High Ankle Sprain (AITFL sprain)

Updated: Sep 29, 2019

Cause: Twisting injury

Appearance: Sudden inability to ambulate after injury, instability of the ankle, pain in the lower leg/ankle junction.

How to Diagnose: X-ray, clinical exam (squeeze test, external rotation test), MRI to confirm anatomy


- If no displacement of the ankle

o Rest, ice, compression, elevation, anti-inflammatories (if ok to take)

o 1-3 weeks of immobilization in boot

o Physical therapy following immobilization

o Bracing for 3 weeks following boot immobilization

o Tennis resumes at 6 weeks

§ High ankle sprains have higher incidence of instability therefore the athlete should be weary of early return to sport

o If residual symptoms persist

§ Surgery to restore the ligament

- If there is displacement of the ankle (>2mm)

o Surgery is indicated to restore function of the ankle

§ 6-8 weeks non-weightbearing

§ Physical therapy to restore function

§ Begin activity after a minimum of 12 weeks

§ Brace with tennis for 3 weeks minimum

· Potential for indefinite bracing depending on the level of surgery

Long-term prognosis: High ankle sprains need to be respected. Recovery times are variable as well as are outcomes. Early recognition is key to successful outcomes. Instability of the ankle warrants consideration for surgery especially in the high level athlete. For athletes who are not candidates for surgical correction or for athletes who have residual issues, custom bracing should be strongly considered.

Who to call: Podiatrist, orthopedic surgeon (skilled in arthroscopy)

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