Running: High Ankle Sprain

By Dr. Donald A. Ozello DC

Las Vegas Informer

“Hey Doc, what the Hell is a high ankle sprain.” “Dr. Ozello, what is the difference between a normal ankle sprain and a high ankle sprain?” “I never even heard of a high ankle sprain until five years ago, now once a month I hear of an athlete with one.” These are actual questions I’ve been asked by patients about the mysterious and dreaded high ankle sprain. Here are the answers to these questions.

A high ankle sprain is an injury to one of the ligaments that connects the two bones of the lower leg. The difference between a high ankle sprain and the more common lateral ankle sprain is the location. A high ankle sprain is located higher on the leg than a lateral ankle sprain. High ankle sprains are not a new injury or a new diagnosis. An internet search will find scholarly articles about high ankle sprains dated 1990.

Description: High ankle sprains make up about ten percent of ankle sprains. A high ankle sprain is a serious injury that requires a longer healing time period than other ankle sprains. Extra precautions must be taken in return to activity following a high ankle sprain.

A high ankle sprain is an injury to a ligament that connects the bones of the lower leg. In medical terminology a high ankle sprain is named a Syndesmotic Sprain.

Anatomy: The tibia and the fibula are the two lower leg bones. The tibia is the thicker bone in the front and inner side of the lower leg. The fibula is the thinner bone on the outer, or lateral, aspect of the lower leg. The tibia and fibula connect with the hindfoot to form the ankle joint. Three ligaments attach the lower fibula to the lateral aspect of the foot. These are the ligaments injured in a lateral ankle sprain, the most common type of ankle sprain.

The syndesmotic ligaments, also known as the high ankle ligaments, attach the tibia and fibula. These ligaments function to hold the lower aspects of the tibia and fibula close to one another. These four ligaments are the Anterior inferior tibiofibular ligament (AITFL), Posterior inferior tibiofibular ligament (PITFL), Interosseous ligament (IO) and the Transverse ligament.

Mechanism of Injury: High ankle sprains can occur in any sport but most commonly occur in football, soccer, basketball, hockey and downhill skiing. These sports are fast moving contact sports and/or sports which the athlete wears a stiff boot or skate.

The injury usually occurs when the athlete pivots suddenly to the inside with his outside foot planted on the playing surface. An excessive amount of external rotation force on the fibula in respect to the tibia pulls the bones apart resulting in a ligament injury.

Symptoms: Pain located slightly higher than the ankle joint begins immediately. The athlete may feel and/or hear a snap, pop, tear or rip. Swelling and bruising may begin very quickly. Tenderness is usually present throughout the entire ankle but is worst directly over the injured ligament.

Ankle motion is limited and weak in all planes. There is limited ability to bear weight on the injured leg and limited ability to push off the toes while walking. The result is an altered gait and most likely the use of crutches.

Treatment: Begin professional and self-treatment as soon as possible. The quicker the path to proper healing begins the better chance of a positive outcome and quicker return to activity.

A professional evaluation, examination and x-rays helps to formulate a correct diagnosis, treatment plan and rehabilitation plan. Chiropractic treatment to the spine, hips and lower extremities re-establishes proper skeletal motion, optimizes nervous system communication and maximizes healing. For peak results the treatment will be extensive and comprehensive.

Early stages of self-management and professional treatment include rest, immobilization and ice. Execute intensity increases in activity and exercise very carefully in very gradual increments. Work at a slow pace and do not push beyond your current capabilities. Patience is a must with high ankle sprains.

Intermediate phases of management include passive and active motion exercises through a pain-free range of motion. Gradual progression from non-weight bearing to partial-weight bearing to weight bearing exercises on the rocker board, wobble board and BOSU ball. Cross training with non-weight bearing and partial weight-bearing exercise limits pressure on the injured ankle while concurrently maintains cardiovascular fitness.

Advanced levels of management include proprioception and balance training on a BOSU ball. Two-legged balancing, single legged balancing, squats, lunges and pistols are extremely advanced exercises which require professional training and supervision.

Gradually return to activity starting with walking, jogging, running, then advancing to sprinting and cutting. Work with a Doctor of Chiropractic and a sports injury rehabilitation specialist for optimal results.

Conclusion: High ankle sprains are a popular conversation topic on sports talk shows, in training rooms and doctor’s offices. Proper treatment is a must for several reasons. First and foremost, high ankle sprains require a longer rehabilitation time frame than a lateral ankle sprain thus proper professional care is a necessity. Equally important for future performance are the facts that incomplete and improper healing of a high ankle sprain are precursors for a re-occurrence.

High ankle sprains are a frustrating injury. Patience and dedicated persistent treatment and rehabilitation are required for complete recovery. Educate yourself on the proper strategies to manage high ankle sprains to expedite a healthy and strong return to activity and to prevent re-occurrence.

Dr_Donald_A_Ozello_thumb_medium150_Dr. Donald A. Ozello DC

Dr. Donald A. Ozello DC is the owner and treating doctor at Championship Chiropractic. 8871 W. Flamingo Rd, Suite #202, Las Vegas, NV 89147.  His web address is He can be contacted at (702) 286-9040 and

Dr. Donald A. Ozello’s mission is to educate and inspire others to live healthier, fitter, more functional lives.

Dr. Donald A. Ozello DC is the author of the book “Running: Maximize Performance & Minimize Injuries: A Chiropractor’s Guide to Minimizing the Potential for Running Injuries.” He writes a weekly health, fitness and nutrition column for The Las Vegas Informer. He is published in OnFitness and He has educational health, fitness and nutritional videos on Informer TV, and YouTube.

Dr. Donald A. Ozello DC proudly handles Standard Process Supplements and Foot Levelers Orthotics.

Dr. Donald A. Ozello DC is an award-winning public speaker. He has spoken to numerous groups on the importance of health, fitness, exercise, ergonomics, nutrition and injury prevention.

Dr. Donald A. Ozello DC is a fitness enthusiast. Functional kettlebell training, running and bike riding are his favorite types of exercise.

Before pursuing his career in Chiropractic, Dr. Donald A. Ozello DC served in the United States Navy aboard the USS Bremerton, SSN 698.

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