Less common than regular low ankle sprains, a high ankle sprain bears damage on the ligaments that connect the tibia and fibula just above the ankle. Injury to the ligaments at this level causes walking to be extremely difficult as a lot of force is placed on this area to make the movements possible.
High ankle sprain is a twisting or rotational injury. It occurs when the ankle is rolled outwards from the leg or the foot is overly bent towards the shin, tearing the ligament. Usually occurring in athletes, American football players and soccer players get this injury when they fall with their ankles twisted outwards or get tangled with other players in a fall.
In an ankle fracture, the fibula might be broken above the ankle level, causing a rupture of the ligaments and the interosseous membrane that supports the tibia and fibula. The fracture usually involves a high ankle sprain and a surgery is most likely need to repair the torn ligament and broken bones.
Patients with high ankle sprains experience minimal swelling but more severe and lasting pain than regular ankle sprains. The injury takes longer to recover as well. The pain occurs just above the ankle and it gets more acute with external rotation.
A mild case of high ankle sprain can be treated with RICE (rest, ice, compression, elevation) as like regular sprains. However, recovery will take much longer. X-rays are done to check for broken bones and if there are none, patient can use a brace after applying RICE to reduce weight bearing on the injury.
A more serious case would require cast immobilization for up to 6 weeks and go through physiotherapy after the cast is removed. This is needed to restore balance and strength as the joints get stiff after weeks of being in a cast.
If the X-ray shows broken bones or a widening between the tibia and fibula, surgery is required. The bones are held back together with screws and a cast followed by a brace has to be worn for 12 weeks. The screws are then taken out in a small surgery and follow-upped with physiotherapy before patient can resume physical activities.
Patient may still experience stiffness after full recovery and certain movements of the ankle might not be as fluid as before. With surgery, infection may occur or the superficial peroneal nerve might get damaged, causing a loss of sensation in the foot. If the injury involves damage of the ankle cartilage, there is a possibility that arthritis would develop.