High Ankle Sprain vs. Low Ankle Sprain: What's the Difference?

Reviewed by the Physiotherapy Team at Waterloo Sports Medicine Centre

Rolled your ankle during sports or exercise? Not all ankle sprains are the same. While most ankle sprains involve the ligaments on the outside of the ankle, some injuries affect a different group of ligaments higher up the ankle and can take significantly longer to heal. 

Understanding the difference between a high ankle sprain and a low ankle sprain can help you seek the right treatment and return to activity safely. 

What Is a Regular Ankle Sprain? 

A low ankle sprain, also called a lateral ankle sprain, occurs when the foot rolls inward and stretches or tears the ligaments on the outside of the ankle. The ligament most commonly injured is the anterior talofibular ligament (ATFL). It’s what you typically think of when hearing about an “ankle sprain” or someone “rolling” their ankle.  

Common Symptoms 

• Pain and tenderness on the outside of the ankle 

• Swelling and bruising 

• Difficulty walking 

• Feeling unstable or like the ankle may "give way" 

• Pain with twisting movements 

Regular ankle sprains are one of the most common sports injuries and often occur during running, jumping, or stepping on an uneven surface.

What Is a High Ankle Sprain? 

A high ankle sprain involves injury to the syndesmosis, a group of ligaments that connect the two lower leg bones (the tibia and fibula) just above the ankle joint. 

These injuries usually occur when the foot is twisted outward while the leg rotates inward, such as during: 

• Football 

• Hockey 

• Soccer 

• Skiing 

• Court sports involving quick changes of direction.

  
  

Common Symptoms 

• Pain above the ankle joint, between the shin bones 

• Pain when walking, running, or pushing off the foot 

• Difficulty bearing weight 

• Less swelling and bruising than a regular ankle sprain 

• Pain when the foot is rotated outward 

Because symptoms can sometimes appear less dramatic, high ankle sprains are occasionally mistaken for minor ankle injuries. 

High Ankle Sprain vs. Regular Ankle Sprain

Feature	Regular Ankle Sprain	High Ankle Sprain
Injured structures	Outside ankle ligaments (ATFL, CFL)	Syndesmotic ligaments between the tibia and fibula
Common mechanism	Foot rolls inward	Foot twists outward and rotates
Pain location	Outside of ankle	Above the ankle joint
Swelling and bruising	Usually significant	Often mild
Recovery time	Usually shorter	Often longer
Return to sport	Typically 2-8 weeks	Often 6-12+ weeks

How Are Ankle Sprains Treated? 

Early management often includes: 

• Relative rest and activity modification 

• High ankle sprains require period of non-weight bearing 

• Ice and compression to manage swelling 

• Gradual return to weight-bearing activities 

• Physiotherapy to restore movement and strength.

  
  

How Can Physiotherapy Help? 

Physiotherapy plays an important role in recovery from both regular and high ankle sprains. 

Your physiotherapist may include: 

Pain and Swelling Management 

Strategies to help control pain and reduce swelling during the early stages of recovery. 

Restoring Range of Motion 

Gentle exercises to improve ankle mobility and reduce stiffness. 

Strengthening Exercises 

Exercises targeting the muscles around the ankle, foot, and lower leg to improve support and function. 

Balance and Proprioception Training 

Ankle sprains can affect your balance and joint awareness. Specific exercises can improve stability and reduce the risk of future sprains. 

Sport-Specific Rehabilitation 

For athletes, rehabilitation progresses to jumping, cutting, running, and agility drills to ensure a safe return to sport. 

When Should You See a Physiotherapist? 

Consider booking an assessment if you have: 

• Significant pain or swelling after rolling your ankle 

• Difficulty walking or bearing weight 

• Pain above the ankle joint 

• Recurrent ankle sprains or feelings of instability 

• Symptoms that are not improving after several days. 

  
  

At Waterloo Sports Medicine Centre, our physiotherapists can determine whether you have a regular or high ankle sprain and create an individualized treatment plan to help you recover safely and return to the activities you enjoy.