Michael Johnson, M.D., is an orthopaedic surgeon with UAB Department of Orthopaedic Surgery and UAB Sports and Exercise Medicine. Below, he answers some common questions about high ankle injuries and how they are treated. This information is based on a typical high ankle injury and may not apply to every case.
What is a high ankle injury?
Sometimes called external rotation ankle injuries, these can include fractures, ligament tears or damage, and high ankle sprains (known as a syndesmosis injury).
How does this type of injury usually happen?
High ankle injuries are often seen in athletes. For example, they commonly happen with football players when the foot twists too far outward toward the little‑toe side. This can happen during quick cutting moves or when a player is tackled in a way that forces the foot and ankle to twist outward.
Outside of athletics, this type of injury can happen to active individuals during everyday activity. For example, it may occur when someone quickly changes direction while running, steps awkwardly off a curb, or slips and twists their foot and ankle outward.
What are the immediate symptoms?
Depending on how bad the injury is, pain and swelling can show up on either the inside or outside of the ankle. If the injury involves the tissue between the shin, the pain may be felt higher up, where the lower leg and ankle meet. Most people with these injuries have trouble walking or putting weight on the injured foot.
How is a high ankle injury diagnosed?
If moving the foot outward (called external rotation) causes pain, it can be a sign of a high ankle injury. To make a diagnosis, doctors usually start with X-rays, and they may order a CT scan or MRI if they need a closer look at the bones and ligaments.
Does this injury require surgery?
Most ligament sprains don’t need surgery, but they often take longer to heal than typical ankle sprains. However, if the injury includes broken bones (fractures) – or if the ligaments are completely torn – then surgery is usually needed to stabilize the ankle and repair the damage.
Because these injuries often come with cartilage problems inside the joint, surgeons may recommend an ankle arthroscopy. This is a minimally invasive repair procedure that requires only a few small incisions (cuts).
What does recovery typically look like?
A period of protected weight-bearing in a brace or boot is recommended for high ankle sprains. Recovery after surgery often requires a period of staying off the ankle, followed by a gradual transition to protected weight-bearing and physical therapy.
When can a person with a high ankle injury return to play or activity?
This depends on how severe the injury is. After surgery, most people can get back to their regular daily activities in about 8-12 weeks. Returning to sports takes longer. Most athletes need about 6-9 months before they can safely resume cutting, pivoting, and other demanding movements.
Can this injury be prevented?
Playing contact sports naturally comes with some risk of getting hurt. Wearing braces or using tape can help lower that risk. It also helps to keep an eye on how much you’re playing or practicing. For example, when you get tired, your muscles react more slowly, which makes high ankle injuries more likely.
When should someone with a high ankle injury see a sports medicine specialist at UAB Medicine?
If you suspect that you have a high ankle injury and have trouble putting weight on that ankle, you should immediately contact UAB Sports & Exercise Medicine at 205-930-8339.