Many of us are all-too aware of what it means to sprain your ankle. Maybe you were running, maybe landing from a jump, and all of a sudden, your ankle rolls over. You might hear a “pop”, and maybe it starts to swell, and eventually bruise. It may be very difficult to put weight on it right away too. Typically what you have done here is sprained (or stretched) a small ligament (or ligaments) on the outside of your ankle. Most often with some proper rest, maybe some physiotherapy, your life will get back to normal before too long.
But what makes an ankle sprain a “high” ankle sprain? Is it like some sort of super sprain? Not really, it just means that you have injured and potentially stretched a different ligament or ligaments above the ankle. More specifically, it involves a ligament, or series of ligaments that hold together the lower parts of the two shin bones, the tibia and fibula. The ends of these two shin bones form a dome shape, under which fits the first bone of the foot, the talus. This dome shape, and the fact that the talus bone fits nicely into it, gives the ankle all kinds of stability. It is important that the tibia, and fibula don’t splay apart when you put weight on the ankle joint. If they do, stability will be lost in the ankle, and if you are running, for example, when you try to push off the ground to take a stride, you will lose the rigid base to push off, leading to a very inefficient running stride.
Certain sports carry more of a risk for sustaining a high ankle sprain. They tend to involve equipment where there is some type of boot that prevents the ankle from turning over. So although this provides more protection for the smaller ligaments on the outside of the ankle that tend to get injured with a roll-over, it means that there is potentially more of a risk to injure the ligaments between the tibia and fibula (shin bones). The most obvious examples of sports with conditions such as this are ice hockey and down-hill skiing. Sidney Crosby missed 28 games during the 2007-2008 season after going feet first into the boards. (Don’t worry, he still managed to return later that season, contributing to the Penguins run to the finals against the the Detroit Red Wings).
Depending on the severity of the high ankle sprain, an athlete may be out of action for a couple of weeks to a couple of months. Immobilization of the ankle may be required (with a walking boot for example), preventing the ankle from going into too much dorsiflexion (moving the toes towards the knee) so that the talus bone doesn’t drive up in between the two shin bones and splay them apart. Immobilization will stop once the athlete can put weight on their ankle with minimal discomfort, or the sense that it wants to give out. Sometimes, if the injury is severe enough, and the damage to the ligaments is extensive, surgery may be required. In this case, a screw is used to hold the ends of the two shin bones together. In either case (surgery or not), the athlete will eventually start their rehab, usually with restrictions on how much weight they can place on the injured foot initially. Reduction of swelling, increasing strength and range of motion in the ankle are all priorities in the early stages of rehab. As the athlete is allowed to put more weight on the ankle, exercises become much more functional, meaning they are attempting to mimic the stresses of their specific sport.
A high ankle sprain can have a significant impact on an athlete’s ability to push off their foot and generate any type of speed or power. Thankfully it is a relatively rare injury, as it can be difficulty to confidently diagnose, and, like most sports injuries, seems to take way too long to recover from!