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HIGH ANKLE SPRAIN
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What is it?
An ankle sprain is one of the most common sports related injuries. A high ankle sprain is a sprain to the strong ligaments that hold the two leg bones, the tibia and fibula, together at the ankle. It is called a high ankle sprain because the area injured is a little bit above the more common area injured in an ankle sprain. A high ankle sprain occurs when the foot is forcefully rotated outward. Because of the shape of the bones, this force pulls the two leg bones away from each other, and can injure the ligaments that hold them together. Athletes who participate in collision sports such as football, ice hockey and rugby are at higher risk. Athletes who have a history of high ankle sprain are at increased risk of re-injury.

Symptoms
The most common symptoms of high ankle sprain are pain and swelling along the front of the ankle joint. Bruising is also common. The athlete may have difficulty putting weight on the injured leg when walking.

Sports Medicine Evaluation and Treatment
A sports medicine physician will look for swelling and bruising. The exam will include the foot, the ankle and the lower leg because a more severe high ankle sprain may also injure or fracture one of the leg bones. Depending on the exam findings, x-rays may be needed to examine the bones of the lower leg and ankle, and to make sure the ankle joint still has its normal shape. Treatment of a simple high ankle sprain is similar to other types of ankle sprain, but the recovery period is known to take a bit longer. Initially, the injury is treated with protection, ice and anti-inflammatory medications. Depending on the severity of the sprain, crutches to decrease the amount of weight placed on the ankle may be required. For more severe sprains, a short period of immobilization in a brace may also be needed. Some initial exercises to move the ankle joint will be recommended, and basic exercises to strengthen the ankle muscles and to improve balance will be added soon after. Once the ankle is feeling better, some more advanced exercise will be added. For more severe sprains, surgery is sometimes recommended.

Injury Prevention
Exercises that increase strength and muscle control around the ankle may help to resist the forces that lead to a high ankle sprain. Athletes who have had previous high ankle sprains are at risk of re-injury, and they may also benefit from the use of an ankle support brace when they return to sport.

Return to Play
An athlete is able to return to play once they can safely perform all activities required for their sport such as cutting, jumping, sprinting and squatting.

AMSSM Member Authors
Shawn Phillips, MD, MSPT; Kyle Goerl, MD

References
Seidenberg, PH, Beutler, AI The sports medicine resource manual. Philadelphia, PA: Saunders/Elsevier. 2008.

Van Heest TJ, Lafferty PM Injuries to the Ankle Syndesmosis. J Bone Joint Surg Am. 2014 Apr 2;96(7):603-13.

Category: Foot and Ankle,

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