The goals of treatment are to have the tibia and fibula located in the correct position with respect to each other and to heal in that position.
It is very important to note that these injuries can take a lot longer than typical ankle sprains to heal. In the absence of a broken bone, the treatment immediately following the injury is to rest the leg, ice for 20 minutes every two to three hours, provide gentle compression in the form of an Ace wrap, and elevate the leg with the toes above the nose.
The patient will commonly have enough tenderness that they need a CAM Walker boot (removable walking boot). Aggressive therapy when weightbearing is possible is very important. This includes strengthening those tendons on the outside of the ankle, called the peroneals, and doing proprioception, teaching a patient to feel how the ankle is positioned and moves.
It usually takes six weeks or more to return to play, but can sometimes take even longer. One good indication that a person is ready to go back to sports is if they can hop on the foot 15 times.
This type of treatment is acceptable if there is no obvious widening between the tibia and the fibula on the X-rays. If there is widening, which is called “diastasis,” or if there is an ankle fracture (broken bone) in the same setting, surgery is often needed. There is debate as to how to properly fix these injuries, but the idea is to put the fibula and tibia back together and hold them with either screws or new devices that contain a suture, which is the same type of material used to close wounds.
The recovery for high ankle sprains can take considerably longer than typical ankle sprains. In fact, it can take six to seven weeks before athletes return to play. In those cases in which a separation of the tibia and fibula or fracture has occurred and surgery is necessary, patients will likely need to be nonweightbearing in a cast followed by a walking boot for about 12 weeks. It is important to do early range of motion passively, meaning with the help of a therapist that moves the ankle, so as to avoid stiffness. The screws are commonly taken out in a second, small surgery before full weightbearing is allowed so they will not break.
Outcomes are generally good if the injury is recognized and treated appropriately. It is more likely, however, to have some stiffness of the ankle after a high ankle sprain as compared to a standard ankle sprain. This is especially true if a fracture has occurred.
Stiffness can occur in the ankle. If surgery is performed, one can have an infection or damage to one of the nerves that provides sensation to the top of the foot called the “superficial peroneal nerve.” This is because that nerve runs very close to the outside of the leg where the incision is commonly made. Arthritis can also develop in the setting of a very severe sprain if the cartilage of the ankle is damaged at the time of the original injury.
*Source: American Orthopaedic Foot & Ankle Society® http://www.aofas.org