High Ankle Sprain vs. Low Ankle Sprain: What’s the Difference and How to Treat Them

Ankle sprains are among the most common injuries, whether you’re an athlete, a weekend warrior, or simply someone who took a misstep on uneven ground. But not all sprains are the same. You may have heard of high ankle sprains and low ankle sprains, but do you know the difference? More importantly, do you know the best way to recover?

At Physio Performance Physiotherapy Central Dunedin, we see countless people struggling with ankle injuries. Some heal quickly, while others take longer, depending on the type and severity of the sprain. Understanding what kind of sprain you have is key to getting the right treatment and avoiding long-term instability. Let’s break down the differences between high and low ankle sprains—and how physiotherapy can help you get back on your feet faster.

What’s the Difference Between a High Ankle Sprain and a Low Ankle Sprain?

Both types of sprains involve ligament injuries, but they affect different parts of the ankle.

Low Ankle Sprain (Lateral Ankle Sprain)

A low ankle sprain is by far the most common type of ankle injury. It occurs when the foot rolls inward, stretching or tearing the ligaments on the outside of the ankle. This usually happens when you step awkwardly off a curb, land on someone’s foot during sports, or wear unstable footwear.

Key characteristics of a low ankle sprain:

• Affects the anterior talofibular ligament (ATFL) and sometimes the calcaneofibular ligament (CFL).

• Often caused by a sudden twisting motion or rolling of the ankle.

• Results in swelling, bruising, and pain along the outside of the ankle.

• Walking may be painful but usually still possible.

High Ankle Sprain (Syndesmotic Sprain)

A high ankle sprain is less common but often more serious. It occurs when the foot is forcefully rotated outward or excessively dorsiflexed (pulled upward), stretching the ligaments that connect the two lower leg bones (tibia and fibula). This type of sprain is frequently seen in contact sports like rugby, football, and basketball.

Key characteristics of a high ankle sprain:

• Affects the syndesmotic ligaments, which hold the tibia and fibula together above the ankle joint.

• Often caused by forceful twisting or impact, especially in sports.

• Results in pain above the ankle, swelling, and difficulty bearing weight.

• Recovery typically takes longer than a low ankle sprain.

How to Treat a Low Ankle Sprain

Most low ankle sprains can be managed with a combination of rest, rehabilitation, and physiotherapy. While mild sprains may heal in a couple of weeks, more severe cases can take over a month.

Immediate Care (First 48 Hours)

Rest: Avoid weight-bearing activities to prevent further injury.

Ice: Apply an ice pack for 15-20 minutes every few hours to reduce swelling.

Compression: Use an elastic bandage to minimize swelling and provide support.

Elevation: Keep the foot raised above heart level when resting.

Rehabilitation and Physiotherapy

Once the initial swelling and pain subside, Physiotherapy Central Dunedin focuses on:

Restoring range of motion: Gentle mobility exercises to prevent stiffness.

Strengthening the ankle: Targeting the surrounding muscles to improve stability.

Balance and proprioception training: Exercises to retrain your body’s ability to stabilize the ankle.

Progressive return to activity: Gradual reintroduction to walking, running, and sport-specific movements.

How to Treat a High Ankle Sprain

High ankle sprains require a longer recovery time due to the role of the syndesmotic ligaments in weight-bearing movements. Unlike low ankle sprains, where walking is usually possible early on, high ankle sprains often make weight-bearing extremely painful.

Immediate Care (First 48 Hours)

Follow the same RICE protocol (Rest, Ice, Compression, Elevation) as with low ankle sprains.

Use crutches or a walking boot if necessary to reduce strain on the syndesmotic ligaments.

Rehabilitation and Physiotherapy

Physiotherapy for high ankle sprains is similar to that for low ankle sprains but requires extra care to prevent excessive stress on the syndesmotic ligaments. At Physio Performance Physiotherapy Central Dunedin, we use:

• Joint mobilization techniques to maintain ankle function while protecting the injured ligaments.

• Gradual weight-bearing exercises to reintroduce movement without overstressing the ligaments.

• Strengthening exercises focusing on the calves, shin muscles, and ankle stabilizers.

• Sport-specific training to ensure a safe return to physical activity.

When to See a Physiotherapist

If you’ve sprained your ankle and are experiencing any of the following, it’s time to seek professional help:

• Persistent swelling and bruising beyond the first few days.

• Difficulty walking or putting weight on the ankle.

• A sensation of instability or the ankle “giving out.”

• Pain that isn’t improving after two weeks.

Ignoring an ankle sprain or returning to activity too soon can lead to chronic instability and a higher risk of reinjury. Physiotherapy helps ensure proper healing and reduces the chances of long-term ankle issues.

Final Thoughts: Get Back on Your Feet with Physiotherapy Central Dunedin

Ankle sprains might seem like minor injuries, but without the right care, they can lead to long-term instability and recurring pain. Whether you’re dealing with a high ankle sprain or a low ankle sprain, the right rehabilitation approach is key to a safe and effective recovery.

At Physio Performance, we help people recover from ankle injuries, rebuild strength, and return to their daily activities without fear of reinjury. If you’re struggling with an ankle sprain, don’t wait—book an appointment today and take the first step toward a strong and stable recovery!