Not Your Average Ankle Sprain: Managing A High Ankle Sprain In A 20-Year-Old University Basketball Player

Meet Simon

Simon is a 20-year-old university student. He has been playing basketball since he was 10 years old, and is now on his university basketball team. He trains three times per week and goes to the gym frequently, too. 

We first met Simon when he came into the clinic with a left ankle injury from the week prior. The pain started when he was chasing an opponent on the court, but he can’t pinpoint the exact moment of injury. He had seen his GP for an x-ray, but unfortunately, it did not reveal a specific injury. Ever since, Simon has been resting his foot as much as possible, and applying ice daily to help with the pain.

Simon’s Podiatry Exam

During his assessment, Simon described his ankle pain as a 6/10, which felt worse when he was standing or putting pressure on his ankle, and better when he was resting the ankle.

Upon feeling Simon’s ankle, we noted some tenderness at the front of the ankle, just above the joint. When we rotated Simon’s ankle outwards, or the foot inwards, it also caused some pain. While Simon’s feet didn’t seem to roll excessively inwards or outwards, it was difficult to clearly assess his gait as he was favouring his (uninjured) right foot and leg, limping on the left to try to minimise his discomfort.

Diagnosis: A High Ankle Sprain

A high ankle sprain, often known as a syndesmotic sprain, is the sprain of the ligaments above your ankle joint that connect your tibia (shin bone) and fibula to stabilise these two major bones of the lower leg. This is unlike a regular ankle sprain that damages the ligaments on either the inside or outside of the ankle. These often result from a sudden twisting of the ankle, like when you accidentally roll out on the outside of your ankle.

The most common cause of high ankle sprains is the twisting of the leg on the foot, while the foot is firmly planted on the ground. For Simon, this is likely to have occurred when he was chasing his opponent and decided to quickly turn and change direction while his left foot was still in contact with the ground.

Treating Simon’s Ankle

The initial goal of Simon’s treatment was to control and limit movement (and hence pain), protect the ankle joint so that the injury starts to improve and doesn’t worsen, and maintain his motion and strength through the ankle.

We achieved this by:

  • Regularly strapping his ankle to reduce the tension on his damaged ligaments
  • Prescribing specific exercises that promote movement in the ankle without causing significant pain and discomfort
  • Prescribing specific exercises for the muscles of the foot and lower leg to help maintain his muscle strength and function
  • We monitored Simon’s exercise progress through the Physitrack app, which helped both Simon and us track his progress and ensure he was completing the exercises!

Four Weeks Later

At Simon’s four-week follow-up, his average pain had dropped from a 6/10 to a 2/10, which was a great indication that his ankle ligaments were healing.

We added ankle strengthening exercises using a theraband into his routine, and introduced gentle proprioception training, which involved elements like tracking how long he could stand on one foot for before any discomfort would start.

Simon continued with his existing exercises and we used gentle ankle mobilisation to help maximise his progress. We then booked Simon in to start gait retraining using our athlete-grade Zebris machine. This treadmill doesn’t just let us assess your gait, it is also a great treatment tool.

Six Weeks Later

We saw Simon again in another six weeks – and his pain was gone completely! Simon is now working with our physiotherapist for return-to-sport training, and given his consistency with his exercises, we don’t expect to see him back again for this same problem.

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