Searching High and Low

The LA Rams won the Super Bowl in 2022, but have had difficulty matching that level of success since then. One bright spot for the Rams this season has been star wide receiver Cooper Kupp. Last season, his season was cut short when he suffered a high ankle sprain requiring surgery. He recently got injured with another ankle sprain in the game against the Seahawks. Early reports indicate that it is a low ankle sprain (www.espn.com).

So, what’s the difference between a low ankle sprain and a high ankle sprain. A low ankle sprain is the most common sports injury and as the name implies, occurs when the lower portion of the ankle rolls inward (utswmed.org). High ankle sprains occurs when more significant rotational injuries stress the syndesmotic ligaments above the ankle that hold the tibia and fiber (shin) bones together. Thus, a high ankle sprain is referred as a syndesmotic injury.

Syndesmosis, aka high ankle ligaments, are composed of 3 major components (footcaremd.org): the ATFL (anterior inferior tibiofibular ligament), PITFL (posterior inferior tibiofibular ligament) and the IO (interosseous membrane). Ligaments connect bone to bone which keeps the bones moving together (compared to tendons which connect muscle to bone).

Both types will present similarly with pain at onset of injury, swelling and even some localized bruising. Generally speaking, high ankle sprains can take twice as long to heal then the low ones - about 3 weeks to 4 months. In addition to physical exam, an imaging modality like radiograph or CT or MRI will be obtained to check for associated broken bones or extent of ligament injury,

There are 3 grades of ankle sprains (rush.edu):

Grade 1 - stretching or slight tearing of ligament, minimal tenderness and swelling, probably still able to walk

Grade 2 - incomplete tear, more swelling and pain, probably not able to walk

Grade 3 - complete tear, severe swelling and pain, not able to walk

Grade1 and 2 ankle sprains are usually managed conservatively. Grade 2 and 2 ankle sprain can be considered for surgical correction. The Brostrom procedure, a surgery to repair and tighten the syndesmosis (Management of Syndesmosis Injury: A Narrative Review, 2022 Ortho Res Rev), is commonly used to stabilize the ankle joint. It can take 1-2 months to recover from surgery on average.

Figure 1 from https://www.physio-form.co.uk/article/how-to-manage-ankle-sprains