Football Injury: High Ankle Sprain

High Ankle

Jerry Jeudy, Dalvin Cook, we’ve seen a lot of nasty high ankle injuries already this season. 

How does a high ankle sprain happen?

The mechanism of injury is aggressive twisting of the foot outwards, often with the inside of ankle moving towards the ground, and/or the toes coming up towards the shin. (Forced external rotation, eversion, dorsiflexion.)

These are almost always a high-velocity, high-energy, traumatic injuries: a defender falling on the outside of the leg, collision in hockey when ankle is fixed in a rigid boot, twisting a ski outwards during a crash. 

What is involved? 

A high ankle sprain is an injury of the syndesmosis between the tibia and the fibula. This causes the tearing or partial tearing of the strong ligaments and tissue between the lower leg bones. Many high ankle injuries have associated fractures. 

How bad is it?

This is a very stable joint, so it almost always is a collision/contact injury. High ankle injuries are more severe than the more common outer ankle sprain, and need a longer recovery period to ensure that prolonged instability doesn’t occur. Athletes often report difficulty cutting or pushing off and feel like they’ve lost explosiveness. 

How long does it take to heal?

In an elite-level athlete like the NFL, a mild high ankle sprain may return little as 4-6 weeks but usually it is closer to a few months. And remember, these athletes are rehabbing every day and are in top physical condition to begin with! In the amateur athlete/weekend warrior populations, return to sport likely looks closer to 16 weeks. Rushing back to sport can increase the likelihood of prolonged instability, and if stability is low, injury recurrence rate and the risk of complications like cartilage damage are higher.