Ankle sprains are injuries to the ligaments that stabilize the ankle joint and are the most common sports injury overall. Most sprains involve the lateral ligaments and heal with non-surgical treatment. Syndesmosis injuries (high ankle sprains) involve the ligaments between the tibia and fibula above the ankle joint and have a different recovery profile than lateral sprains.
What Are Ankle Sprains and Syndesmosis Injuries?
The ankle joint is stabilized by ligaments on the lateral side (anterior talofibular, calcaneofibular, posterior talofibular), the medial side (deltoid ligament complex), and superiorly between the tibia and fibula (the syndesmosis, including the anterior inferior tibiofibular ligament and interosseous ligament).
Lateral ankle sprains (the typical sprain) involve injury to the lateral ligaments, most commonly the anterior talofibular ligament (ATFL). They occur from inversion of the ankle (rolling outward).
Syndesmosis injuries (high ankle sprains) involve the ligaments between the tibia and fibula above the ankle joint. They occur from external rotation of the foot relative to the leg, often in football, hockey, or skiing. High ankle sprains take longer to heal than lateral sprains and have different return-to-sport timelines.
Sprains are graded I through III by severity, from mild stretch to complete tear.
Causes and Risk Factors
- Inversion injury (rolling the ankle inward) for lateral sprains
- External rotation injury for syndesmosis injuries
- Sports involving cutting and pivoting (basketball, soccer, football)
- Uneven surfaces or stepping off curbs
- Prior ankle sprain (the strongest predictor of future sprains)
- Generalized ligamentous laxity
Symptoms
- Pain and swelling at the ankle after the injury
- Bruising over the lateral or anterior ankle
- Difficulty bearing weight
- Tenderness over the involved ligaments
- For syndesmosis injuries, tenderness above the ankle joint
- Squeeze test pain (compressing the calf produces pain at the ankle for syndesmosis injuries)
Diagnosis
Dr. Chudik’s evaluation includes the mechanism, timing, and a focused examination palpating each ligament complex. Stress testing of the lateral ligaments and the syndesmosis distinguishes the injury pattern. X-rays rule out associated fractures. MRI is ordered for high-grade injuries, suspected syndesmosis disruption, or persistent symptoms beyond the expected healing time. The Westmont office has on-site high-field MRI and X-ray.
Treatment
Non-surgical treatment is appropriate for most ankle sprains:
- Rest, ice, compression, elevation (RICE) in the acute phase
- A short period of immobilization in a boot or brace
- Early functional rehabilitation with progressive weight-bearing and motion
- A targeted physical therapy program for proprioception, peroneal strengthening, and balance
- Functional ankle bracing during return to sport for several weeks
Syndesmosis injuries follow a longer recovery timeline. Higher-grade syndesmosis disruptions and unstable injuries may require surgical fixation with a screw or suture button construct between the tibia and fibula.
Recovery and Outcomes
Recovery from a Grade I lateral sprain typically allows return to activity within one to two weeks. Grade II sprains require three to four weeks. Grade III sprains require six to eight weeks.
Syndesmosis injuries take longer: typically four to six weeks for non-surgical injuries and three to four months for surgically fixed injuries before return to sport.
Outcomes are generally good when rehabilitation is completed. Failure to complete proprioceptive rehabilitation is a leading cause of recurrent ankle sprains and chronic ankle instability.
When to See Dr. Chudik
Schedule an evaluation after a significant ankle injury with persistent pain or swelling, after recurrent sprains, or if a syndesmosis injury is suspected. Call 630-324-0402 or request an appointment online.