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Sprained Ankles Can Be Complicated—and Misdiagnosed

Ankle sprains may be one of the most common injuries, but they are also commonly misdiagnosed. That is because the two major types of sprained ankles—high ankle sprains and lateral ankle sprains—often look the same, even though they affect entirely different ligaments.

The less common type—a high ankle sprain—is often mistaken for a lateral sprain. Misdiagnosis can delay getting the right treatment—and that can impair recovery.

One problem is that the symptoms of high ankle sprains parallel those of the lateral ankle sprain, which occurs in the lower ankle area.

Pain, swelling, limited motion and bruising in the entire ankle region can occur in both high ankle sprains and lateral ankle sprains. The difference lies in where the injury occurs and which ligaments are involved.  

High ankle sprains can get complicated because this region has five ligaments connecting two bones in the leg, compared with three ligaments that can be affected in lateral ankle sprains.

The more ligaments that have been involved and the worse they are torn, the more severe the injury.

To select proper treatment, the physician must first “grade” the sprain’s severity based on the extent of ligament injury. Grading also enables the physician to predict how long it will be before the patient can return to normal activity.

Ankle sprains are common in sports, where getting back in the game is a top concern. A popular misconception is that professional players receive “magical medicine” that speeds recovery. According to foot and ankle surgeons, that is a myth. It does not matter whether it is a professional athlete or a weekend warrior, if their injuries are exactly the same; they will heal in the same amount of time.

So when a high school athlete hears it will take six to eight weeks before s/he can return to the game and s/he wants to know why New England Patriots tight end Rob Grankowski played in the Superbowl only 14 days after his high ankle sprain, the answer is clear: Not all ankle sprains are created equal.

In diagnosing an ankle sprain, it is important for physicians to understand how the injury occurred. Lateral sprains are caused by the foot turning inward, whereas high ankle sprains are the result of the foot being forced outward.

Nowhere is this difference in motion more evident than in the world of sports. Surgeons see more high ankle sprains during the four-month football season. And in the basketball season, they go away and many patients come in with lateral ankle sprains.

Treatment for less serious ankle sprains involves immobilization of the foot and nonweightbearing for two to four weeks. More severe high ankle sprains require surgery and a longer time to recover.

Considering that ankle sprains vary so widely in severity, what is a good rule of thumb for when to seek medical care? People with ankle injuries should see a doctor any time there is bruising or the inability to bear weight on that foot.

If these symptoms are not present, home treatment involving rest, ice, compression and elevation should suffice.

The key message regarding an ankle sprain is to have it correctly diagnosed and treated to achieve the best possible recovery.