High Ankle Sprain/Syndesmosis

This Injury is a common occurrence for athletes. Especially sports and practices involving jumping.

Often it is missed or overlooked because it is in addition to and follows a classic “sprained ankle injury” which should and does take priority in treatment.

Most often, your initial ankle sprain is injured via rolling of the foot either medially or laterally causing immediate pain and initial damage to the ligaments on the inside and/or outside of the ankle.

Syndesmosis injuries are the secondary sprain and should be treated as such. In fact, in my clinic the primary sprained ligaments needs to be treated and cleared up BEFORE we move on to the high ankle sprain.

So look for this as an underlying issue when you are sure the ankle sprain is better but the athlete is still having pain weeks and sometimes months later.


When the two lower leg bones (fibula and tibia) have been slightly separated from the talus below.   Normally, the talus should have a smooth, slide and glide allowing you to walk, run and shift in all positions.  (see picture)

When you have a high ankle sprain, the talus is in essence, jammed up.  Because the movement is incorrect, and is not properly “rocking” it keeps the transverse ligament holding the tib. and fib. from completely healing.

Just like any “sprain,” there are degrees of severity. These can be severe and debilitating and I push you to check out a video on the surgical intervention of these as it really helps make sense of the non-surgical, grade 1 sprains I am talking about in this article.

The high ankle sprain I work on as well as Athletic Trainers, physio, and PTs is a lesser “non-surgical” (Grade 1) version.

I explain to my clients that the transverse ligament involved is typical, by treatment time, 90% strong but just can’t get to 100% until the support of this area has been re-established.  Hence the easy but effective tape job allows the final stages of healing and proper stability each time you take a step.   This tape job needs to be present for the majority of the day to help with all the steps you take. In my experience, it’s not the recurrence in sports keeping you from healing fully but instead the number of unsupported steps throughout the day.

As with any ankle issue, having the adjustments done to the foot and ankle really helps to speed the healing along by assuring the motion and position of the foot and ankle are optimal.  The electric stimulation, ultrasound and tools we use maximize recovery time and reduce inflammation and help restore strength.  Typically, we’ll have you out of pain within a week and the condition typically heals up in about 2 weeks.

There is one fairly unique trivia “clue” I bring up when teaching this condition that may cue you in to this issue if you work with athletes for a living. “Hey doc, my ankle is killing me all day as I walk from class to class but seems to be nearly pain free during practice. What’s happening?”

This was how it was for me when I was playing college football. I fought this issue for months.

The reasoning is simple but took some discovery. A lot of athletes are taped prior to practices and games. The stability is built in as a anchor at the start of the practice. It feels better and functions better as the stability is there. During the day, no tape. It hurts.

Vet wrap or similar “mild support tape” just above the malleolus give your transverse ligament the extra 10% help it needs to fully heal.

The simple tape job I use is only to help with the day to day stability and allow the ligament in essence, to recover.

I prefer Vet wrap. Simple, easy, cheap. Classically these are healed and fully recovered in 2 weeks and continue treatment with your sports med. team.

BONUS TIP:   To bulletproof ankles I suggest to every athlete to brush their teeth while standing on one leg. 

Typically the additional 30 seconds over weeks and months really helps to establish proper motor control and better brain proprioception to the ankle and foot which is paramount in sports but is often missing even in younger athletes. This is a quick, no time out of your day, basic option that just helps reestablish a better baseline of autonomic control.   So wrap a rubber band around your toothbrush (as a reminder) and make yourself just a little bit better each day.

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