A syndesmosis sprain, also referred to as a high ankle sprain, occurs as a result of ligament damage in the ankle. This damage is of the joint between the splint bone and the shin bone, called the ankle syndesmosis. It can occur with the interosseous membrane between the bones in the ankle and shin, causing pain and other symptoms.


The most common symptoms associated with a syndesmosis sprain are pain, inflammation, and lack of movement. You might also feel more severe pain when you bear any weight on the ankle.

There are also different levels of pain and symptoms depending on the degree of the syndesmosis sprain.

  • First degree sprains. This type of sprain generally causes pain only when touching the ankle or putting weight on it.
  • Second degree sprains. The pain tends to be more severe when you have a second degree sprain, in addition to having swelling.
  • Third degree sprain. This is the most severe type of syndesmosis sprain. You’ll likely experience excruciating pain even without putting weight on it, and you can’t walk with this degree of sprain.


A high ankle sprain commonly is the result of activities or sports where you use a lot of force with your ankles. Wrestling, football, soccer, and hockey players are prone to getting a syndesmosis sprain, since they participate in forceful contact sports. Participating in these types of sports also involves the use of the ankle not only for running or skating, but also in a twisting motion during the game.

A syndesmosis sprain can result when the toes are forced toward the shin too far in what is referred to as hyperdorsiflexion. This is common among athletes who push forward when the foot is planted on the ground. The ligaments tear because the bones are pulled apart.


If you believe you have a syndesmosis sprain, it is important for you to consult with your Pensacola orthopedic specialist. He will run a series of tests to determine if this is the type of ankle sprain you have.

Typically, he will start by asking about the severity of your pain and where it is located. With a high ankle sprain, the pain is usually above the ankle, unlike other types of ankle sprains and conditions. Your doctor will also perform a physical examination.

Following this evaluation, these tests may be performed:

  • Squeeze test. During the squeeze test, the doctor applies pressure to the leg below the knee and asks if the pain has worsened or not.
  • External rotation test. The doctor might also perform the external rotation test where you bend your knee and the ankle is moved at a certain angle to see how the ankle moves with the leg.
  • X-rays. The doctor needs to perform x-rays to look at the sprain close up, including finding out if you have any fractures. They can see if there is a fracture on the tibia, which often means you have a high ankle sprain.
  • MRI. In some cases, an MRI is also performed for diagnosis.


With a syndesmosis sprain, the first level of treatments are non-surgical, including taking anti-inflammatory medications. These can help tone down the pain, while also reducing some of the inflammation and swelling.

You may also need to get a massage to help with the scar tissue and tightened muscles from the injury. Electrotherapy is a type of ultrasound therapy sometimes performed for this type of condition as well.

Once your ankle is pain free, physical therapy in the form of strengthening and mobility exercises, through the use of wobble board exercises for example, is helpful to restore the ankle to its previous full function.

Surgery is not typically needed for syndesmosis sprains.

Frequently Asked Questions

Q: What’s the difference between a high ankle sprain and a regular ankle sprain?

A regular ankle sprain occurs where you tear or damage your lateral ankle ligaments. Generally, if you sprain an ankle, you stretch or tear your outer ligaments. Ankle sprains cause swelling and pain in and around your ankle causing serious discomfort.

A high ankle sprain is where you tear the ligaments of your ankle that connects to your fibula and tibia. These ligaments are stronger. You may experience similar symptoms as you do with an ankle sprain. You'll experience pain if you squeeze your calf or externally rotate your ankle.

Q: How long does a high ankle sprain take to recover?

You may get back to your regular sporting activities around six weeks after the date you sustained the injury. However, the severity of your sprain ultimately determines your recovery timeline. If you displace an ankle bone and require surgery, full recovery may not occur for a three to four months.

Q: What should I do if I think I suffered a high ankle sprain?

When dealing with a high ankle sprain, you should definitely contact Dr. Nilssen by calling our office. Things you can do in the meantime include:

  • Getting 24 to 48 hours of rest so there's no further damage.
  • Apply ice packs for around 15 minutes a few times daily for the first 72 hours. Be sure not to apply the ice right on your skin.
  • Elevate your leg or ankle for several hours during the day to limit swelling.
  • Take ibuprofen, aspirin or naproxen to reduce inflammation and relieve pain, unless recommended by your physician to avoid these medicines.

Dr. Nilssen may prescribe you an ankle support device or air brace to protect your ankle.

Q: Can I tape a high ankle sprain?

Taping is a good stabilization technique for high-ankle sprains. If you have a more acute, severe high-ankle sprain, rigid tape for aggressive stabilization works better. If your sprain is mild, all you really need is simple kinesiology tape.

Make sure you clean your skin and free it from any lotions, oils or moisture before you apply the tape. Clip or shave long hairs that could hinder the tape's adherence. Ensure your clothes allow you to access the area to be taped.

Q: Is there a brace I can wear to help prevent a high ankle sprain from happening?

Healthy athletes shouldn't wear braces to avoid high ankle sprains since wearing a brace for an extended time can cause proprioception loss. This is your body's innate ability to recognize where your joint is in space. When you have decreased proprioception, it could predispose you to an ankle sprain.

If you have damage to your ankle ligament, the ligament loses receptor activity reducing proprioception at the joint of your ankle. You may lose balance. You may have to retrain this balance to get complete functional ankle complex return. Recurring ankle sprains is a risk if this isn't achieved.