usefulness of the item, they really didn't look very exotic. I have to say though, after using them for just four days, I have experienced grand relief from my foot pain. Even the very first day, I was able to do a lot of work while on my feet with at least a 75% reduction of pain. It has only gotten better every day, and I go nowhere without my shoes with the orthotics.
I had been experiencing extreme heel and sole pain for about six months and had to take extended breaks off my feet many times a day as well as regular doses of Ibuprofen. Since getting the orthotics, my life has returned to normal and I feel good again.
Just wanted to say thanks for the recommendation for a very effective item, I had no idea what a change this item could affect.
Thanks for the Response, you hit it on the head.
Redondo Beach, CA
Thank you for your time and expertise in answering my question…..
First, thanks for putting together this website. Its the most informative site I have found dealing with foot problems.
Last June I started having pain and swelling at …….
First of all, thank you for having all this useful information available in one place. I've been through most of your website and based on my research, pain and evaluations I think I've narrowed things down quite a bit.
Thank you for the best site I have found when researching foot pain.
Thanks for replying so quickly. I was a bit concerned. I think your website is great, and chock full of info.....
Thank you so much for your reply which seemed to be right on. I have researched many sites but you put me on the right path to the possible answer. My foot pain may not rule the rest of my life after all! I believe I'll make a sign that reads, "THE END IS NEAR!"
Thanks Very Much,
West lafayette, IN
Dear sir...no doubt you get positive comments re your site...May I please be added to the list of your admirers. In all of my years of web surfing I would say your site is right there with the very best.
Thank you for taking the time to write the terrific info you provide and for putting things into laymen terms for us mere mortals. I pray you have much on going success and thank you again for a deed well done.
As for me I did not find much help for my symptoms and will continue on my quest. Were you anywhere in the South I would make and appointment...Thanks again dear sir...m.e.
Tampa, Florida 33624
Hi. This is a great site! I'm a healthy middle aged woman who is in good health, but.....
Just a wee word of thanks for your wonderful website...It is a terrific service...Thank you for providing your knowledge and help...With highest regards, m ebeling
Michael D. Ebeling
Tampa, Florida 33624
Thanks for a most interesting website, which has helped a lot.
I usually do my research on the Mayo clinic website. I think your website is the most informative site I have found when researching foot pain.
I thank you for putting together this incredible website.
....I have been told that it is not hard enough to be cut off. Please help, I am not sure what to do now! THANKS FOR A WONDERFUL AND VERY HELPFUL SITE!
You have an unusually clear, informative and well-written website for laypersons. Thank you for that.
Mansfield Ctr, CT
First, I'd like to thank you for all the information that you provide on your website and the opportunity to write to you.
First, I want to let you know that you have the best web site I've found related to foot issues. (The only thing I had difficulty finding was the "ask a question" page.)
I received the orthotics Monday afternoon and began wearing them Tuesday. After two days I would say that I have noticed a huge improvement in the discomfort I have been experiencing. My foot feels better than it has in months.
I greatly admire someone like you who would donate and dedicate so much time and effort to helping strangers with no compensation. Truly, it is uncommonly kind. And your site is so intelligently arranged.
Pacific Grove, CA
I used to work for a podiatrist (front desk) back during summers in
college years ago, so I know the benefits of good care. Again, I want
to thank you for an EXCELLENT website. It was so great to get to your
site (top of google search) and actually find all the answers I needed
EASILY and QUICKLY! Clearly you put a ton of work into it and I really
All the best,
By the way, millions of websites could use yours as a guideline on how to organize information and make the site user-friendly. Kudos to you!
Thank you for your very interesting and informative site!
Hi. I come to your site often looking for information. It is really informative and I appreciate it very much. I have RA and have been having considerable amount of foot pain......
Thanks very much for the wonderful informative site.
Thank You for my answer! I have been schedule for a bone density scan, allingment, and I am in the process of getting orthotics made, and checking out the natural remedies.
What a great web site!
Yes I want both pair of orthotics. You don't have an option of ordering 2 at one time so I had to place the order twice. Thanks. My husband likes these and wants to put them in all of his shoes. (referring to Superstep orthotics)
I searched the internet everywhere for a clear description and illustration of my symptoms/problem. http://www.foot-pain-explained.com/ was where I ended my search with answers. If I lived in Jersey (left 30 years ago) and didn't live in Florida I would definetly make an appointment with Dr. Mitnick.
1st of all THANKS A LOT for your great site......
Thank you so much for your response. I will let you know how I am doing if you would like. Your website is awesome!
I want to thank you for such an informative website! I found you based on my ankle pain search and am happy to realize that there may be a relatively simple cause and solution....
...Thanks for your fantastic service.
Thank you so very much, that would be much appreciated. I love those insoles, by the way. (referring to Superstep orthotics)
San Clemente, CA
Dr Marc is fantastic...He seems to know exactly what you are feeling with the problems you are having. I wish he was in my home town so I could go to him with my problems!!!!!!!!!!!!!
Great insights! Thanks Doc, you're the best.
I have been experiencing foot pain of various sorts and am working to figure out what it is. I found this site and can only say BRAVO!! What an excellent site! The time it must have taken to put all this together must've been a daunting task! I am sure it has helped so many people. Thank you so very much for doing this.
Dr. Mitnick, Thank you so much for your reply. I did let my physician know and they took an x-ray - all is well! Also, thank you for providing this wonderful site, it is very helpful with lots of useful information! I appreciate your gift of time! God bless.
Thank you, you were 100% correct. The pain finally brought me to the ER. I spent 8 days in the hospital. The Doppler you spoke of was able to show that there was no pulse in that foot. This was an arterial clot that split and traveled throughout my leg. My leg was almost amputated. I am in rough shape but have all my parts intact!! You certainly know what you are talking about. Thank you for taking the time to answer. Yours Truly!
Staying at home after hallux surgery I spend quite a lot of time seaching info useful for avoiding problems which might come back. Today I found your site and I am .... delighted it happened. It's one of the best site I found last days.
Thanks for taking time to read and answer so many questions. It is truly a public service!
I just wanted to say that I am very greatful for
Also, and importantly, just want to praise this web site. Thorough and thoughtfully presented, it certainly must be of considerable assistance to anyone with a foot problem. Terrific -- and very interesting.I trust the address comes up easily for those seeking information.
Thanks so much for answering my question. You've been more help to me than my own Dr. has been lately. Thanks again....I hope to be able to walk without pain someday.
Wow, that is exactly the information needed!!! thank you thank you thank you!!! I appreciate this help so very much from Marc Mitnick DPM.
Excellent information and help to improve One's life.
Thanks so much for this website Dr. Marc! It is so nice that you have this ask the doctor feature..I'm sure I'ts been helpful for alot of people. I will try what you suggested and see if it helps...thanks again!
I just want to say thank you for the quick response and the good info. I find it amazing and a super nice thing that you do here by answering medical questions at no charge.
Your website is full of a lot of helpful information, and I am very impressed with the time in which you responded to my post. Thank you again for your time and consideration in your response.
Thank you very much for the information, I will consider it. Excellent web site.
San Diego, CA
Just want to say thank you so very much for your quick response and very informative reply! After reading what you had to say, I called the doctor's office and was able to get in and see him the same day as my injury. Toe was x-rayed and luckily, it is not broken or fractured. Very badly bruised and will probably lose the toe nail. And although my toe and toe nail are still very black and blue and very sore, they ARE both starting to feel a little better.
So again, thank you! I am so very happy that I came across your website. The service you provide is outstanding and immeasurable!
Thank you so much for all of your advice. In searching the web for people dealing with this same issue i can tell you that you are a Knight In shining Armor! If I lived in Jersey I would gladly be your Spokesperson. Hopefully next time you hear from me it will be good news. God Bless,
THANK YOU SO VERY MUCH FOR YOUR TIME AND EFFORTS, YOU ARE SO VERY APPRECIATED. THANK YOU FOR ALL YOU DO.
thanks again, this site is very helpful.
Like others have stated...This site is amazing and I am so thankful that it was created.
....Keep up what your doing. Your a life saver.
Thanks again for the information provided on your site. It's easy for non-medical folk to understand your writing, and helps provide better communication between patient and doctor.
This is the best site for foot problem info.
Thank you for this information. This description fits my pain and inflammation behind my 2nd toe perfectly.
Again, I really appreciate that you responded to my inquiry, and that your mention of Parkinson's helped me to find my way to a diagnosis of this difficult to diagnose disease. Most patients see on average 16 doctors before they are diagnosed. I hope that you can help other people that ask for your expertise in the future.
I just wanted to say that I am very greatful for
this website!! I have had a fusion in my rt foot
and am finally getting a little bit better......
Again, Thank you from the bottom of my heart for taking the time to answer my question....your an angel!
Thank you for your response. You have provided some great insight (to my question)....
Thank-you so very much for responding so quickly and in such detail to my question!! I will give my surgeon a call today!!
This website is terrific!!!!
Many Thanks Dr Marc!
Thank you for your response. It sounds like a good plan to me. He did not cut the wart out first ...
Thanks again doc for having this website and we STILL need qualified Podiatrists in beautiful sunny Tampa Bay (Bradenton) Florida.
Dear Dr. Mitnick,
Thank you so very much for taking your time to answer my question. You have greatly relieved my anxiety related to the continual tingly I feel in my feet. I will share your response with my podiatrist next week. God bless you for having this question and answer page on your website! Most gratefully,
Your webpage is excellent, I commend you on sharing your knowledge to the public.
Thank you. you were more detailed than what others have told me they finally called from the last xrays and my son is now in a cast for 2 weeks he did have a fracture that was not noticeable.
I have read your website and I have to admit that I am amazed at all the information that is on here. I have learned more than the three years I have been going to several doctors that I have seen!!
Thank you so much Doc for a quick and thorough response!
I cannot thank you enough for your response, opinion, and suggestions! I want you to know how much it means to me, and I'm sure everyone else who has ever asked you a question! I feel like you're a lifesaver and have empowered me to take a stronger role and stand up for myself and my feet!