Highankle

Highankle refers to injuries of the syndesmotic ligaments that stabilize the tibia and fibula above the ankle. The term is commonly used to describe a high ankle sprain, in contrast to the more common lateral ankle sprain.

Anatomy and mechanism: The syndesmosis includes the anterior and posterior inferior tibiofibular ligaments, the interosseous ligament, and the interosseous membrane. Injuries occur with external rotation of the foot or with dorsiflexion, often during sports such as football or basketball, and may accompany a fracture.

Symptoms and signs: Pain and tenderness above the ankle, near the distal tibiofibular joint, swelling may be less prominent than in lateral sprains, and pain with weight bearing or certain ankle movements. A positive external rotation or squeeze test suggests syndesmotic injury.

Diagnosis: Initial evaluation includes clinical examination and radiographs to exclude a fracture. If syndesmotic injury is suspected, MRI or CT can assess ligament disruption and tibiofibular clear space widening.

Treatment: Management depends on severity. Nonoperative care includes immobilization in a boot or cast, partial weight bearing as tolerated, and progressive rehabilitation. Surgical repair or fixation may be required for high-grade injuries with tibiofibular instability.

Recovery and prognosis: Healing typically takes longer than lateral ankle sprains, with return to sport commonly in 3 to 6 months for uncomplicated cases; chronic pain or instability may occur if instability persists.

Prevention and outcomes: Proper conditioning, balance training, and appropriate footwear can reduce risk. Rehabilitation focuses on ROM, strength, and proprioception to restore function.