How a High Ankle Sprain Is Treated

high ankle sprain
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A high ankle sprain is an injury to the syndesmotic ligament complex that connects and stabilizes the bones of the lower leg, the tibia (shin bone) and fibula. Syndesmotic injuries occur when the ankle is forcefully twisted outward (an external rotation injury) or when the leg twists inward while the foot is planted. High ankle sprains tend to heal more slowly than common ankle sprains. If a high ankle sprain isn't treated, the ankle joint can become susceptible to further injury. That treatment will depend on the extent of injury: A mild injury in which the ankle joint can function normally typically can be treated with basic care, perhaps a splint, boot, or walking cast, and physical therapy. A more extensive high ankle injury may require surgery.

The typical recovery time for a high ankle sprain that doesn't require surgery is between six and eight weeks.

Home Remedies and Lifestyle

If the joint is stable, a high ankle sprain usually can be successfully treated with RICE and immobilization.

RICE is a four-part protocol for reducing swelling and inflammation in an injured joint:

  • Rest. This simply means not walking or standing or putting weight in any way on the affected ankle.
  • Ice. During the first couple of days after an injury, apply ice for about 15 minutes every few hours to reduce inflammation and swelling.
  • Compression. Wrap the lower leg with an elastic bandage to minimize swelling. The bandage should be snug but not tight enough to cut off circulation.
  • Elevation. Sit or lie down with your foot propped up above the level of the heart to reduce swelling and pain.

Keeping the joint as still as possible will facilitate healing. This can be done with a brace, splint, or cast—usually paired with crutches if moving about is unavoidable. Another option is a special boot that allows for walking while keeping the foot and ankle in a stable position so the injury can heal.

Over-the-Counter (OTC) Therapies

To alleviate pain and ease swelling and inflammation caused by a high ankle sprain over-the-counter pain medications should be adequate. Options include:

  • Non-steroidal anti-inflammatory drugs such as Advil or Motrin B (ibuprofen)
  • Tylenol (acetaminophen)
  • Aleve (naproxen)

Your doctor can help you decide which pain reliever is likely to work best for you based on other medications you may already be taking.

Surgeries and Specialist-Driven Procedures

When a high ankle sprain is so severe the ankle is no longer stable, as in cases in which an affected ligament is completely torn, corrective surgery is usually necessary.

The standard procedure for repairing and stabilizing a severe high ankle sprain involves placing one or two screws between the tibia and fibula to hold the two bones together, which relieves pressure on the ligaments and allows them to heal in the proper position.

After the ligament has healed, some surgeons remove the screws so the bones can move normally again. Others recommend leaving the screws in place. The potential problem with this is that screws can break under repetitive stress and will have to be removed surgically.

After immobilization or surgery, physical therapy may be necessary to strengthen the supportive structures of the ankle, improve range of motion of the ankle, and fine-tune balance with neuromuscular training.

A Word From Verywell

A high ankle sprain tends to be more complicated and challenging to treat than a "regular" ankle sprain. Because these injuries are common among athletes who engage in high-impact sports such as football, hockey, basketball, and lacrosse, players should be especially cautious about returning to their sport, waiting until their doctor and/or physical therapist give them the green light—which can take as long as six weeks to six months—and being compliant with stretching or other exercises prescribed to them to keep the ankle strong and stable.

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