Houston Methodist. Leading Medicine

Ankle FAQ

Question:

My daughter was out skiing over Christmas break and sprained her ankle badly. The X-rays and MRIs show a separation between the two bones in the lower leg. They called this a high ankle sprain. How long should we expect her to be off her feet? We have a family ski trip planned in two weeks.

Answer:

Most people are familiar with the typical ankle injury that occurs just below the ankle bones. But there are other types of ankle injuries. One of those is the syndesmosis ankle sprain. The syndesmosis is a specific location in the upper ankle where the tibia and fibula (bones of the lower leg) meet. Athlete and soldiers have the highest incidence of syndesmosis injuries. Football players, skiers, and hockey or basketball players are at increased risk of this injury. Once the injury has been identified and evaluated, the surgeon uses the information to classify it as a grade one, two, or three injury. The difference between the grades is based on amount of edema, tenderness, and ability to put weight on the foot. Distance between the two bones as seen on imaging studies is also factored into the classification. The final step is to plan a course of treatment. There are two basic choices: conservative (nonoperative) care and surgery. There haven't been enough studies done to show what's the best way to approach conservative care. Right now, nonoperative treatment is broken down into three parts or phases. Phase one is the acute phase. When there is swelling, the ankle joint must be protected until the inflammation is controlled. Moderately painful injuries are aided by an ankle brace or taping to provide compression and stability along with ice, rest, and elevation. Severe pain may require immobilization in a cast or splint. Physical therapy to restore normal joint motion and neuromuscular control may be needed. Therapy continues during phase two, the subacute phase with strength and functional tasks. The program is progressed until the patient is no longer using assistive devices (splints, braces, crutches). When the athlete is ready for more advanced training, then phase three begins. The focus will be on returning the athlete to active sports participation at the preinjury level whenever possible. There's no set amount of time before players return to sports. This varies according to the severity of the injury. Studies report anywhere from three and a half weeks up to two months before rehab is complete. In some cases, conservative care isn't even possible. Surgery to repair the damage and restore ankle stability is required. Recovery is delayed by three to four months. Two weeks probably isn't enough time to get back on skis, but your physician will be the one to say yes or no. There are some tests he or she can perform to help predict who can treat this problem with physical therapy and who needs surgery. It's best to follow any recommendations made by the surgeon in order to avoid reinjury. Michael J. DeFranco, MD, et al. High Ankle Sprains Require a High Index of Suspicion. In The Journal of Musculoskeletal Medicine. December 2008. Vol. 25. No. 12. Pp. 564-569.

*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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