High vs Low Ankle Sprain

High vs Low Ankle Sprain

The ankle joint connects the body to the feet, supports the entire body weight, and allows foot mobility. In addition, its cartilage cushions the connected bones from external impact, reducing the risk of injury.

However, sometimes the impact might be way beyond what the ankle joint cartilage can cushion, causing an ankle injury.

The ankle injury can take any form, including tendinopathy, fracture, sprain, and muscle strain, depending on the degree of injury.

However, an ankle sprain is more prevalent than any other ankle injury. According to a study published in the National Library of Medicine, ankle sprain accounts for more than 75% of ankle injuries.

Generally, ankle sprain happens when you twist, turn, or roll your ankle in a way that compels the ligaments holding your ankle joint together to stretch more than they should, tearing them. An ankle sprain can either be high or low, depending on the position of injury.

This guide compares the high vs low ankle sprain to help you understand its nature, causes, symptoms, and other related aspects.

What Is a High Ankle Sprain?

ankle pain with ankle being held

As the name suggests, the high ankle sprain happens when you tear the syndesmotic ligaments joining the tibia and fibula bones above the talus, or ankle bone.

The tibia and fibula bones typically experience spreading force as they support the heavy body weight. Luckily, the syndesmotic ligaments always prevent excess spread and absorb any shock between the two bones.

However, if the shock is too intense, it may strain the ligaments beyond their capacity and tear them.

The ligaments will likely tear if you accidentally turn the ankle inward or outwards when your foot is flexed.

High ankle sprains are common in high-impact sports like wrestling, soccer, skiing, and basketball.

What Ligaments Are Affected in a High Ankle Sprain?

runner holding ankle in pain

The ligaments that are torn in a high ankle sprain include:

  • The posterior inferior tibiofibular ligament holds the tibia and fibula together from the back
  • The posterior inferior tibiofibular ligament also inhibits fibular displacement and external talar rotation
  • The anterior inferior tibiofibular ligament holds the tibia and fibula together from the front
  • The interosseous membrane is found between the tibia and fibula, stabilizing the two bones

What Are the Symptoms of High Ankle Sprain?

The common signs of high ankle sprain include:

  • Difficulty climbing a sloped area or stairs
  • Swelling around the ankle
  • Bruising that begins a few days after injury
  • Difficulty or inability to walk on toes
  • Pain that moves up the leg with each step
  • Pain around the ankle, whose severity increases when you rotate your foot outwards

Diagnosis of High Ankle Sprain

doctor examining an ankle injury

As part of the diagnosis, your doctor may ask about the history of your ankle sprain and then proceed to a physical examination.

To examine you, the orthopedic specialist may push up your foot and turn outwards slightly as they monitor your reaction. The high ankle sprain is likely the culprit if you experience much pain.

Next, they may squeeze the tibia and fibula simultaneously to test whether you experience any pain up your interosseous membrane. If the results are positive, then you have a high ankle sprain.

If the above results aren't satisfactory, the doctor may press the anterior inferior tibiofibular ligament to test if there is any pain.

To test for any fracture or broken bones, healthcare providers may ask for imaging tests like magnetic resonance imaging (MRI) scans, X-rays, computed tomography (CT) scans, etc.

With the above results, healthcare providers can judge your injury degree and devise the proper treatment procedure.

What Is a Low Ankle Sprain?

As the name echoes, the low ankle sprain affects ligaments that support the ankle in the area below the subtalar joint (true ankle joint).

In most cases, the low ankle sprain results from an ankle inversion. The Ankle inversion sprain occurs when you accidentally twist your ankle inwards, straining lateral ligaments on the lower ankle. It accounts for 80% of lower ankle sprains.

The remaining 20% of lower ankle sprains result from eversion (forceful outward twist of your lower ankle). Ankle aversion affects the medial ligaments of the ankle.

The primary culprits behind low ankle sprains include walking on uneven ground, awkward landings, a fall that causes your ankle to twist, and injury from sports.

Which Ligaments Are Affected in Low Ankle Sprain?

woman walking and rolling ankle causing injury

The ankle inversion, which accounts for most lower ankle sprains, affects three main ligaments:

  • The Anterior Talofibular Ligament (ATFL): A lateral ligament that stabilizes the talus. It is also the weakest and the most commonly injured ligament of the ankle.
  • The Posterior Talofibular Ligament: It’s found on the medial surface of the lateral malleolus. It supplements the stability of the ankle when the lateral ligament collateral is intact.
  • The Calcaneofibular Ligament: It’s found in the middle of the lateral collateral ligament network. It controls inversion by stabilizing the ankle and subtalar joints. On the other hand, forceful eversion affects the medial deltoid ligament, which prevents your ankle from over-rotating inwards.

What Are the Symptoms of Low Ankle Sprain?

The common symptoms of low ankle sprain include:

  • Pain in the lower lateral part of the ankle
  • Bruising, which starts a few days after injury
  • Swelling and stiffness of the ankle
  • Inability to withstand body weight

Note: The high and low ankle sprain symptoms are closely related, making it difficult to judge the kind of sprain you might be experiencing. So, it's always safe to book an appointment with an orthopedic expert for an examination.

What Is the Diagnosis for the Low Ankle Sprain?

Like the case with the high ankle sprain, the orthopedic doctor will ask about the history of your injury, and then perform various physical examinations to establish whether you have a lower ankle sprain. In addition, orthopedics may request imaging tests like (MRI) scans, X-rays, and CT scans to establish whether you have a bone fracture.

Treatment and Recovery

injured ankle elevated with an ice pack

You should see an orthopedic specialist for examination and treatment, whether you are suffering from a high or low ankle sprain. Generally, the treatment plan will depend on the type of sprain and the degree of injury. Likewise, the recovery period will depend on the degree of your injury and your commitment to following the doctor's instructions.

After the recovery, the doctor may recommend you use home treatments like the icing regimen, ankle brace, rehabilitation exercises, and other practices to reduce the chances of future injuries.

Final Thoughts

We hope this reading helps you understand high vs low ankle sprain. Since you might not tell the two apart at times, it is advisable to seek professional help. Have you or your loved one experienced rolled ankles, sprained ankles, strained ankles, and breaks? Check out what they are and how to treat them.