Common vs High Ankle Sprains: What Are the Differences

Common vs High Ankle Sprains: What Are the Differences

According to a study, ankle sprains account for 16-40% of all sports-related injuries. As such, athletes will experience this common lower limb injury at some point in their life, especially if they play basketball, football, and American soccer. But besides the common ankle sprain, there is another type of ankle sprain that one can sustain while being active: high ankle sprains. Read on to learn the difference between these two and why high ankle sprains take longer to recover from.

Common ankle sprain vs high ankle sprain

Common ankle sprains range in severity from a partial tear to a complete tear and typically affect the anterior talofibular ligament (ATFL). This ligament is one of the ankle’s core stabilisers and gets torn whenever an athlete rolls or internally inverts their ankle with excessive force. Swelling and bruising usually follow an ankle sprain that can spread to the foot, hence the need to be checked by a healthcare provider to ensure no fractures or a more severe injury.

On the other hand, high ankle sprains only account for 14% of ankle sprains and affect a different set of ligaments, which are now located above the ankle joint between the fibula and tibia. These strong ligaments connect the two adjacent bones to form a fibrous joint called a syndesmosis and serve as shock absorbers whenever the leg bears weight and spreads apart the tibia and fibula.

Causes and prevention of high ankle sprains

A high ankle sprain occurs when the leg and ankle turn outward and damage the ligaments above the ankle in an external rotation injury. This typically results from sudden turning, twisting, or cutting motion while running, falling, or jumping. The ligaments of the syndesmosis experience very high forces during these situations, which causes injury.

Warm-ups involving neuromuscular training, i.e. movements focused on coordination and balance, may help to decrease the chances of high ankle sprain injuries. This is backed by a SHRed study where basketball players saw a 35% reduction in the rate of ankle and knee injuries by performing dynamic warm-ups that engage all the major muscle groups before physical activity.

Besides that, another good way to avoid high ankle sprains is by constantly doing performance training for balance and strength, accompanied by good nutrition and good sleep to promote performance and injury prevention.


The foremost symptom of a high ankle sprain is pain that originates from the ankle and radiates up the leg, often worsening when pivoting or bearing weight on the affected foot. This injury usually only causes minimal swelling higher on the leg and seemingly looks “not that bad” to athletes and their coaches. It is this unawareness of the severity of the injury that causes people to not rest and rehabilitate enough for complete healing.

Treatment and rehabilitation

It is important not to underestimate high ankle sprains as they can have a long-term impact on limb function and pain. Thus, once the diagnosis confirms a high ankle sprain, your doctor can guide you with the proper ankle pain management to begin recovery. Besides a prescribed rehabilitation program, basic concepts like the RICE (Rest, Icing, Compression, Elevation) protocol can also help treat a high ankle sprain. Moreover, unlike lateral ankle sprains that benefit from early mobilisation, most high ankle sprains need more bracing and a short period of limited weight bearing.

After the first couple weeks of following the RICE protocol and protected weight bearing, your healthcare provider will typically get you started on physical therapy to regain strength and range of motion. In addition, they may also recommend proprioception training, which effectively reduces the rate of recurrent injury.


There are two types of ankle sprains, common ankle sprains and high ankle sprains. The difference between the two is not just location but how they occur: high ankle sprains involve turning outward or inward while the foot is flexed up, while common ankle sprains occur when the ankle itself rolls inward or outward. Also, since high ankle sprains damage ligaments that lift a heavier load, they take at least twice as long to heal compared to common ankle sprains. For common ankle sprains, try simple physiotherapy exercises to relieve the pain.

If you recently experienced a sporty injury like an ankle sprain, consult a pain management specialist today to start your recovery. At Pain SG, we are dedicated to treating all pain conditions disrupting your daily life. Whether it is our ankle pain management or other proven solutions, we are always ready to work with you and bring you the relief you seek.

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