High Ankle Sprain – Symptoms, Causes, and Treatment Options

A high ankle sprain is an injury to the ligaments that connect the two bones of your lower leg (tibia and fibula) just above the ankle joint. Unlike a common ankle sprain, which usually affects the ligaments on the outside of the ankle, a high ankle sprain often causes pain when you walk, twist, or put weight on your foot.

Many people with a high ankle sprain find relief and faster recovery with physiotherapy for high ankle sprains, which restores strength, stability, and range of motion, or with massage for high ankle sprains, which reduces swelling, eases soreness, and promotes circulation. Chiropractic care for high ankle sprains can improve alignment and relieve joint stress, while nutrition for high ankle sprains supports healing by reducing inflammation and providing key nutrients for tissue repair. Kinesiology for high ankle sprains also offers guided exercises to rebuild movement patterns and prevent re-injury. Together, these services provide a complete, supportive approach to getting you back on your feet.

Overview of High Ankle Sprain

A high ankle sprain (also called a syndesmotic ankle sprain) happens when the ligaments that connect the tibia and fibula at the lower end of the leg are stretched or torn. These ligaments form what’s called the syndesmosis, which stabilizes the ankle joint during movement.

While most ankle sprains involve rolling the ankle inward and injuring the lateral ligaments, a high ankle sprain usually happens from a twisting injury where the foot is forced outward and upward. This makes it less common than a typical ankle sprain but often more serious and slower to heal.

How Common Are High Ankle Sprains?

Research shows that high ankle sprains account for 10–20% of all ankle sprains. They are particularly common among athletes in sports that involve cutting, twisting, and collisions, such as football, soccer, basketball, hockey, and skiing (Waterman et al., 2010).

Daily Life Impact of High Ankle Sprains

The effect of a high ankle sprain can be significant:

Work: Walking or standing for long periods may be painful, making it hard to keep up with daily tasks or jobs that require mobility.
Sports: Athletes often miss more time from play with high ankle sprains than with common sprains because recovery takes longer.
Sleep: Pain and swelling may disrupt sleep, especially if the injured leg is bumped or turned.
Relationships and mood: Being sidelined from normal activities can cause frustration, irritability, and stress, particularly for active people.

How Is a High Ankle Sprain Different From a Regular Ankle Sprain?

Regular ankle sprain: Usually involves ligaments on the outside of the ankle, caused by rolling the ankle inward.
High ankle sprain: Involves ligaments higher up, between the tibia and fibula, caused by twisting or forceful external rotation of the foot.

This difference matters because high ankle sprains typically require more time and structured care to heal.

Reference: Waterman, B. R., Owens, B. D., Davey, S., Zacchilli, M. A., & Belmont, P. J. (2010). The epidemiology of ankle sprains in the United States. Journal of Bone and Joint Surgery, 92(13), 2279–2284. https://doi.org/10.2106/JBJS.I.01537

Symptoms of High Ankle Sprain

A high ankle sprain can cause pain, swelling, and difficulty walking, but the symptoms are often different from a standard ankle sprain.

What Are the Main Symptoms of a High Ankle Sprain?

Pain above the ankle where the tibia and fibula meet.
Pain with walking or running, especially when turning or twisting.
Swelling and bruising around the top of the ankle and lower leg.
Tenderness when the ankle is squeezed (the “squeeze test” often used in clinics).
Instability or the feeling that the ankle won’t hold up during activity.

Severity Spectrum of High Ankle Sprains

Mild: Slight stretching of ligaments, mild pain, and discomfort during activity but minimal swelling.
Moderate: Partial tearing of ligaments, significant pain with weight-bearing, noticeable swelling, and bruising.
Severe: Complete tearing of ligaments, inability to bear weight, instability, and severe swelling; may occur with fractures.

Red Flag Symptoms to Watch For

Inability to put any weight on the ankle.
Severe pain or swelling that increases rather than improves.
Visible deformity or suspected fracture.

These may signal a more complex injury that needs immediate medical evaluation.

Impact on Daily Function

Work: Jobs that involve standing, climbing, or walking can be very difficult.
Sports: Returning to sport may take weeks to months, depending on severity.
Sleep: Nighttime throbbing pain is common, especially after activity.
Mental health: Long recovery times can impact mood, causing frustration, especially for athletes or people with active jobs.

Reference: Williams, G. N., Jones, M. H., Amendola, A., & Brophy, R. H. (2007). Syndesmotic ankle sprains in athletes. American Journal of Sports Medicine, 35(7), 1197–1207. https://doi.org/10.1177/0363546506296410

Causes and Risk Factors for High Ankle Sprains

A high ankle sprain occurs when the foot is twisted outward (external rotation) or forced upward (dorsiflexion) under pressure. This can damage the syndesmotic ligaments.

Common Causes

Sports injuries: High ankle sprains often happen in football, soccer, basketball, skiing, and hockey when the foot is planted and the leg is twisted.
Falls or accidents: Landing awkwardly from a jump or slipping on ice can force the foot outward.
Contact injuries: Collisions in sports may force the ankle into unnatural positions.

Risk Factors for High Ankle Sprains

Athletic participation: Particularly sports requiring cutting, pivoting, or collisions.
Previous ankle injuries: A history of sprains increases susceptibility.
Footwear and surface: Poorly supportive shoes or uneven ground raise risk.
Age: Young athletes and active adults are most commonly affected.
Occupation: Jobs involving climbing, carrying heavy loads, or uneven terrain increase risk.

How Is a High Ankle Sprain Different From a Fracture?

High ankle sprain: Soft tissue injury affecting ligaments; recovery often takes weeks to months.
Fracture: Bone injury that may require immobilization or surgery.

Sometimes, both injuries happen together, which is why accurate diagnosis with imaging is important.

Lifestyle and Long-Term Impact

If untreated or improperly managed, a high ankle sprain can lead to chronic ankle instability, recurrent sprains, or even early arthritis. This can impact daily life—limiting activity, reducing sports participation, and affecting long-term mobility.

Reference: Hunt, K. J., & George, E. (2013). Syndesmosis injuries of the ankle. Journal of the American Academy of Orthopaedic Surgeons, 21(5), 298–305. https://doi.org/10.5435/JAAOS-21-05-298

Diagnosis, Recovery, and Management of High Ankle Sprain

A high ankle sprain is diagnosed through physical tests and imaging, has a longer recovery timeline than a typical ankle sprain, and is best managed with a combination of rest, rehab, and prevention strategies.

Diagnosis of High Ankle Sprain

A high ankle sprain is diagnosed through a combination of history, physical examination, and imaging when needed. Doctors aim to determine whether the injury involves the syndesmotic ligaments or if another condition (like a regular ankle sprain or fracture) is the true cause of pain.

How Do Doctors Test for a High Ankle Sprain?

During a clinical evaluation, a provider usually:

Asks about your injury: They’ll want to know how it happened, whether your foot was twisted outward, or if there was a collision.
Checks for swelling and bruising: In high ankle sprains, bruising is often higher up the leg.
Performs stress tests:
- Squeeze test – squeezing the tibia and fibula together just above the ankle to see if pain occurs.
- External rotation test – gently rotating the foot outward to check for ligament pain.
- Single-leg hop or step test – in mild cases, testing stability and strength.

Do You Always Need an MRI for a High Ankle Sprain?

Not always. Imaging is usually reserved for moderate or severe cases.

X-ray: Helps rule out fractures and widening of the joint space.
MRI: Best for detecting ligament damage and severity.
CT scan: Used if surgery is being considered or to evaluate complex injuries.

How Is the Root Cause Identified?

Because ankle pain can come from many sources, doctors compare physical exam findings with imaging. If you have pain above the ankle during weight-bearing and positive stress tests, a high ankle sprain is strongly suspected. Imaging confirms the extent of ligament damage and whether other structures, like bones, are involved.

Comparison With Other Injuries

High ankle sprain vs. lateral ankle sprain: Pain is higher up the leg, not just around the ankle bone.
High ankle sprain vs. fracture: Fractures often involve deformity and significant inability to bear weight, whereas sprains involve soft tissue.

Reference: Hunt, K. J., & George, E. (2013). Syndesmosis injuries of the ankle. Journal of the American Academy of Orthopaedic Surgeons, 21(5), 298–305. https://doi.org/10.5435/JAAOS-21-05-298

Recovery Timeline and Prognosis for High Ankle Sprain

Most people with a high ankle sprain recover, but timelines are usually longer than with a standard ankle sprain. The prognosis depends on severity, age, activity level, and how well you follow a rehab plan.

How Long Does a High Ankle Sprain Take to Heal?

Mild sprain: 2–6 weeks, often with rest, bracing, and gradual return to activity.
Moderate sprain: 6–10 weeks, requiring physiotherapy and progressive weight-bearing.
Severe sprain: 3–6 months, sometimes involving surgery if the ligaments or joint are unstable.

If/Then Recovery Pathway

If pain improves steadily in the first 2 weeks → continue conservative care.
If pain persists or weight-bearing is very difficult → get imaging to confirm severity.
If instability or joint widening is detected → surgical consultation may be needed.

Return-to-Work and Return-to-Sport

Desk jobs: Many return within 1–2 weeks, provided movement is limited.
Jobs requiring walking or standing: Often need 4–8 weeks of recovery.
Athletes: Return to sport averages 6–12 weeks, depending on intensity and reinjury risk.

Long-Term Outlook

Most people regain full function, but recovery can be slower than with other ankle sprains. Recurrence risk is higher if rehabilitation is rushed or strength isn’t fully restored. Without proper management, chronic ankle instability and arthritis may develop over time.

Management of High Ankle Sprain

Managing a high ankle sprain involves reducing pain, restoring movement, and preventing recurrence. Care usually follows three phases: acute (pain control), subacute (rehabilitation), and maintenance (long-term prevention).

What’s the Best Way to Manage a High Ankle Sprain at Home?

Step-by-Step Self-Help Tips:

Rest and protect the ankle with crutches or a brace during the early phase.
Ice for 15–20 minutes several times a day in the first 48 hours.
Elevate your ankle above your heart to reduce swelling.
Wear supportive footwear or a boot as recommended.
Begin gentle motion exercises once pain allows (circling the ankle, light stretches).
Gradually add strength training for calves, hips, and core to protect the ankle.

Therapy and Lifestyle Approaches

Physiotherapy: Focuses on regaining stability, mobility, and balance.
Strengthening: Core, hips, and legs help reduce strain on the ankle.
Ergonomics: Adjusting posture at work and in daily life prevents uneven pressure.
Taping or bracing: Protects during return-to-sport or high-risk activity.

Community and Mental Health Supports

Being sidelined from sport or work can affect mood and motivation. Supportive counseling, coaching, and social groups help with stress, anxiety, and long recovery periods.

Preventing Future High Ankle Sprains

Warm up before sports and training.
Wear supportive shoes designed for your activity.
Build ankle and hip strength with regular exercise.
Practice balance training (e.g., standing on one leg).
Avoid returning to full activity too soon after injury.

Multidisciplinary Coordinated Care for High Ankle Sprain at CARESPACE

At CARESPACE, treatment for a high ankle sprain goes beyond addressing the injury itself. We use a multidisciplinary, evidence-based approach that integrates physical therapies, mental health support, and lifestyle strategies. This team-based care helps you recover faster, reduce the risk of re-injury, and feel supported in every aspect of your health.

How Does CARESPACE Treat High Ankle Sprain Differently?

Most clinics treat high ankle sprains with a single-discipline focus—such as physiotherapy or bracing alone. At CARESPACE, we believe you deserve a coordinated plan that brings together different specialists working as one team.

Your care may include:

Physiotherapy for mobility, strength, and balance exercises.
Chiropractic care to support joint alignment and relieve compensatory stress.
Massage therapy to reduce muscle tension and improve circulation around the injured area.
Kinesiology and fitness training to rebuild function and prevent recurrence.
Psychotherapy and mental performance coaching to help you manage stress, frustration, or fear of re-injury.
Nutrition and naturopathic support to optimize healing and reduce inflammation.
Acupuncture to manage pain naturally and support recovery.

Why Does a Team Approach Help High Ankle Sprain Heal Faster?

Recovery from a high ankle sprain is often longer and more complicated than from a typical ankle sprain. That’s why a team approach makes the difference.

In the acute phase, physiotherapists focus on pain relief, swelling reduction, and gentle mobility. Massage therapists may ease muscle tightness caused by guarding. Chiropractors may make small adjustments to improve overall movement.
In the subacute phase, kinesiologists and fitness coaches introduce strength and stability training. Psychotherapists or coaches may help you cope with frustration from being sidelined, while nutritionists recommend foods that reduce inflammation.
In the maintenance phase, your team shifts focus to injury prevention, sport-specific training, and long-term mental resilience.

Because every provider communicates with each other, your care is seamless and consistent, reducing overlap and ensuring no gaps in your treatment plan.

How Does CARESPACE Support Mental Health During High Ankle Sprain Recovery?

A high ankle sprain doesn’t just affect your body. It can impact your mental health too. Being unable to play sports, work, or stay active may cause stress, anxiety, or sleep problems. CARESPACE integrates mental health care into your treatment plan so you don’t feel like you’re managing recovery alone.

Psychotherapy can help you manage frustration, cope with setbacks, and rebuild confidence.
Mental performance coaching supports athletes returning to play with strategies to overcome fear of re-injury.
Nutrition guidance helps stabilize mood and energy while supporting physical healing.
Exercise and fitness coaching improves endorphins, sleep, and resilience.

By combining physical and psychological care, we make sure you heal more completely—both physically and emotionally.

A Personalized, Evidence-Based Plan for High Ankle Sprain

No two high ankle sprains are alike, which is why CARESPACE designs personalized treatment plans. Your journey may look something like this:

Acute phase (weeks 1–3): You may start with physiotherapy for gentle mobility, massage to reduce swelling, and bracing to stabilize the ankle. A psychotherapist may help you manage pain-related stress.
Subacute phase (weeks 4–8): As pain improves, you progress to strengthening and stability training with kinesiology, while nutrition support helps speed tissue repair.
Maintenance phase (weeks 9+): Focus shifts to return-to-sport drills, long-term posture and gait correction, and mental performance coaching to rebuild confidence.

This progression ensures that you don’t just recover from your current injury—you build a stronger foundation to prevent future sprains.

The CARESPACE Advantage

Multidisciplinary: Every relevant discipline is integrated.
Coordinated: Providers communicate about your progress and goals.
Evidence-based: Care is guided by the latest clinical research.
Holistic: Both body and mind are supported throughout recovery.
Prevention-focused: Plans are built to reduce recurrence and protect long-term joint health.

Why Multidisciplinary Care Beats Single-Treatment Approaches

With a single-discipline approach, important pieces of your recovery may be missed. For example, physiotherapy might restore movement, but without strength training or coaching, you may remain vulnerable to reinjury. Massage may relieve tension, but without nutrition or psychological support, healing may feel incomplete.

At CARESPACE, all these elements are woven together into one plan, helping you:

Return to work or sport faster.
Reduce the risk of long-term instability.
Feel supported in both body and mind.
Build sustainable habits for long-term health.

Related Conditions, FAQs, and Disclaimer for High Ankle Sprain

A high ankle sprain can sometimes look or feel like other injuries around the ankle and lower leg. Knowing about related conditions helps you understand why accurate diagnosis is important and why recovery may look different from a typical sprain.

Related Conditions for High Ankle Sprain

Several injuries and conditions can mimic or overlap with a high ankle sprain:

Lateral ankle sprain: The most common type of sprain, usually caused by rolling the ankle inward. Pain is usually around the outside of the ankle, not above it.
Ankle fracture: A break in one of the ankle bones. Fractures often present with severe swelling, inability to bear weight, and sometimes deformity.
Achilles tendon injury: Pain and swelling in the back of the ankle or calf, which may be mistaken for ligament injury.
Shin splints (medial tibial stress syndrome): Pain along the shin bone, usually from overuse, not ligament damage.
Chronic ankle instability: Recurrent sprains or giving way of the ankle due to weakened ligaments, which can follow a poorly healed high ankle sprain.

These overlapping conditions highlight why medical evaluation is key—especially if pain persists or worsens.

Looking for information on a different condition? Visit our full Conditions List.

FAQs About High Ankle Sprain

If you’re dealing with a high ankle sprain, you may have questions about symptoms, causes, and the best treatment options available. Below, we’ve outlined the most important information to help you understand high ankle sprains, what recovery might look like, and how CARESPACE can support you with a personalized care plan.

1. What is the fastest way to relieve high ankle sprain pain?

The fastest way to relieve high ankle sprain pain is to reduce stress on the injured ligaments while controlling swelling. Most people start with rest, ice, compression, and elevation (RICE).

In the first 48 hours, ice can help reduce swelling. Elevating your ankle above heart level also helps drain fluid buildup. A brace or supportive boot may be needed for stability. Pain-relief medication may help in the short term, but recovery also requires rehabilitation through physiotherapy and strengthening.

Quick relief is possible, but lasting recovery depends on following a structured care plan, not just masking the pain.

Disclaimer: This content is for informational purposes only and is not a substitute for professional medical advice. If you think you may have a high ankle sprain, consult a qualified health provider.

2. Can a high ankle sprain go away on its own?

A mild high ankle sprain may improve on its own with time and careful self-care. However, these sprains typically take longer to heal than common ankle sprains.

The syndesmotic ligaments are essential for ankle stability, and without proper management, they may not heal correctly. Untreated injuries can lead to chronic ankle instability or even arthritis later in life. Most people benefit from medical guidance, even if treatment is conservative.

If your pain improves steadily, that’s a good sign. But if it persists beyond a couple of weeks or worsens, it’s best to see a doctor.

3. When should I see a doctor for a high ankle sprain?

You should see a doctor for a high ankle sprain if:

You cannot put weight on your ankle.
Pain is severe or located above the ankle joint.
Swelling or bruising extends up the leg.
Symptoms worsen instead of improving after a few days.

Immediate medical care is needed if you notice deformity, numbness, or loss of sensation. These may indicate a fracture or more complex injury.

Even if your symptoms feel manageable, consulting a professional ensures the injury heals properly and prevents long-term instability.

4. What exercises help with a high ankle sprain?

Gentle, progressive exercises can speed recovery from a high ankle sprain. These usually start once pain and swelling are controlled.

Common exercises include:

Range of motion: Ankle circles or alphabet writing with your toes.
Strengthening: Calf raises, resistance band ankle pulls, and toe walks.
Balance training: Standing on one leg or using a wobble board.
Functional drills: Later, hopping and agility exercises to prepare for sports.

Always begin slowly and under guidance from a physiotherapist to avoid reinjury.

5. Does sitting or standing make a high ankle sprain worse?

Yes, both sitting and standing can worsen discomfort from a high ankle sprain if done for long periods without breaks.

Sitting for too long can lead to stiffness and swelling if the leg isn’t elevated.
Standing for extended periods puts weight through the injured ligaments, slowing recovery.

The best approach is to alternate positions, keep the ankle elevated when possible, and take breaks to gently move the joint. Supportive footwear or braces may also reduce strain.

6. Is surgery always required for a high ankle sprain?

No, surgery is not always required for a high ankle sprain. Most cases heal with conservative treatment, including bracing, physiotherapy, and gradual return to activity.

Surgery is usually reserved for severe injuries where ligaments are completely torn, or the bones of the ankle have widened apart. Even after surgery, rehabilitation is critical to restore stability.

For most people, non-surgical care leads to full recovery when combined with patience and structured rehab.

7. How can I prevent a high ankle sprain from coming back?

You can reduce your risk of another high ankle sprain by strengthening and protecting your ankle.

Prevention tips include:

Wearing sport-specific shoes with good ankle support.
Strengthening calf, hip, and core muscles.
Doing balance and agility training to improve stability.
Using braces or taping during high-risk sports.
Avoiding premature return to play after injury.

Consistency is key—prevention is not just what you do after an injury, but part of your daily routine.

8. What’s the difference between a high ankle sprain and a regular ankle sprain?

The difference lies in where the ligaments are injured.

Regular ankle sprain: Affects the ligaments on the outside of the ankle, usually from rolling the foot inward.
High ankle sprain: Affects ligaments between the shin bones, often from twisting or external rotation.

High ankle sprains take longer to heal and often require more structured rehabilitation. Recognizing this difference is important for setting realistic expectations for recovery.

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Disclaimer: This content is for informational purposes only and is not a substitute for professional medical advice. If you think you may have an AC joint sprain, consult a qualified health provider.