Houston Methodist. Leading Medicine

Ankle FAQ

Question:

I'm trying to help our 17-year-old son form realistic expectations about an ankle injury he got playing ice hockey. The orthopedic surgeon called it a high sprain. Our son seems to think the word "sprain" means it's not that bad. But the doctor distinctly said one or more of the ligaments is torn and the ankle is unstable. Surgery wasn't required, so he's starting physical therapy tomorrow. What should we expect in terms of recovery?

Answer:

You are right in thinking that the word "sprain" doesn't adequately describe the type of damage that is present with a high sprain. But to fully appreciate what's going on, a little anatomy review might be helpful. A high ankle sprain refers to tearing of the connective tissue that connects the lower part of the tibia to the fibula. The tibia is the larger of the two bones in the lower leg. Your shin is the front of the tibia. The fibula is the smaller bone (along the outside of the leg). Syndesmosis is the name of the connecting tissue between these two bones. Another word used to describe high ankle sprains is syndesmotic. The syndesmosis is actually more than just a single layer of connective tissue between the tibia and fibula. That's certainly part of it but there are also four strong ligaments involved (anterior inferior tibiofibular ligament, posterior inferior tibiofibular ligament, interosseous ligament, transverse tibiofibular ligament). When surgery isn't needed, a plan of conservative (nonoperative) care is suggested. A three-phase rehab program is made up of 1) the acute phase, 2) subacute phase, and 3) advanced training phase. Each phase has its own goals, treatments, and criteria for progression (moving along to the next phase or getting back into sports participation). Every athlete is evaluated individually in order to determine the best treatment approach. Once the three-phase program is tailored for the athlete, the therapist carefully monitors symptoms, concerns, goals, and each part of the program. In the acute phase, the goal is to protect the joint and decrease symptoms, especially pain, swelling, weakness, and loss of motion. A variety of tools are used to accomplish these goals such as immobilization in a cast or brace and limiting weight-bearing if needed. Modalities such as ice, compression, electrical stimulation, manual therapy, and/or complementary therapies (e.g., acupuncture) may be used. When the patient can walk with minimal difficulty on different types of surfaces (uneven ground, stairs, grass, curbs), then they are progressed to the subacute phase. Now the goal is to get normal joint motion, strength, and motor control back. The early phase of a strength-training program is started during the subacute phase. The foot and ankle will be challenged with balance activities (e.g., rocker board, wobble board, air cushion). A foot cycle, aquatic therapy, ankle weights or elastic resistance, and weight machines are just a sampling of the many ways training continues. Advanced training is begun when the athlete can jog and hop with little discomfort and can perform all daily activities. The goal, of course, is to get back into sports action. Running, hopping, figure-8, and jumping drills are an important first step in the advanced training series of exercises. The athlete will progress through advanced strengthening, plyometrics, speed drills, and running patterns. Plyometrics involve making fast changes with momentum (speed). This is kept up until they can perform sport tasks at game speed without pain or discomfort. Correct movement patterns and quality motor control are also required. That's when they are released to return to full participation in whatever sport they want to participate in. This progression from acute phase to return-to-sports can take anywhere from weeks to months. Each athlete should be prepared to make a concerted effort to get back into shape before setting foot on the basketball court, football field, soccer field, or as in this case, the ice rink. Glenn N. Williams, PhD, PT, ATC, and Eric J. Allen, MS, PT, ATC. Rehabilitation of Syndesmotic (High) Annkle Sprains. In Sports Health. November/December 2010. Vol. 2. No. 6. Pp. 460-470.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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