A syndesmotic (upper ankle) sprain is a common but often misunderstood injury. Compared to a typical ankle sprain, it involves different ligaments, creates different instability, and usually takes longer to recover.
Knowing which type of ankle injury you have matters. It affects how rehab is planned and how safely you can return to sport, work, and daily activity.
Typical (Low) Ankle Sprain vs High Ankle Sprain
Typical (Low) Ankle Sprain – Outside Ankle Ligament Injury
A typical ankle sprain (also called a low ankle sprain) affects ligaments on the outside of the ankle, below the ankle joint. These ligaments help prevent the ankle from rolling inward and provide side-to-side stability.
The most commonly injured ligaments are:
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Anterior talofibular ligament (ATFL)
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Calcaneofibular ligament (CFL)
This injury often happens when the foot rolls inward, such as during a misstep or awkward landing.
In more significant sprains, the ankle can feel loose because the foot can slide slightly forward under the ankle more than it should. This forward looseness is one reason people describe the ankle as “giving way.”
High Ankle Sprain – Ligament Injury Above the Ankle Joint
This injury involves ligaments above the ankle joint that connect the two lower leg bones (the tibia and fibula). These ligaments help the lower leg bones work together during walking, running, twisting, and pushing off.
It often occurs when:
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The foot is forced outward
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The ankle is pushed upward
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A strong twisting force is involved
It is common in sports such as hockey, football, soccer, and skiing.
Instead of the foot sliding forward, the main issue is reduced stability between the two lower leg bones, making pushing off, cutting, and running more difficult.
Can a High Ankle Sprain and a Typical Ankle Sprain Happen Together?
Yes. These injuries can occur at the same time.
When they co-exist:
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The ankle may have forward looseness from injured side ligaments
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AND reduced stability between the lower leg bones
Combined injuries often take longer to recover from, which is why a thorough assessment is important.
What Do 2nd and 3rd Degree Ankle Sprains Mean?
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2nd degree sprain: Partial ligament tear (similar to a frayed rope), moderate swelling, some instability
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3rd degree sprain: Complete ligament tear, significant instability
Both low ankle sprains and upper ankle ligament injuries can fall into these categories.
How Long Does a High Ankle Sprain Take to Heal?
Because the injured ligaments are stressed with every step, recovery often takes longer than a typical ankle sprain.
General Recovery Timeframes
Typical (Low) Ankle Sprain
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1st degree: 2–4 weeks
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2nd degree: 4–8 weeks
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3rd degree: 8–12+ weeks
Upper Ankle (Syndesmotic) Sprain
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1st degree: 6–8 weeks
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2nd degree: 8–12 weeks
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3rd degree: 3–6 months (sometimes longer)
If both injuries are present, recovery often takes longer than either injury alone.
Important Note
These timelines are general guidelines, not guarantees. Healing can be affected by age, overall health, injury severity, how early treatment begins, and how consistently rehab is followed.
Early Care You Can Do at Home
Early on, you can help by:
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Avoiding painful activities
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Using ice for pain relief
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Light compression if comfortable
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Elevating the ankle when resting
These steps help settle pain and swelling, but they don’t fully restore stability.
Why Physiotherapy Matters for High Ankle Sprain Recovery
At North 49, we look at the whole picture, not just where it hurts.
There are two sides of rehab, and both are essential.
What We Do
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Identify which ligaments are injured
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Determine what type of instability is present
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Protect healing tissues
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Progress rehab safely
Physiotherapy may include hands-on treatment, taping or bracing, strengthening, balance training, and a gradual return to activity.
What We Guide You to Do
We also coach you on:
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Home exercises
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Safe activity levels
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When to progress and when to back off
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How to reduce the risk of re-injury
Both sides matter. Together, they create the best environment for recovery.
Prognosis After a High Ankle Sprain
With proper assessment and physiotherapy, most people recover fully and return to the activities they enjoy.
Our goal is to help you return as soon as possible, but always in the safest way.
We’re Here to Help in Saskatoon
If you live in the Saskatoon area, it would be an honour to work with you. The team at North 49 has experience assessing and treating ankle injuries, from common low ankle sprains to more complex upper ankle ligament injuries.
If your ankle isn’t improving or still feels unstable, a proper assessment can make a real difference.
Call North 49 today at 306-343-7776 or book an Initial Assessment online through our online platform.
References
Boytim MJ et al. Syndesmotic ankle sprains. American Journal of Sports Medicine.
Hopkinson WJ et al. Syndesmosis sprains of the ankle. Foot & Ankle.
Nussbaum ED et al. Syndesmotic ankle sprains without diastasis. AJSM.
Gerber JP et al. Persistent disability after ankle sprains. Foot & Ankle International.
Waterman BR et al. Epidemiology of ankle sprains. AJSM.
van den Bekerom MPJ et al. Evidence-based ankle sprain guidelines. BJSM.