Anke injury: High Ankle or Low Ankle?
Ankle injuries are highly prevalent among people of all ages. The most common ankle injury is a lateral ankle sprain, often a result from a sudden twist or impact. Predisposing ankle sprains further compound the likelihood of re-injury. This can result in chronic ankle instability if not treated correctly and lead to further lower limb deterioration. Because of this, ankle injuries are vital to correctly diagnose so that the right management plan can be put in place.
When diagnosing ankle pathologies, it’s important to differentiate the difference between and high and low ankle sprains. In this blog, we will be delving into the differences between high and low ankle injuries, how we diagnose them and how the mechanisms of injury differ.
High ankle sprains, or more commonly referred to as syndesmosis injuries, are tearing or damage to the tibiofibular ligaments. The tibiofibular ligaments connect both the tibia and fibular together and are damaged when there’s external rotation to the lower leg whilst the foot is in a fixed position. This type of injury is less common than your traditional lower ankle sprain however, sports that require fast changes in direction/twisting and wear shoes with studs such as AFL, rugby and soccer, are at a higher risk of sustaining this injury.
As a clinician it’s important to look out for specific symptoms such as, pain proximal to the ankle joint approx. 2-3 cm, pain produced when squeezing the mid portion of the leg – to gap the tibia and fibular, unable to hop and increase in pain through dorsiflexion.
Low ankle sprains refer to damaged ligaments connecting the tibia/fibular to the foot. A low ankle sprain can occur either to the medial or lateral aspect of the ankle depending on which motion the foot moves in relation to the tibia and fibular. Most common are inversion sprains or lateral ankle sprains, they occur when the foot is forcefully inverted past its traditional range of motion which will damage/tear the lateral ligament complex, most commonly the anterior talofibular ligament. Less commonly seen are eversion or medial ankle sprains, they are caused by the opposite motion to a lateral ankle sprain and affects the deltoid ligament.
When diagnosing a lower ankle sprain, visual inflammatory signs are extremely common, typically more so than a high ankle sprain. Palpation is also a very important technique to determine which structure is damaged and its location. Other tests such as the anterior talar draw are used for assessing the ligaments integrity given ligament damage.
Overall, it is extremely important to distinguish the difference between a high and low ankle sprain because the time frame of the rehab plan differs. If you are concerned with any ankle instability or unsure if your ankle sprain is high or low, make an appointment today for a thorough diagnosis.
Written by Cooper Garoni