High Ankle Sprain Treatment Options

Syndesmotic ligament injuries, or more commonly known as high ankle sprains, are very common in the United States and can lead to chronic pain and instability if it is not recognized and treated appropriately.

Anatomy

The ankle syndesmosis is a group of ligaments that help to hold the tibia and fibula together just above the level of the ankle joint. This ligamentous complex is crucial in stabilizing the ankle joint while still allowing some motion to allow for rotation in the leg during weightbearing activities.

Mechanism of injury

High Ankle Sprain PictureIt is estimated that 10% of all ankle sprains involve injury to the syndesmotic ligament. There are several mechanisms of injury to the syndesmotic ligamnet. Isolated syndesmotic ligament injuries often will occur when there is a forced upward motion of the ankle against the leg, causing separation of the tibia and fibula, and disruption of the syndesmotic ligament. Syndesmotic ligmanet injuries that often accompany an ankle fracture are usually injured when there is a forceful rotation of the ankle bone (talus) relative to the leg bone (tibia). Lastly, direct impact injuries during a fall, motor vehicle accident, or other injury may result in a high ankle sprain.

Diagnosis

Diagnosing syndesmotic injuries are done through clinical and radiological exams. Clinically, patients with a syndesmotic ligament injury will experience pain along the ligament and with stress of the ligament through a rotational force or by squeezing the leg bones (tibia and fibula) together.   Although x-rays do not show ligaments, the alignment of the ankle joint, as well as associated fracture patterns of the ankle can give signs that a syndesmotic ligament injury has occurred. In cases where the clinical and x-ray exams are inconclusive, an MRI can be performed on the ankle to visualize the ligament.

Treatment

If the ankle joint is well aligned and there is no associated fracture, cast or boot immobilization for 6-8 weeks is recommended for the ligament to heal.

If the ankle joint is not well aligned, and/or there is an associated displaced fracture, surgery is needed to realign the bones and/or ligaments. The goal of surgical correction is to realign the ankle joint. After reduction of the ankle back into its anatomical alignment, there are two methods that are frequently used to help stabilize the ligament: Screw fixation and tightrope fixation

Screw fixation

Screws have been historically used to help stabilize the syndesmotic ligament after a injury. They are placed above the ankle joint, crossing the syndesmotic ligament. They are positional screws to help hold the tibia and fibula in place as the ligaments heal. Patients are in a non-weightbearing cast for 2-3 months to allow the ligaments to heal in a stable position before the screws are removed.

Tightrope

A tightrope can also be placed across the syndesmotic ligament to help stabilize the joint. This technology is newer, but provides an effective alternative to using screws to hold the ligament stable as it heals. A tightrope is a strong suture that is held to the bone with 2 buttons. The buttons abut against the bone and the suture is pulled tight, holding the bones in position as the syndesmotic ligament heals. The advantage to the tightrope is that no additional surgery is required to remove the tightrope after the syndesmotic ligament heals.

Conclusion

High ankle sprains are common and can lead to significant instability and pain. It is important to have a specialist evaluate your ankle after an injury to allow for the best possible results.

For an appointment with a doctor at one of our nine Greater Los Angeles and Southern California locations please call (877) 989-9110 or visit us at www.footankleinstitute.com.

Dr. Sydney K. Yau

Dr. Sydney K. Yau

Dr. Yau received his initial medical training at Temple University in Philadelphia where he specialized in diabetic limb salvage, sports medicine, foot and ankle reconstruction and trauma.

He then went on to complete his surgical reconstruction fellowship with the University Foot and Ankle Institute, one of only a few fellowships recognized by the American College Foot and Ankle Surgeons.

Now playing an integral role at the University Foot and Ankle Institute, Dr. Yau’s treats various sports injuries, including sprains, arthritis and fractures. He also is passionate about helping diabetic patients avoid amputation through correction of deformities and wound healing.

Dr. Yau is available for consultation at our Simi Valley location.
Dr. Sydney K. Yau

Latest posts by Dr. Sydney K. Yau (see all)

Leave a Reply

Your email address will not be published.

fifteen + 11 =

  • CustomerSure
    Everyone was very helpful and I was so happy to be squeezed in for a same day appointment. Thanks again!
    Anci K.
  • HealthGrades
    Dr. Yau takes time with his patient(s) and explains the foot condition professionally. I highly recommend Dr. Yau as a podiatrist.
    Art H.
  • Yelp
    Dr. Baravarian is a very caring and patient doctor. During my first visit with him he really took the time to listen to my concerns and talk to me about all my options regarding my chronic pain. I highly recommend Dr....
    Sarah L.
  • Yelp
    Right after my first visit with Dr, Briskin was over I knew I found the right doctor. My problem was approached with caution, care and expertise treatment. The treatment was important, but the doctor's mannerism is al...
    Kirk W.
  • Yelp
    I highly recommend Dr. Baravarian at UFAI.  After months dealing with another doctor and getting no results (and a really painful cortisone shot), I was finally diagnosed correctly and had a successful surgery.  I fou...
    Mari W.
  • Yelp
    Dr. Franson and the entire staff at University Foot & Ankle Institute - Valencia are awesome!! I had both feet corrected (bunion surgery) by Dr. Franson and he did amazing work!! He is caring, gentle and friendly, and...
    Helena O.
  • CustomerSure
    Everyone is amazing.
    Susan H.
  • CustomerSure
    I'll love you even more if I get my boot off tomorrow!
    Linda H.
  • CustomerSure
    PT Staff are very nice and knowledgeable. It took me a little time to understand how the PT was correcting my issue, but I think I've been cured!
    Terasa H.
  • Yelp
    Dr. Bob is outstanding.  A week ago today he performed surgery on my tarsal tunnel, and I am well on the mend from his handiwork.  He is professional, patient, and thorough in explaining his procedures and opinions.  ...
    Karen L.
Same day appointments now available!
or call 24/7:
  • University Foot & Ankle, a Preferred Provider to:
  • UCLA Health System - UCLA Medical Group
  • MPTF - Member Industry Health Network
  • Cirque du Soleil
  • ATP - Association of Tennis Professionals
  • And consulting physicians for:
  • C&S - Cedars-Sinai
  • Saint John's Health Center