High Ankle Sprain vs. Ankle Sprain: What’s the Difference?

The ankle joint is made up of the tibia (shin bone), fibula (calf bone) or the bone on the outer side of the leg, and the talus located below the tibia and the fibula where they sit directly. These three bones are connected and supported by strong fibrous ligaments that stabilize the ankle during weight-bearing activities such as standing, walking, and running.

The ankle receives many high-impact forces daily. Therefore, it is a fairly common area for a sprain. A sprain involves an injury to the ligaments of the joint. When the ankle joint moves beyond its normal range due to excessive force, the ligaments that support it can be stretched, partially torn, or completely torn.

A low or lateral ankle sprain, which is the most common, involves an injury to the anterior talofibular ligament (ATFL). The ATFL connects the fibula and the talus and is found on the outer side of the ankle. This ligament can be injured when the ankle inverts or moves inwards excessively such that the sole faces the inner side of the body.

Meanwhile, a high ankle sprain involves an injury to a band of ligaments collectively called syndesmosis. Syndesmosis is a syndesmotic joint formed by two bones (distal tibia and fibula) and multiple ligaments (mainly the distal anterior tibiofibular ligament, the distal posterior tibiofibular ligament, the transverse ligament, and the broad fibrous interosseous membrane that spans between the two bones).

It connects the tibia and the fibula and is located just above the ankle. The syndesmosis is usually damaged during extreme or sudden twisting, turning, or change in direction during running or jumping. The foot is usually planted and turned outward while the lower leg rotates inwards.

How does a low ankle sprain feel?

The symptoms of a low ankle sprain include immediate pain, swelling, and bruising on the outer side of the ankle. The area will also be tender to the touch and may feel warm due to the swelling.

You may also feel or hear a popping sound at the time of injury. Putting weight on the affected ankle will be painful, resulting in difficulty in standing and walking.

How does a high ankle sprain feel?

A high ankle sprain involves pain above the ankle between tibia and fibula that may spread up to the leg. The swelling and bruising are less severe in a high ankle sprain than in a low ankle sprain.

In mild to moderate cases where there is no fracture involved, you might still be able to stand or walk because pain is at a lesser degree. However, the pain will increase if performing the same activity that caused the injury. For example, if you injured your ankle during jumping, you might not be able to do this again because of pain.

Some individuals have also reported increased pain while climbing up and down the stairs because the ankle moves upwards, receiving greater forces and subjecting the syndesmosis to greater stress.

Is a high or low ankle sprain more severe?

The syndesmosis consists of multiple ligaments and all of these can be injured in a high ankle sprain. Meanwhile, a low ankle sprain involves damage to only one to three ligaments. Because of this, a high ankle sprain is generally more severe than a low ankle sprain.

Also, during sudden rotation of the ankle, the syndesmosis gets pulled, and the tibia and the fibula become separated. If the pulling force is too great, the fibula might get fractured.

A high ankle sprain is usually misdiagnosed or ignored by the individual especially during mild cases because it is less painful at rest and there is less swelling and bruising.

This leads to recurrent sprains and longer healing and recovery time. The high ankle sprain can be mistaken for a low ankle sprain as injury sometimes looks similar and misdiagnosis may impair the recovery.

Can I walk with a high ankle sprain?

If there is no fracture involved, walking with a high ankle sprain is possible. It might elicit pain at every step, but there is typically less bruising, swelling, and pain above the ankle compared to a low ankle sprain. Due to this, individuals tend to overlook the injury and continue with their activities.

Is it possible to have a high and low ankle sprain simultaneously?

A high ankle sprain and low ankle sprain rarely occur together. They have different mechanisms of injury and so different movement forces are normally required for them to get injured.

A high ankle sprain results in rotational movements in which the foot is turned outwards while the shin moves inwards. A low ankle sprain results when the ankle is forced to invert or is turned inwards.

Should I go to the doctor for a high ankle sprain?

It is important to visit your doctor if you feel pain above the ankle. The doctor will help diagnose your condition and look for other signs of complications such as bone fractures. Even if the injury does not look bad, it does not mean that it is not damaged.

Oftentimes, a lack of proper diagnosis and treatment and continuation of high-impact activities despite a suspected injury leads to recurrence of an ankle sprain. Increased recurrence of injury leads to greater and more complicated damage and poorer athletic performance.

It can even lead to bone fractures if the ankle is forced to perform beyond its capacity. Further, the more severe the injury is, the longer the healing time required and the longer it will take for you to get back to your normal activities.

A high ankle sprain usually heals between six weeks to three months. However, if there is a fracture and if the sprain is severe, surgery might be needed and it can take more than three months up to a year to completely heal.

How is a high ankle sprain treated?

During the first three days after the injury, your doctor will require you to do the following:

Rest your injured ankle and avoid movements that cause pain. You might need to use a cast or a bootleg to properly position your ankle, and crutches to allow you to move as the injury heals.

An ice compress during the first 72 hours might be beneficial if there is considerable pain and swelling. This needs to be done several times a day for no more than 20 minutes each time. Use a hot compress instead to increase the blood flow to the area and facilitate healing for up to 20 minutes for each application. 

Pain medications such as Ibuprofen may be taken as prescribed by your doctor to reduce pain at the affected ankle.

A light compression bandage may be used while elevating the injured ankle above the heart to drain fluid and reduce swelling.

Physical therapy and rehabilitation should be done as soon as possible. Early and controlled movements have been shown to facilitate healing and speed recovery time.

During rehabilitation, your physical therapist will provide you with exercises to help strengthen your leg, ankle, and foot muscles, achieve a normal range of motion, improve your balance and coordination, and guide you with proper body mechanics and joint conservation techniques to prevent re-injury.

The exercises will be progressed gradually and safely as the injury heals. You must get immediate treatment before the injury worsens. This will reduce the healing time and will help you return to your daily activities faster.

It will also prevent injury to other structures of the ankle or other parts of the body. If left untreated, a high ankle sprain can result in arthritis, long-term pain, joint stiffness, and difficulty returning to function.

An athlete will be able to return to sports as long as the injured ankle is completely healed such that there is no more pain during weight-bearing and during high-impact activities like jumping and running.

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