High Ankle Sprains Recovery: Causes and Recovery

By Revamp Physiotherapy, Carina Brisbane

High ankle sprains may not be as common as the typical lateral ankle sprain, but they can be significantly more serious and require a longer recovery period. This type of injury affects the syndesmosis — the ligaments that connect the tibia (shin bone) and fibula (outer lower leg bone) just above the ankle joint.

These ligaments are crucial for ankle stability. Damage to them can result in persistent pain, instability, and limited movement if not managed correctly. While high ankle sprains are often associated with sports injuries, they can also occur in everyday situations, making awareness and early management essential for everyone.

Understanding High Ankle Sprains

Unlike a standard ankle sprain, which usually involves the ligaments on the outer side of the ankle, a high ankle sprain involves the structures higher up between the shin bones. This injury typically occurs when the foot is forced upwards (dorsiflexion) and rotated outwards (external rotation) under weight-bearing conditions.

Because the syndesmosis plays a vital role in transferring force through the ankle, damage to these ligaments often results in a slower recovery time and a more structured rehabilitation process compared to regular ankle sprains.

Common Causes of High Ankle Sprains

High ankle sprains are usually the result of strong twisting forces or direct impact to the lower leg. Common causes include:

• Sporting injuries – especially football, rugby, basketball, and netball, where sudden changes in direction or tackles are common.

• Direct contact – collisions or falls that twist the ankle outward while the foot is planted.

• Falling or tripping on uneven ground with the foot trapped or awkwardly positioned.

• Sudden pivoting during high-speed movements.

• Previous ankle or lower leg injuries that compromise joint stability.

  
  

Athletes are particularly at risk, but the injury can happen to anyone, even during day-to-day activities.

Recognising the Symptoms

High ankle sprains can sometimes be mistaken for mild ankle injuries, but they have some distinct signs:

• Pain located above the ankle joint, particularly between the tibia and fibula.

• Swelling and tenderness over the front or sides of the lower leg.

• Pain when walking, especially when pushing off the toes.

• Discomfort during twisting or pivoting movements.

• Instability or reduced strength in the ankle.

• Pain that worsens when the foot is turned outwards while the leg is fixed.

  
  

Because of the important role of the syndesmotic ligaments, even a mild high ankle sprain can cause long-term issues if not treated correctly.

Immediate Management: The First 48 Hours

The first two days following a high ankle sprain are crucial for controlling swelling, reducing pain, and preventing further damage.

Follow the RICE protocol:

1. Rest – Avoid weight-bearing activities and keep strain off the injured ankle.

2. Ice – Apply an ice pack for 15–20 minutes every 2–3 hours to reduce inflammation.

3. Compression – Use an elastic bandage to control swelling and protect the joint.

4. Elevation – Keep the ankle raised above heart level whenever possible.

   
   

Additional early care tips:

• Use crutches if you cannot walk without limping.

• Wear supportive taping or a brace to limit unwanted movement.

• Take over-the-counter anti-inflammatory medication if advised by your GP or pharmacist.

  
  

Unlike many mild lateral sprains, high ankle sprains often require a longer rest period before starting rehabilitation exercises.

When to See a Physiotherapist

Not all ankle sprains are the same — and high ankle sprains almost always need professional input to ensure proper healing. You should seek help from a Physiotherapist in Carina or a Physio in Carindale if:

• Pain and swelling are not improving after 3–5 days.

• You cannot walk more than a few steps without significant discomfort.

• Pain is concentrated above the ankle joint and worsens with twisting.

• Your ankle feels unstable or weak.

• You need clearance and guidance before returning to sport.

• There is concern about a severe ligament tear or associated fracture.

  
  

A physiotherapist will perform a comprehensive assessment, sometimes in collaboration with your GP for imaging such as X-ray or MRI. Your treatment plan will likely include:

• Manual therapy to restore movement.

• Swelling and pain management techniques.

• Progressive strengthening and stability exercises.

• Sport-specific drills to safely return to activity.

• Education on injury prevention and long-term joint care.

  
  

Why Early Physiotherapy Matters

Returning to sport or normal activities too soon after a high ankle sprain can increase the risk of re-injury and long-term instability.

Structured rehabilitation under the guidance of an experienced physiotherapist ensures:

• Faster recovery with reduced risk of setbacks.

• Restoration of strength, flexibility, and balance.

• Improved confidence in ankle function.

• Reduced risk of developing chronic ankle instability.

  
  

At Revamp Physiotherapy in Carina, we have extensive experience managing high ankle sprains, from initial injury assessment to complete rehabilitation. Whether you need a Physiotherapist in Carina or a Physio in Carindale, we will provide a personalised plan to help you recover fully and get back to the activities you enjoy.

Injured your ankle? Don’t wait. Book an appointment with Revamp Physiotherapy today and take the first step towards a full, confident recovery.