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High Ankle Sprains are a Pain in the Ligament

By Kathy Hubbard

 

When I watched Jimmy Garoppolo, the quarterback for the 49ers, go down with a high ankle sprain, I said something like, “Rub a little dirt in it, it’ll be fine.” But, apparently, it’s a more severe injury than that. And, since it’s not only a common football injury, it can happen while skiing or snowboarding and many other sports, I thought it was a good time to put high ankle sprains on the subject list.

“A high ankle sprain is an injury that involves a different set of ligaments than in the common ankle sprain,” explains the Hospital for Special Surgery’s website. “These ligaments are located above the ankle joint and between the tibia and fibula. They form what is known as the syndesmosis.”

When you put weight on your leg, the tibia and fibula are separated due to the force. The ligaments that make up the syndesmosis serve as a shock absorber that prevents the bones from pulling too far apart. These forces are pretty intense when you’re running, jumping, and skiing.

A high ankle sprain is caused by an inversion or dorsiflexion trauma to the syndesmosis. A what? Dorsiflexion is the backward bending and contracting of your hand or foot. In this case, the foot.

“Unfortunately, there is no high ankle sprain brace that has been shown to prevent these injuries. The best way to avoid this injury is continual performance training for strength and flexibility, including appropriate stretching exercises especially just before playing sports,” HSS says.

So, you skiers and snowboarders here’s the scoop for you. Mount Sinai Hospital says that regardless of your skill level, prevention of injuries starts with preparedness. “For snowboarding, in particular, 25 percent of all injuries occur in the first session.” They also say that stretching along with appropriate warm-up and cool-down are essential to prevent sprains.

And, here’s another bit of info from Mount Sinai that’s interesting: “Compared to other sports, proper fitting equipment, particularly boots, is also equivalent to a successful, injury-free day. Loose-fitting boots account for more than 1/3 of lower extremity injuries. Snowboarding boots are particularly important. Soft boots double the risk of ankle injury when compared to hard.”

It sounds like a good time to put new boots on your Santa list.

If you experience a high ankle sprain, the pain will typically radiate up your leg from your ankle. “Each step you take may be quite painful, and the pain is usually even worse if you move your foot in the same way as when the injury occurred,” HSS says. “For example, if you sprained syndesmosis ligaments by running and then quickly turning left using your right foot, repeating that motion later will be very painful.”

Rarely do high ankle sprains cause a lot of swelling or bruising. So, you might think the injury isn’t as bad as it actually is. But, this truly isn’t a “rub dirt in it” injury. You need to rest and rehabilitate it seriously. And seriously, you’ll want to call an orthopedic surgeon for a diagnosis. (Bonner General Health Orthopedics phone number is 208-263-8597.)

Standard treatment for a high ankle sprain is similar to the common ankle sprain. You know the acronym RICE: Rest, Ice, Compression, and Elevation.

“For severe high ankle sprains, or in cases where a ligament is completely torn, surgery may be appropriate. The standard procedure is to insert a screw between the tibia and fibula to hold the two bones together, which relieves pressure on the ligaments and allows them to scar and heal,” HSS says.

The really bad news is that the recovery time can be twice as long as for a common sprain. You’re looking at a minimum of six weeks, which is a huge chunk out of the good snow season. Around 50 percent of those injured will experience pain for as long as six months. Ouch.

That said, outcomes are generally good if the injury is diagnosed and treated appropriately and in a timely fashion, as in don’t wait to see if it gets better on its own. It might not. Be safe out there, okay?

 

Kathy Hubbard is a member of Bonner General Health Foundation Advisory Council. She can be reached at kathyleehubbard@yahoo.com.

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