‘Poorly diagnosed Ankle Pain can often be A High Ankle Sprain’
Up to 10% of all ankle injuries can be diagnosed as a High Ankle Sprain. A high Ankle sprain which is often difficult to diagnose involves a sprain or tearing to the anterior tibiofibular ligament and the Interosseous membrane of the Tibiofibular joint. The tibiofibular joint comprises the end surfaces of the two bones of the lower leg namely the tibia or shin bone and the fibula which is the outside protruding bone of the ankle joint. Binding these two bones together is the Interosseous membrane which is a sheet of connective tissue. The Interosseous Ligament and Anterior Tibiofibular ligament overlap and help bind this joint at the front of the ankle, with the posterior Tibiofibular ligament providing support behind the joint. These 2 bones sit on top of the talus bone and it is this articulation that creates the talocrural joint which bends the ankle up and down.
Causes of High Ankle Sprain
Landing heavily on the foot from a fall whereby the foot makes a sudden movement towards the shin (tibia) can cause the tibiofibular joint to widen, this is known as Diastasis. Secondly, the injury can occur during sport when an athlete is lying on their stomach such as a rugby player in a ruck and an opposing player falls against their heel causing a degree of separation within the tibiofibular joint. The joint may also be injured when a player receives a blow to the outside leg when turning in the opposite direction. For example a player turning left will have their right foot planted in the ground with the knee slightly bent. If they receive a blow to the outside of the right knee and experience sudden pain into the ankle then a high ankle sprain should be suspected.
Signs & Symptoms
Some Pain noted on the inside of the ankle joint (medial ankle region)
Swelling noted just above the ankle joint in the days immediately after the injury has occurred
Pain along the front of the ankle (on the fibula side) can indicate injury to the interosseous membrane & interosseous ligament
Pain into the front of ankle joint on weight bearing activities such as standing.
Pain on attempting to bend foot inwards (dorsiflexion movement) towards shin bone (tibia)
Next week I will discuss the 3 grades of High Ankle Sprain and treatment.
Tomás Ryan is a Registered Physical Therapist with The Irish Association of Physical Therapy (MIAPT) and is based in Clonmel & Thurles.
Contact Number: 0504 26672
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