High Ankle Sprain Management

Diagnosis

The American Academy of Family Physicians notes that high ankle sprains are distinct from common lateral ankle sprains and require specific clinical tests for diagnosis, including the mechanism of injury, such as dorsiflexion with external rotation of the leg, or eversion with internal rotation of the tibia 1
Pain location is typically in the syndesmosis area between tibia and fibula, above the typical lateral ligament injury site 2
The crossed-leg test (squeeze test) can be used to diagnose high ankle sprains, where applying pressure to the medial side of the knee while the patient sits with legs crossed produces pain in the syndesmosis area 2, 3

Functional treatment with early mobilization is superior to immobilization and should be initiated immediately using the PRICE protocol combined with semirigid bracing, as recommended by the American College of Sports Medicine 3, 4
The PRICE protocol includes protection with a semirigid ankle brace, rest with limited weight-bearing for 3-5 days, ice application for 20-30 minutes per session, compression with a wrap, and elevation of the ankle above heart level 2, 3, 4
Pain management with NSAIDs, such as piroxicam, celecoxib, or naproxen, can improve pain control, decrease swelling, and accelerate return to activity 2, 4, 5
Heat application is contraindicated in acute ankle injuries, and supervised exercise therapy should be initiated within 48-72 hours, including range of motion exercises, progressive strengthening exercises, proprioception training, and coordination exercises 3, 4, 5

High ankle sprains require more intensive rehabilitation and significantly longer recovery time than lateral ankle sprains, with a return to sports expected to be 4.6 days sooner with functional treatment versus immobilization 3, 4
Return to work is expected to be 7.1 days sooner with functional treatment versus immobilization, and ligamentous strength may not fully return until months after injury, even with optimal treatment 4, 5
Semirigid bracing should be continued throughout rehabilitation and upon return to sport, as it has Level 1 evidence for preventing recurrent sprains 4