The Problem is in the Ankle Joint
Ankle sprains are one of the most common injuries for athletes, especially among football and basketball players. What’s unique about ankle sprains is that they come in all different shapes and sizes, so to speak. The ankle is such a delicate and complex mechanism that a patient may not know if they are suffering from ankle instability, a lateral ankle sprain, or a high ankle sprain. While all ankle injuries vary in severity, high ankle sprains are usually more damaging because they affect different ligaments.
Ankle Anatomy
Before we explain more about the injury, let’s examine the anatomy of your ankle. Your ankle joint is stabilized by ligaments that allow your foot to flex in a variety of different motions. There are two groups of ligaments inside your ankle:
- The lateral ligaments located on the outside of your ankle, and
- The medial ligaments located on the inside of your ankle
If you’re reading this while sitting down, you can feel these ligaments at work just by moving your foot. If you rest your right foot on the ground with the inside of your foot facing up, you can feel the ligaments on the outside of your ankle begin to stretch. An ankle sprain in this direction is called an inversion sprain, and it affects your lateral ligaments.
Now turn your foot the other way. Position your right foot with the inside of your foot facing towards the floor. This motion seems a little more unnatural because you are working the medial ligaments above your ankle. These ligaments are less flexible, but because of their position they are oftentimes more stable than your lateral ligaments. This is known as an eversion sprain. Kobe Bryant and Austin Rivers demonstrate great examples of inversion and eversion sprains.
A high ankle sprain is a more intense inversion sprain, often categorized by a sudden and forceful outward turning of the foot. A high ankle sprain occurs when the foot twists outward tearing the ligaments between the tibia and the fibula. Damage to these ligaments is often very painful, and the most severe cases require surgery and months of time to fully heal.
3 Grades of Ankle Sprains
A high ankle sprain is also more severe because it involves the joint above the ankle. This joint is known as the syndesmosis, which is a tight tissue that holds the two bones of the leg (the tibia and the fibula) together. The bones in the leg stretch apart when the foot twists outward at a 90-degree angle. Like most sprains, injuries to the sydesmosis are graded in accordance to their severity. These grads are explained in the following table:
| Grade I | A Grade I high ankle sprain is categorized by mild partial disruptions of one of the ligaments connecting the tibia to the fibula. Grade I injuries usually only effect the anterior tibiofibular ligament, but sometimes other ligaments are slightly damaged. Stress tests show that the ankle is stable and the injury usually heals within a few weeks. |
| Grade II | Grade II injuries are more severe than Grade I injuries as there is greater tissue disruption between at least two or three ligaments. A stress test, weight bearing on the ankle, and checking for widening is unlikely to help since it is too painful to test in a normal setting. Any stress tests would be done with the use of anesthesia to better demonstrate the injury. Grade II sprains can also be revealed by MRI technology. In most cases, Grade II sprains are best treated with surgical stabilization, which involves a minor operation to ensure the ligaments heal correctly and prevent recurring injuries. Regardless of surgical or non-surgical treatment, the timetable to return to sporting activities can be two months or longer. |
| Grade III | Grade III sprains are the most severe type of high ankle sprain, and surgery is needed to fix the ligament damage. Grade III sprains are associated with obvious dislocation of the tibiofibular joint. It usually takes 2-3 months to return to sporting activities following ligament reconstruction surgery. |
High ankle sprains are often more troublesome than regular sprains because the ligaments can heal incorrectly if not properly addressed. In fact, ligaments do not heal in the right position more than 50% of the time. If the ligaments don’t heal correctly, a person will be subjected to constant ankle instability and a higher likelihood of re-injury. A person who suffers a high ankle sprain will also lose significant “push off” power, and arthritis progresses much more rapidly in people with weak or damaged ligaments.
Surgical Ligament Reconstruction
At Silverman Ankle & Foot, we stabilize your weakened ligaments with a reconstructive operation. Dr. Silverman has preformed this surgery numerous times, and patients can return to sporting activities quicker than if they forgo the surgery. Many patients return to sporting activities within 3 months. Patients are also less likely to suffer an aggravation of their high ankle sprain if they have their ligaments addressed by a surgeon.
Minnesota Ankle Sprain Doctor
You shouldn’t have to sit on the sidelines with a high ankle sprain, and you’re only hurting yourself by not considering a surgical procedure to fix the ligaments. But don’t just take our word for it, listen to patients who have already had the surgery and are experiencing the fantastic results.
No matter what your problem, Dr. Silverman will work with you to provide the best individualized treatment. For a list of common orthopedic ankle and foot conditions click here.
