High Ankle Sprain: Recovery Time, Return to Play, and Role of Rehabilitation

 

Though high ankle sprains are less common, they typically have a longer recovery time. Learn when you can resume your activities and how rehabilitation can help. 

 

What is A High Ankle Sprain?

A high ankle sprain occurs when you overstretch or tear your syndesmotic ligaments. Syndesmotic ligaments are fibrous connective tissues in the ankle that connect the shinbone and calf bone. Therefore, such sprains are also called syndesmotic injuries.

Most cases occur when your foot turns outward, causing your syndesmotic ligaments to stretch beyond the limit or tear. Sometimes, they may also happen when you have an ankle fracture. 

A high ankle sprain is less common than other ankle injuries. Sports often associated with high ankle sprains are:

  • Football
  • Basketball
  • Wrestling
  • Ice hockey
  • Skiing
  • Soccer

Click here to learn about the causes, risk factors, treatment, and prevention of high ankle injuries. 

 

High Ankle Sprain Fast Facts

  • High ankle sprains account for 11 to 17% of all ankle sprains in individuals who compete in sports activities. For reference, approximately 75% of all ankle sprains are lateral ankle sprains. (1,2)
  • More than 50% of the injuries happen during competitions, and repeated injuries occur in nearly 10% of the cases. (3)
  • Injury rates are higher in males than females and the National Football League (NFL) participants.

Further Reading: What Are Common Sports Injuries?

 

Recovery Time For High Ankle Sprains

Most cases are treated nonsurgically with rehabilitation, and recovery time can range from 6 to 8 weeks (or longer). (1)

Notably, the recovery time for high ankle injuries is longer than that for lateral sprains. For example, in a 2014 study, participants with high ankle injuries took 62 days to recover. In contrast, those with lateral ankle sprains took only 15 days. (4)

Similarly, another recent review reported a mean recovery period of 46 days following the injury. (5) 

The wide variation in recovery time could be due to the perplexing nature of the injury. For instance, studies show that some athletes initially presenting with mild symptoms have prolonged recovery periods. On the other hand, those with severe injuries recover earlier than expected. 

 

Injury Severity and High Ankle Sprain Recovery Time 

The West Point Ankle grading system categorizes high ankle injuries into:

Grade I

  • Mild, stable sprain with no X-ray abnormalities. The ankle is usually stable. 

Grade II

  • Moderate injury with normal X-ray and positive external rotation and squeeze tests. The ankle may be stable or unstable. 

Grade III

  • Severe injury with complete ligament tearing and positive imaging and other tests. The ankle is unstable.

Grade I injuries are treated conservatively. However, an unstable grade II or grade III sprain requires surgery.

Athletes who had surgery have a longer recovery time than those who receive conservative treatment. For example, a 2022 review in the journal Foot and Ankle Orthopaedics reveals that athletes undergoing surgery missed games for 71 days compared to 39 days among conservatively treated athletes. (6)

Other factors that may affect how early you may heal include:

  • Age
  • Overall health
  • Similar injuries in the past
  • Obesity and body mass index 
  • Compliance with treatment and rehabilitation 
  • The type of the sports 

 

Return to Play After A High Ankle Injury

A team of providers (or surgeons), physical therapists, and athletic trainers decide when you can return to work, training, or competitive sport. They may allow you to return if you have:

  • Minimal or no tenderness
  • Full ankle range of motion
  • Adequate ankle and leg strength (⩾ 90% of the uninjured leg)
  • No instability when doing single-leg hops and lunges
  • Ability to fulfill sport-specific functional testing requirements

Individuals with grade I sprain can expect to return to usual activities within 2 to 9 weeks following the injury. Nonetheless, factors like injury severity and compliance with rehabilitation can affect the recovery period. Luckily, most people with grade I sprain regain their pre-injury abilities.  

Individuals with surgically treated grade II and III sprains may take as long as 103 days to return to play. On the other hand, if you have an isolated grade II injury, you may be able to resume your activities within 45 days. 

There has yet to be a consensus on the exact timeline for the return-to-play decisions. Thus, clear communication between healthcare providers and the affected person is critical.

 

Rehabilitation For High Ankle Sprain: Things to Know

Rehabilitation aims to allow an athlete to return to play as early and safely as possible. The phases of rehabilitation are:

Phase I 

This phase focuses on relieving pain, reducing inflammation, and restoring the normal ankle range of motion. It typically lasts for 1 to 4 weeks.

Phase II 

This phase helps you regain your foot and ankle flexibility and functional strength of the injured ankle. It usually lasts for 4 to 8 weeks. 

Phase III 

This phase focuses on helping you regain pre-injury functional abilities. 

Various models of rehabilitation exist. The choice depends on your preference, how you respond, clinical circumstances, and your provider’s local expertise. 

 

What Happens During High Ankle Sprain Rehabilitation?

Initially, your provider will likely recommend a walking cast or custom orthosis to protect the injured joint. Likewise, you may also be asked to do gentle exercises to maintain strength and mobility. 

Once you can walk with minimal or no support, you will do activities to restore mobility, strength, and neuromuscular control. Examples include long-duration stretching, joint mobilization, heel raises, and calf presses. 

After you can jog with minimal discomfort, you will do activities that help you return to play. Examples include hopping, running, jumping rope, and plyometrics. 

Most experts recommend athletes wear an ankle brace during the first season of the sport following rehabilitation. 

 

High Ankle Sprain: FAQs

Question: How long do high ankle sprains take to heal?

Answer: Recovery from high ankle sprains can take 6 to weeks, depending on injury severity and the need for surgery. 

Question: Can you fully recover from a high ankle sprain?

Answer: Yes, complete recovery from high ankle injuries is possible if you stick to treatment. This is especially true if you have low-grade injuries that do not require surgery.

Question: Is it good to massage a high ankle sprain?

Answer: Massage may help reduce pain and swelling. However, it is not likely the best thing to do when you have a high ankle sprain.

Question: Can you squat with a high ankle sprain?

Answer: You may do a few repetitions of body squats once you have completely received from a high ankle sprain.

Question: What is the high ankle sprain recovery time for NFL players?

Answer: According to a 2022 study, the average return to play NFL players with injured high ankles was about 11 weeks.

 

Can Telemedicine Help?

Telemedicine is gaining popularity because it can help bring you and the doctor together quicker and more efficiently. It is particularly well suited for sports injuries such as a high ankle sprain and facilitating the diagnosis of the severity of the injury and a treatment plan.  Learn more via SportsMD’s 24/7 Telemedicine Service.

 

Kleiger’s Test for High Ankle Sprain

 

 

References

  1. Williams, Glenn N, and Eric J Allen. “Rehabilitation of syndesmotic (high) ankle sprains.” Sports health vol. 2,6 (2010): 460-70. doi:10.1177/1941738110384573
  2. Herzog, Mackenzie M et al. “Epidemiology of Ankle Sprains and Chronic Ankle Instability.” Journal of athletic training vol. 54,6 (2019): 603-610. doi:10.4085/1062-6050-447-17
  3. Mauntel, Timothy C et al. “The Epidemiology of High Ankle Sprains in National Collegiate Athletic Association Sports.” The American journal of sports medicine vol. 45,9 (2017): 2156-2163. doi:10.1177/0363546517701428
  4. Sman, Amy D et al. “Prognosis of ankle syndesmosis injury.” Medicine and science in sports and exercise vol. 46,4 (2014): 671-7. doi:10.1249/MSS.0000000000000151
  5. Vancolen, Seline Y et al. “Return to Sport After Ankle Syndesmotic Injury: A Systematic Review.” Sports health vol. 11,2 (2019): 116-122. doi:10.1177/1941738118816282
  6. Salameh, Motasem et al. “Return to Play After Isolated Syndesmotic Ligamentous Injury in Athletes: A Systematic Review and Meta-analysis.” Foot & ankle orthopaedics vol. 7,2 24730114221096482. 16 May. 2022, doi:10.1177/24730114221096482