Key Takeaways
- A lateral ankle sprain affects the ligaments on the outer side of the ankle.
- A high ankle sprain involves the syndesmosis, the ligament complex above the ankle joint.
- Pain location and movement patterns can help distinguish between the two injuries.
- High ankle sprains often take longer to recover due to stress during weight-bearing.
Why These Two Injuries Are Often Confused
Although both injuries are called ankle sprains, they affect different ligaments and can have different recovery timelines. A lateral ankle sprain involves the ligaments on the outer side of the ankle, while a high ankle sprain affects the syndesmosis above the ankle joint.
Both injuries can occur after a twist, awkward landing, or fall, and often cause pain, swelling, bruising, and difficulty walking. Because the symptoms can overlap in the early stages, it is not always easy to tell them apart. However, identifying which ligaments are injured is important, as it helps guide appropriate treatment and recovery expectations.
Where the Injury Occurs
A lateral ankle sprain affects the ligaments on the outer side of the ankle, most commonly the anterior talofibular ligament (ATFL). These ligaments help stabilise the ankle during side-to-side movements.
A high ankle sprain affects the syndesmosis, the ligament complex that connects the tibia and fibula above the ankle joint. This structure helps keep the two lower leg bones aligned during walking and other weight-bearing activities.
Understanding where the injury occurs is one of the main differences in a high ankle sprain vs an ankle sprain. A lateral sprain typically causes pain around the outer ankle, while a high ankle sprain is more likely to cause pain above the ankle joint between the tibia and fibula.
When comparing a syndesmosis injury vs a lateral sprain, pain location is only one clue. A syndesmosis injury often becomes more painful during twisting movements, pivoting, or pushing off while walking because these actions place stress on the injured ligament complex.
How the Injury Happens
A lateral ankle sprain usually occurs when the foot rolls inward suddenly. This can happen when stepping on uneven ground, missing a step, landing awkwardly after a jump, or changing direction during sport.
A high ankle sprain is more commonly caused by a twisting force while the foot remains planted. As the lower leg rotates over the foot, the syndesmosis is stretched, placing stress on the ligaments that connect the tibia and fibula.
This type of injury is often seen during sports that involve rapid changes in direction, such as badminton, basketball, futsal, and tennis. It can also occur after falls or other twisting injuries during everyday activities.
Pain Patterns and Symptoms
One of the main differences between the different ankle sprain symptoms is where the pain is felt.
A lateral ankle sprain usually causes pain, tenderness, swelling, and bruising around the outer side of the ankle. Discomfort often worsens when standing, walking, or bearing weight.
A high ankle sprain typically causes pain above the ankle joint, between the tibia and fibula. The discomfort may become more noticeable during twisting movements, climbing stairs, brisk walking, or pushing off the foot.
Comparing outer ankle pain vs above ankle pain can provide an early clue. Pain around the outer ankle is more commonly associated with a lateral sprain, while pain higher above the ankle joint may suggest a syndesmosis injury.
Unlike a lateral ankle sprain, a high ankle sprain may not cause obvious swelling or bruising immediately. Even so, walking and movements that twist the ankle can still be painful and restricted.
How the Ankle Feels During Movement
A lateral ankle sprain may make the ankle feel weak or unstable, particularly when turning or walking on uneven ground. Some people describe it as feeling like the ankle could “give way”.
A high ankle sprain is more likely to cause stiffness and discomfort during weight-bearing activities. Walking, pivoting, or pushing off the foot may be painful because these movements place stress on the syndesmosis.
The way the ankle feels during movement can also provide clues about the injury. A lateral sprain may improve as swelling settles, while a high ankle sprain can continue to cause pain during walking or twisting movements even if swelling is minimal.
Swelling and Early Signs
A lateral ankle sprain usually causes swelling around the outer ankle and may be accompanied by bruising that spreads towards the foot.
A high ankle sprain often causes less obvious swelling, with discomfort occurring above the ankle rather than around the ankle bone. Because the injury may appear relatively mild at first, it can be easy to underestimate. However, persistent pain during walking, twisting, or pushing off the foot may suggest that the syndesmosis is still injured.
Recovery Differences
When comparing between a high ankle sprain and an ankle sprain, recovery time is often one of the biggest differences. Recovery depends on the severity of the ligament injury, the individual’s activity level, and whether other structures have also been affected.
Mild lateral ankle sprains often recover more quickly when the ligaments remain stable and rehabilitation begins at the appropriate time. In contrast, a high ankle sprain may take longer because the syndesmosis is involved in keeping the tibia and fibula aligned during weight-bearing. As a result, everyday movements such as walking can continue to place stress on the injured ligaments.
In some cases, an ankle ligament tear may require further evaluation, particularly if there is significant instability, persistent swelling, or difficulty returning to normal activities. Depending on the assessment, imaging such as X-rays or MRI may be recommended to evaluate the injury and check for associated fractures or syndesmotic instability.
Why an Accurate Diagnosis Matters
A high ankle sprain may be mistaken for a typical lateral ankle sprain because the symptoms can overlap in the early stages. However, returning to work, exercise, or sport too soon may prolong recovery, as the syndesmosis continues to be stressed during walking and twisting movements.
Identifying the injured structures helps guide appropriate treatment, which may include bracing, temporary immobilisation, physiotherapy, or further investigation where needed.
During assessment, your doctor may consider:
- How the injury occurred
- Where the pain is located
- Whether walking or weight-bearing is difficult
- Which movements make the pain worse
- How symptoms have changed since the injury
At Specialist Orthopaedic Centre, assessment of foot and ankle injuries includes reviewing the injury mechanism, examining the ankle, assessing movement and stability, and recommending imaging where appropriate to clarify the diagnosis.
If your symptoms persist, walking remains painful, or the injury continues to affect your daily activities, consider consulting a foot and ankle specialist. For those looking for an ankle specialist, a detailed assessment can help determine whether the injury is a lateral ankle sprain, a high ankle sprain, or another condition affecting the ankle.
Conclusion
Although both injuries are referred to as ankle sprains, they affect different ligaments and can vary in their symptoms, treatment, and recovery. Understanding the difference between a high ankle sprain vs an ankle sprain can help you recognise when an injury may require closer assessment, particularly if pain persists or walking remains difficult.
If you continue to experience ankle pain, difficulty bearing weight, or discomfort during twisting movements after an injury, consult Specialist Orthopaedic Centre. Following a detailed assessment, our doctor can help identify the cause of your symptoms and discuss treatment options that are appropriate for your condition and recovery goals.