When the sprain sits higher than your ankle
Insight from a foot and ankle specialist and a physical therapist
Just above your ankle, ligaments bind the shinbone and the thinner fibula bone together. Hurting these ligaments is called a high ankle sprain, or a syndesmosis injury. Your foot may have twisted during the crash or as you climbed out of the car. The pain often sits above the ankle and gets worse when you walk or turn. Swelling may be mild. The big question is whether the two leg bones still hold the ankle joint snugly. [1]
Check that the two leg bones are holding firm
Show your doctor exactly where it hurts, including any pain higher up along the fibula. Ask what the exam and X rays found. If the diagnosis or the joint’s stability is unclear, you may need more imaging. Find out whether a broken bone was ruled out. An unstable syndesmosis may need surgery to fix it in place. A stable injury usually needs protection and a guided return to walking. [1]
Your walking limit is part of the treatment
Find out if you should keep weight off the foot, wear a boot or use crutches. Low pain doesn’t prove the ligaments are ready for pivoting or long walks. When your doctor clears each stage, a therapist can help you rebuild ankle motion, strength and balance. Ask what movement test will show it’s safe to go back to work, climb stairs and drive. [1]
Go back if healing seems off track
Call the foot team if pain above the ankle won’t go away, walking is still hard or the ankle feels wobbly. Get urgent care for a cold or pale foot, new marked numbness or severe pain that keeps building. While you’re moving around less, new pain or swelling in your calf also needs a prompt check. [1, 2]
What to ask about your ankle
- Is the syndesmosis stable? Was a fracture ruled out?
- What is my walking limit this week?
- When should I start balance and strength exercises?
Map where it hurts
Note where the pain is and which movement sets it off. Take those notes to your follow up visit. [1]
Sources and further reading
General education from foot and ankle care and physical therapy. A high ankle sprain can take longer to heal than a common sprain on the outside of the ankle. How stable the joint is decides the treatment.
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