A high ankle sprain usually takes about TWICE as long as a normal ankle sprain to regain full movement, proprioception and physio training and treatments.
Even a stable one often needs 6 to 8 weeks before everyday walking feels normal, and athletes often need longer before they’re back to full sport. Some ache when pushing off can linger for months.
The key question is whether the two lower leg bones have been pulled apart. If they haven’t, that’s very good news: a boot, crutches and physio usually do the job.
If the bones are separating…the joint is then unstable, and surgeons usually hold the bones together with a screw or a strong cord called a tightrope while the ligaments heal.
What a high ankle sprain is
- It sits above the ankle joint. The doctor’s word is a syndesmosis injury. The syndesmosis is the tough band of ligaments that holds the lower ends of your shin bone (tibia) and thinner outer bone (fibula) together
- A normal sprain is lower down. It tears the ligaments on the outside of the ankle. See ankle sprain recovery
- It happens when the foot twists outward, often with the foot planted and the ankle bent up. Football, soccer, rugby and skiing are common settings
- It can come with a fracture, sometimes of the fibula high up near the knee. That’s why your whole lower leg may be checked
Why it takes longer
- Every step pushes the two bones apart. When you walk, the top of the ankle bone wedges up between the shin bone and fibula, stressing the healing ligaments each time
- Pushing off hurts most. Stairs, rising onto your toes, running and cutting all load the injured area
- It’s easy to go back too soon. Walking can feel fine while running, jumping and changing direction are still painful
A normal sprain hurts on the outside. A high sprain hurts when you push off.
Signs it’s a high sprain
- Pain higher up, at the front of the ankle between the two bones, sometimes spreading up the shin
- Trouble standing on your toes or pushing off when you walk
- Pain when the foot is turned outward
- Bruising that shows up days later
Tests your doctor may do
- Squeeze test: squeezing the shin bone and fibula together halfway up the calf. Pain down at the ankle points to a high sprain
- Rotation test: turning the foot outward while the knee is held still
- X-rays: to look for a fracture and a gap between the bones. Standing X-rays, or X-rays of both ankles, can show a gap that a lying-down X-ray misses
- MRI: shows the ligaments themselves and is the best scan for this injury
- A look inside: if it’s still unclear, a surgeon may check stability through a small keyhole camera
Treatment without surgery
- Boot and crutches for the first weeks, with weight as your doctor allows. See weight bearing after surgery for what the terms mean
- Avoid forcing the ankle up early on. That position spreads the bones
- Physio in stages: ankle movement and calf strength first, then balance, then hopping, running and cutting
- Return to sport by milestones, not dates. Pain-free single-leg calf raises and hopping come before running. Cutting and sprinting come last
When surgery is needed
- The bones have separated on X-rays, or the ankle is unstable on testing or on the keyhole check
- There’s a fracture as well. The syndesmosis is often fixed during the same operation. See broken ankle surgery recovery
- Symptoms don’t settle and the joint stays unstable after good nonsurgical care
Screws or tightrope?
- Screws hold the bones rigidly. Some surgeons take them out after a few months, others leave them in. A screw can loosen or break over time, which is often harmless
- A tightrope, also called a suture button, is a strong cord with a small metal button on each side. It holds the bones while allowing some natural movement. It needs removing less often, though a button that irritates the skin sometimes comes out
- Both work. Your surgeon picks based on your injury and their experience
- After surgery: expect a boot and a period of protected weight bearing. Many athletes return to sport from around 3 months, some later
Cleveland Clinic has a clear overview of high ankle sprains if you want more on symptoms and tests.
Go to the emergency department if
- You can’t take any weight at all, or there’s a bony lump or tenderness high up the outer leg
- Your foot turns cold, pale or numb
- You get sudden calf pain or swelling, chest pain or shortness of breath while in a boot
Get it checked if
- Pain above the ankle isn’t easing after 2 weeks
- The ankle feels unstable or gives way
- You still can’t push off or hop at 6 to 8 weeks
- You were told it was a normal sprain, but the pain is at the front, between the bones
A normal sprain asks for weeks. A high ankle sprain asks for months, so protect it early and earn each step back.