If you have rolled your ankle and been told it is a high ankle sprain, you may be surprised to learn it is quite different from the far more common ankle sprain, and often more stubborn. Known medically as a syndesmosis injury, it damages the ligaments that bind the two lower leg bones together, rather than the ligaments on the outside of the ankle. It is a frequent and frustrating injury for athletes in particular. This article focuses on how to recognise one and why it behaves so differently.
What Is a High Ankle Sprain?
A syndesmosis injury affects the joint just above the true ankle, where the two lower leg bones, the tibia and fibula, are held together by a group of strong ligaments. When the foot is forced outward or twisted, usually with the ankle bent upward, these ligaments can be stretched or torn. It is called a high ankle sprain because the injury sits above the level of a standard ankle sprain. If you want the full rundown of the anatomy and recovery stages, our companion guide on how to recover from a syndesmosis injury covers it in detail. This article zeroes in on how to spot one and why it is different.
High Ankle Sprain vs Regular Ankle Sprain
The everyday ankle sprain, the kind almost everyone has had, involves rolling the ankle inward and damaging the ligaments on the outside. A high ankle sprain is a different beast. It involves a different mechanism, usually an outward twist rather than an inward roll, and it damages a different set of ligaments higher up. The two can feel similar at first, which is exactly why they are so often confused, but they behave very differently once you start walking and loading the ankle.
Why the Difference Matters
Getting this distinction right is not just academic. A regular ankle sprain often settles within a few weeks, while a syndesmosis injury tends to take considerably longer and, in more severe cases, may need surgery to stabilise the joint. Treating it as if it were an ordinary sprain, and returning to sport too soon, is a common path to a drawn-out recovery for an athlete. The right diagnosis shapes the right plan from the start.
How It Happens in Sport
This injury is especially common in contact and field sports such as football and rugby, where the foot can be planted while the body twists over it, or where a tackle forces the ankle outward. The classic scenario involves the foot being fixed to the ground while an external rotation force is applied, straining the ligaments that hold the leg bones together. It is a familiar sight on the sporting field, and one reason athletes often miss more time than expected.
Signs to Watch For
A few features point towards a syndesmosis injury rather than a regular sprain. Pain is typically felt higher, above the ankle joint, rather than over the outer ankle bone. It often hurts to push off, pivot or turn, and squeezing the leg together or rotating the foot can reproduce the pain. Swelling may be less obvious than with a standard sprain, which can be misleading. Athletes often notice the ankle is not settling as quickly as a normal sprain should, and that itself is a clue worth acting on.
Why These Injuries Take Longer to Heal
The ligaments of the syndesmosis carry significant load every time you walk, run or push off, and they have a demanding job holding the leg bones in place. That makes them slower to settle than the outer ankle ligaments, and it means the joint has to be genuinely ready before returning to sport. Rushing this stage is the single most common reason the injury lingers or recurs, which is why patience and a graded return matter so much for any athlete.
Getting the Right Diagnosis
Because the signs can be subtle, a proper assessment is the best way to tell this injury from a regular sprain. A physiotherapist can use specific tests that stress the syndesmosis, and where needed, imaging can confirm the diagnosis and gauge its severity. This matters most when the ankle is not improving as expected, or when a return to demanding sport is the goal. Our ankle and foot physiotherapy starts with working out exactly what you are dealing with.
Common Questions
Is It Worse Than a Regular Sprain?
Usually more involved, yes. It affects the ligaments that bind the leg bones together, which take longer to heal and are more important for stability, so recovery is generally slower than for a standard outer-ankle sprain.
How Long Does a High Ankle Sprain Take to Heal?
It depends on the severity. A mild one may take several weeks, while a higher-grade injury or one needing surgery can take a few months before a full return to sport. A staged, criteria-based return is more reliable than a fixed timeline.
Can I Keep Playing Sport With a High Ankle Sprain?
Playing through it is not advised, as continued loading can worsen the injury and prolong recovery. It is best to have the ankle assessed and follow a guided return rather than pushing through the pain.
How Is It Diagnosed?
A physiotherapist or doctor uses specific hands-on tests that stress the syndesmosis, combined with your history and how the injury happened. Imaging such as an X-ray or scan may be used to confirm it and rule out a fracture.
How BeFit Can Help
At BeFit Training Physiotherapy, our physiotherapists assess and rehabilitate high ankle sprains at our Edgecliff and Coogee clinics. We help work out whether your injury is a syndesmosis injury or a regular sprain, then build a staged plan to get athletes back to sport safely. Every initial consultation runs for forty-five minutes, one-on-one, with a thorough assessment and a clear plan. Whether you rolled your ankle at sport or are not sure what you have done, no referral is required to book, and our return to sport conditioning supports the whole journey back.
Book an appointment at BeFit Training Physiotherapy — no referral needed.
Edgecliff: (02) 9327 7749 | Coogee: (02) 7205 2805 | befittrainingphysio.com/book-now
Related Services
Learn more about our shin, ankle and foot injury physiotherapy, joint sprain treatment and return to sport conditioning in Sydney.
Further Reading
For more on ankle injuries, see The Truth About Repeated Ankle Sprains and Syndesmosis Injury: How to Recover From a High Ankle Sprain.
References
Sman AD, et al. Diagnostic accuracy of clinical tests for ankle syndesmosis injury. Br J Sports Med. 2015.
Williams GN, et al. Syndesmotic ankle sprains in athletes. Am J Sports Med. 2007.
Vopat ML, et al. Return to sport following syndesmosis injury: a systematic review. Sports Health. 2021.
Australian Physiotherapy Association. Clinical guidelines. physiotherapy.asn.au.
