High Ankle Sprain (Syndesmosis Injury) in Football Players

Introduction

High ankle sprains, also known as syndesmotic sprains, are a significant concern for football players due to their potential impact on performance and playing time. In this article, we will review the management of high ankle sprains in football players, exploring the underlying causes, rehabilitation techniques, and the importance of a holistic approach to recovery.

What is a High Ankle Sprain?

A high ankle sprain refers to an injury involving the syndesmotic ligaments that connect the tibia and fibula bones in the lower leg. The main ligaments and structures that can be injured in a high ankle sprain include:

Anterior inferior tibiofibular ligament (AITFL)
Posterior inferior tibiofibular ligament (PITFL)
Transverse tibiofibular ligament (TTFL)
Interosseous ligament (IOL) / Interosseous membrane

High ankle sprains in football players are typically caused by:

Forced external rotation of the foot
Excessive dorsiflexion with external rotation of the foot
Direct impact to the lower leg
Sudden changes in direction or uneven playing surfaces

Symptoms of a High Ankle Sprain

Footballers with a high ankle sprain may experience the following symptoms:

Pain and swelling: High ankle sprains typically result in pain and swelling at the front of the lower leg, just above the ankle joint. The pain may be sharp and intense, making it difficult to bear weight or continue playing.
Difficulty bearing weight: Footballers with a high ankle sprain may find it challenging to put weight on the affected leg. Walking or running can be painful and unstable due to the injured ligaments.
Limited range of motion: The ankle may have a reduced range of motion, making it challenging to flex or extend the foot fully. Movements that involve twisting or turning the foot may be particularly painful.
Tenderness and bruising: The area around the injured ligaments may be tender to touch, and bruising may develop over time. The bruising can spread upwards from the ankle toward the shin.
Instability and loss of balance: Footballers with a high ankle sprain may experience a sense of instability in the ankle joint. This can lead to difficulty maintaining balance and coordination, affecting their performance on the field.
Pain with specific movements: Certain movements, such as rotating the foot outwards or upwards, may elicit increased pain and discomfort. These motions stress the injured ligaments and can exacerbate symptoms.

It is important for footballers who suspect a high ankle sprain to seek medical evaluation from a healthcare professional or sports medicine specialist. An accurate diagnosis is crucial for appropriate treatment and rehabilitation.

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Ankle Sprains in Football

Assessment of High Ankle Sprains

Accurate assessment of high ankle sprains is essential to establish an appropriate treatment plan. The assessment may include:

Comprehensive history-taking to understand the mechanism of injury and previous ankle problems
Physical examination to evaluate tenderness, swelling, and stability of the ankle
Specialised tests, such as the squeeze test, external rotation stress test, and fibular translation test, to assess the integrity of the syndesmotic ligaments
Diagnostic imaging, such as X-rays or MRI, to confirm the diagnosis, assess the severity of the injury, and rule out fractures or other complications

Treatment Options for High Ankle Sprains

The management of high ankle sprains can vary depending on the severity of the injury and may include both non-surgical and surgical options.

Non-surgical treatment options:
- Rest, ice, compression, and elevation (RICE)
- Immobilisation with a boot or cast to stabilise the ankle
- Non-steroidal anti-inflammatory drugs (NSAIDs) to alleviate pain and reduce inflammation
- Physical therapy and rehabilitation exercises focused on range of motion, strengthening, and proprioception
- Gradual return to weight-bearing and functional activities
Surgical treatment options:
- Surgical intervention is considered for severe high ankle sprains or cases that do not respond to conservative treatment. Surgical procedures may involve repairing the damaged ligaments or stabilising the syndesmosis with screws or a TightRope wire.

Products that may help

Aircast Boot – View this product on Amazon for more details

The Aircast boot is often required to immobilise the ankle during the early stages of a syndesmosis injury. The Aircast boot has air cushions and shock absorption features, which make this boot the gold standard for ankle injuries.

Anti-inflammatory patch – View this product on Amazon for more details

The Nurofen Joint and Muscular pain relief plasters continuously releases ibuprofen over 24 hours to target pain and inflammation at the site of pain. This can be an effective option for reducing the initial swelling from the ankle sprain injury.

Ankle Ice Pack – View this product on Amazon for more details

This foot & ankle ice pack provides cold therapy for the entire foot and ankle area, providing pain relief and helping to reduce swelling. The ice pack contains gel to ensure longer lasting cold therapy and the ankle specific design also provides compression to the injured area.

Balance Cushion – View this product on Amazon for more details

The balance cushion is a useful piece of equipment to provide challenging proprioception exercises that help to improve stability of the ankle.

Ankle Support – View this product on Amazon for more details

The aim of ankle sprain rehabilitation is to regain full function of the ankle and hopefully return to training and games without needing an ankle strapping. However, in the initial stages after an ankle sprain, or cases of chronic instability, an ankle strapping is often required. This ankle support is a high quality option for football players.

Rehab Techniques for High Ankle Sprains

Rehabilitation plays a vital role in the recovery process of high ankle sprains. The rehabilitation program should be divided into three stages: early, intermediate, and advanced. The progression through these stages will depend on the individual’s healing response and the guidance of a qualified healthcare professional. Here’s a breakdown of each stage:

Early Stage:

Protect the injured ankle with a supportive brace or boot to minimize stress on the ligaments.
Focus on reducing pain, swelling, and inflammation through rest, ice, compression, and elevation (RICE).
Use crutches to avoid putting full weight on the injured ankle initially.
Perform gentle range of motion exercises to maintain joint mobility without exacerbating pain.
Begin isometric exercises to activate the muscles around the ankle without causing excessive strain.
Gradually introduce weight-bearing activities under the guidance of a healthcare professional.
Start proprioceptive exercises, such as balancing on one leg, to improve ankle stability.

Intermediate Stage:

Gradually increase weight-bearing activities and transition from the supportive brace or boot to a more flexible ankle brace.
Focus on strengthening exercises to improve muscle stability and support around the ankle, including calf raises, ankle dorsiflexion/plantarflexion exercises, and resisted ankle inversion/eversion exercises.
Incorporate balance and proprioception training using wobble boards, balance discs, or unstable surfaces to challenge ankle stability.
Initiate functional exercises that mimic football-specific movements, such as lateral shuffling, cutting, and jumping.
Begin agility drills, such as ladder drills or cone drills, to enhance coordination and footwork.
Gradually introduce controlled running activities, ensuring proper form and avoiding excessive stress on the ankle.

Advanced Stage:

Progress to sport-specific exercises and drills that involve rapid changes of direction, sprinting, and jumping.
Incorporate plyometric exercises to enhance power and explosive movements, such as box jumps or single-leg hops.
Focus on building endurance through interval training, gradually increasing the intensity and duration of cardiovascular exercises.
Implement on-pitch conditioning sessions to simulate football movements and demands.
Gradually reintroduce contact activities, such as tackling or challenging defensive movements, under the supervision of a sport rehab professional.
Ensure a gradual return-to-play protocol that includes controlled practice sessions, modified training sessions, and clearance from a medical professional before returning to competitive play.

Conclusion

High ankle sprains can be challenging injuries for football players, but with proper management, rehabilitation, and a tailored approach, athletes can make a successful recovery and return to the game. Understanding the anatomy, causes, assessment techniques, treatment options, and the importance of a comprehensive rehabilitation program is crucial for optimising outcomes and preventing future complications. By prioritising proper care and rehabilitation, football players can regain their strength, stability, and confidence, ensuring a safe and successful return to the field.

Disclaimer

The information provided in this article is for educational purposes only and should not substitute professional medical advice. Always consult with a qualified healthcare professional for diagnosis, treatment, and personalised recommendations based on your specific condition. Some affiliate links may also be used in this article, these are from products we have specifically selected to display based on our own experience.

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