High ankle sprain vs. low ankle sprain: What are the key differences?

Low ankle sprains and high ankle sprains damage different ligaments and require specific recovery timelines. If your ankle sprain is taking longer than expected to heal, or if the pain sits higher up than you’d expect from a typical rolled ankle, understanding which type you have can help explain why.

At Cascade Foot & Ankle Center in Provo and Nephi, Utah, board-certified podiatric surgeon and wound care specialist Jared Clegg, DPM, FACFAS, and our team diagnose and treat both types of ankle sprains. Learn how they differ and why location partially determines recovery time.

Low ankle sprains injure the outer ligaments

Low ankle sprains most often affect the ligaments on the outside of your ankle. These ligaments connect the ankle bone to your foot and keep your ankle stable when you walk, run, or change direction.

Low ankle sprains typically happen when your foot rolls inward. This type of injury produces immediate pain and swelling on the outside of your ankle. You might have trouble bearing weight, and bruising often appears within a day or two.

Some low ankle sprains occur when you roll the foot outward, affecting the medial ligament. In this case, pain, bruising, and swelling may be more apparent on the inner ankle.

High ankle sprains damage ligaments above the joint

High ankle sprains injure the syndesmotic ligaments connecting your tibia and fibula just above the ankle. These ligaments stabilize the connection between your two lower leg bones.

High ankle sprains happen when your foot is planted and your leg rotates outward, or when your ankle gets forced upward beyond its normal range. The injury produces pain higher up on the ankle, often extending several inches above the joint. Swelling may be less obvious at first, but the pain is typically more severe.

Pain location differs between high and low ankle sprains

Low ankle sprains hurt most at the ankle joint. Pain worsens when you walk or put weight on the foot, especially on uneven surfaces. Swelling and bruising appear quickly around the ankle.

High ankle sprains typically hurt above the ankle joint and along the front or inside of the lower leg. Pain increases when you push off with your toes, climb stairs, or rotate your leg. Swelling may be less visible, but the joint feels unstable. 

A squeeze test — where Dr. Clegg compresses your lower leg bones together at mid-calf — reproduces pain in a high ankle sprain but not in a low one.

Diagnosing high ankle sprains vs. low ankle sprains

Physical examination usually reveals which type of sprain you have. Dr. Clegg tests ankle stability, checks where the pain concentrates, and performs specific tests to identify ligament injuries above the ankle.

X-rays rule out fractures and check the spacing between the tibia and fibula. If the bones have separated too much, it indicates severe ligament damage. Magnetic resonance imaging (MRI) scans show the extent of ligament tears when imaging is needed to guide treatment decisions.

Treatment for low and high ankle sprains

Low ankle sprains typically respond to conservative care:

• Rest, ice, compression, and elevation
• Over-the-counter anti-inflammatory medication
• Ankle braces or walking boots for support
• Physical therapy to restore strength and range of motion
• Gradual return to activity as symptoms improve

High ankle sprains need longer immobilization in a walking boot or cast while the ligaments heal. Severe cases require staying off the ankle completely for several weeks. We generally recommend physical therapy later to build stability and strength. Surgery is often necessary when the bones have separated and need to be realigned.

Pushing through pain or returning to activity too soon with either type increases the risk of chronic ankle instability, where the ankle gives out repeatedly during normal activities.

Ankle sprain treatment in Provo and Nephi, Utah

Any ankle sprain that doesn't improve with a few days of home care deserves professional evaluation. Severe pain, inability to bear weight, swelling that doesn’t respond to ice and elevation, or pain that persists beyond two weeks all warrant an appointment.

Call Cascade Foot & Ankle Center or schedule an appointment online to have Dr. Clegg evaluate your ankle sprain and develop a treatment plan.