painful ankle

High Syndesmotic Ankle Sprain vs. Regular Ankle Sprain: Key Differences Every Athlete Should Know

Posted on January 6, 2025June 27, 2025 by admin

Ankle sprains are the most common injury in the foot and ankle. In this blog, we will discuss the two types of ankle sprains. The most common type is a low ankle sprain and a sprain that occurs less frequently is referred to as a syndesmotic ankle sprain or high ankle sprain. You will learn how both these injuries can occur and gain insight into determining if you have such a sprain.

The Basics

Before categorizing a high ankle sprain versus a low ankle sprain, we must first understand the anatomy. The ankle joint is formed by the talus which sits between the two leg bones called the tibial bone and the fibula bone. The fibula is a smaller bone that lies on the outside of the leg and opposite of the other leg.

Low Ankle Sprains

When you have a low ankle sprain, it involves the ligaments that attach the end of the fibula bone on the outside of your ankle and the end of the tibial bone in the inside of your ankle to your foot. There is one major ligament on the inside that connects the tibia to the foot which is called the deltoid ligament. There are three ligaments on the outside of the ankle connecting the fibula to the heel (calcaneus) and the talus bone. These are called the anterior talofibular ligament, calcaneofibular ligament, and posterior talofibular ligament. These ligaments are all involved in low ankle sprains.

High Ankle Sprains

The other ligaments that are referred to as high ankle ligaments support the ankle joint structure are less frequently injured and they connect the leg bones, tibia and fibula, together. When these are injured, it is referred to as a syndesmotic ankle sprain. They are called the anterior and inferior tibiofibular ligament, posterior and inferior tibiofibular ligament, inferior transverse ligament, and the interosseus membrane.

Anterior and inferior tibiofibular ligament – this ligament is towards the front of the leg just above the ankle and connects the larger tibia bone to the smaller fibula bone.
Posterior and inferior tibiofibular ligament – this ligament connects the back portion of the larger tibia bone to the smaller fibula bone.
Interosseous membrane – this fibrous membrane lies between the two ligaments and its function is to connect the tibia and fibula together.
Inferior transverse ligament – it goes on the back of the ankle, and it goes from the fibula to the tibia, and it is closer to the ankle ligament.

How does a high ankle sprain occur?

High ankle sprain occurs typically when the foot is flexed upwards, and the foot is planted on the ground and there is significant twisting of the leg around the ankle joint most commonly with external rotation. This can put stress on the bones and partially or fully tear the ligaments that are higher above the ankle joint. In contrast, the low ankle sprains are much more frequent with the foot being typically in a downward position, and the foot will rotate inward or outward in relationship to the leg. Syndesmotic ankle sprains occur more frequently in activities such as football where the foot is planted on the ground and possibly because of a collision, twisting is occurring in the leg.

How do I know if I have a high ankle sprain?

Typically, a high ankle sprain will not present with a significant swelling in the outside or inside of the ankle or foot, but pain will be above the ankle joint. You will have swelling in the lower leg region. And also, you may have had the injury when your foot was planted firmly on the ground and the foot was flexed upward.

How is a syndesmotic ankle sprain diagnosed?

The doctor will inquire about how the injury occurred. The examination will usually show pain and swelling in the lower leg close to the ankle and the doctor will perform a squeeze test where the tibia and fibula bones are squeezed together, and this will typically create pain.

X-rays

X-rays will be taken, and, in some cases, there will be a fracture noted particularly in the fibula bone or there could be a portion of bone that was pulled away by one of the injured ligaments. If there appears to be a separation between the tibia and fibula bone on x-ray, surgery may be needed to bring the two bones back into a more anatomical alignment.

CAT scans

CAT scans may be useful to more specifically evaluate for possible bone injury to the tibia and fibula and to ensure that no fracture is associated with syndesmotic injury.

Treatment for a syndesmotic ankle sprain

Rest, Ice, and Compression – if the injury is milder, cutting back on activities and resting the area, icing, and wrapping it with compression is helpful. Anti-inflammatory may be used
Physical Therapy – physical therapy may be needed to reduce the swelling and promote returning to full activity.
Immobilization – in more severe cases, it may be recommended not to bear weight on the ankle for a period of time or simply wear a CAM walker as part of the recovery.
Surgery – if there is any fracture where displacement may be present or an injury was severe enough to cause more separation between the tibia and fibula bone, surgery may be suggested.

Because ankle sprains are one of the most common injuries of the lower extremity, it is important to understand the concept that they are frequently under-evaluated and under-treated. For many, treatment of an ankle sprain may involve a visit to an urgent care facility, nothing shows up on an x-ray and they are advised to use an ace wrap, ice the area and gradually return to regular activity.

It is important to consider getting a consultation with a foot and ankle specialist to make sure you get an accurate diagnosis, and that appropriate treatment is done early so that you may get back to full activity sooner with less ankle complications in the future. Finally, syndesmotic ankle sprains are a rare occurrence but important for you to know about so that if you suspect you have one, you can seek a consultation with a foot and ankle specialist.

Call us today at our Fort Collins location (970) 484-4620, Broomfield location (720) 259-5053 or use our online scheduling system to book your appointment.

What Are the Benefits of Wearing Orthotics?

Posted on December 23, 2020July 1, 2025 by admin

As a podiatrist, we often recommend orthotic devices as they can be of great benefit for the wearer. Before we dive into the benefits of wearing orthotics, let’s answer the question of what an orthotic is, from a podiatrist point of view.

In today’s world, it seems like everyone is marketing their orthotics. You see them in retail stores, shoe stores, ski shops, and even Facebook ads. As a podiatrist, the whole concept of what an orthotic is has been muddied. My opinion is shared by my colleagues- podiatrists believe there is a non-weight-bearing, neutral-point position of the foot. And so, whatever technique is utilized to fabricate an orthotic, an impression of the foot should be taken in this position.

The foot is positioned at its optimal functional position. Any kind of orthotic that is made from a technique that involves any partial or full weight-bearing, we feel is not done accurately. There are small, torsional abnormalities, sometimes between the front half and rear foot, that are not taken into account when the foot is bearing weight. A podiatrist’s orthotic is much more precise and is able to support and control excessive motion in the foot more accurately. That is not to say that an orthotic made from a weight bearing technique won’t work, but the chances are greatly reduced. It is a common story of patients we treat.

Benefits of Orthotics

I am writing this blog at a time where some advocate barefoot running, or running in minimalist shoes. So hear me out from a foot specialist’s point of view. Outside the office, when someone finds out I’m a podiatrist, I’m often asked what types of shoes are best. Using tact, I’ll make the point that it’s like asking an optometrist what lens prescription they should have. We expect that kind of precision for our eyes, but medicine seems to not think the same rules apply to the feet.

If one has excellent foot structure, I’m not opposed to the idea of barefoot running. My point is that it all starts with what foot type you’ve inherited. It has been observed that 70% of people may have feet that overpronate. Pronation is simply the motion that involves the flattening of your feet. The foot will flatten the arch and abduct, or move away from the other foot. A more ideal foot type does not overpronate, and the actual bony structure helps stabilize and support the foot. There is a locking mechanism that takes place in the bones in the midfoot area. Those that have feet that are much more flexible, or pronates more easily, are thought to have a foot where the bones do not lock and support the foot. Therefore, soft tissue needs to. This can cause excessive stress on structures such as tendons, joints, nerves and other soft tissue structures such as fascia. So, how do you know if custom orthotics might be useful? The following are some tips and specific conditions you should know about.

If you keep getting the same type of injury or foot pain over and over, or if you’ve had that injury for an extended period of time, it may be time to look into orthotics. Especially if you’ve already tried resting, anti-inflammatories, and icing the area. This could also be an indication that your foot type lends itself towards having specific issues.

Soft tissue problems

Plantar fasciitis and Achilles tendinitis
- One of the more common problems is plantar fasciitis commonly referred to as heel pain. Orthotics will reduce the stress of the plantar fascia pulling on the bottom of the heel. For Achilles tendonitis the stress on the Achilles will be reduced.
Foot deformities
- Bunions may also be helped with orthotics. If you have an enlargement on the inside of your big toe you may benefit especially in the early stages of the deformity.

Nerve problems

Neuromas and tarsal tunnel syndrome
- Neuromas are a nerve enlargement that can occur in the ball of the foot. If you’re experiencing burning, tingling and numbness on the bottom of your foot, you may have tarsal tunnel syndrome.
Joint pain
- Arthritis in the foot can also be treated with orthotics and it’s a safer, drug free approach. This may include big toe joint pain commonly referred to as Hallux limitus. Also, ankle pain and pain in the small joints in your arch.

Final Thoughts

You may save money as you’ll quit shopping for shoes to solve your foot problems. The orthotic can be taken from shoe to shoe and will neutralize the less optimal shoe as it’s designed precisely for your foot.
You’ll avoid injuries as certain foot structures lend themselves to certain injuries
You could lose weight and sleep better as you become more active.

If you yourself frustrated with your inability to stay active, please consider a consultation with us to truly understand more about the foot structure you have and how it may be the issue that no one has explained to you. There are many benefits of wearing orthotics, so it’s time you discover for yourself!

Are Custom Orthotics For Foot Problems Right For You?

Posted on December 8, 2020 by admin

There are two basic principles to consider when dealing with your feet and your lower extremity pains that you may have. First, do you think you have a foot that over flattens, otherwise called pronation? As foot specialists, we have been trained in biomechanics and believe that most patients are born with different foot types. If you tend to overpronate the bony structure of your foot, you cannot adequately support the foot. This results in soft tissue structures being stressed more. Orthotics simply position the foot so that the joints can support the foot and demand less of other structures.

Secondly, do you have a condition that continues to plague you in spite of attempts with anti-inflammatories, icing, resting or maybe even physical therapy? Do you find that if you lay off from running or walking and return to it, the same problem occurs? If this is you, then this blog is right for you! Let’s find out if custom orthotics for foot problems are right for you.

Over-pronation

Let’s address your first concern. Over pronating is a very simple concept to understand. People tend to flatten their arch or roll their foot inward too much and too often. The old adage is, if you walk in the sand and you can’t see much of an arch, this could be an indication of pronation. This is somewhat true in most cases, but it may be more complex than that. Some people have an arch that doesn’t over flatten; but if you look at their heel from behind, their heel tends to roll in quite a bit. It does not stay perpendicular to the ground.

Different kinds of feet present different kinds of pronation. Sometimes, a professional is the best to tell you if you are an overpronator. If you have tried various treatments and you have had a problem that’s been persisting; for over one, three, six or twelve months – it is an indication that your foot structure needs additional support. The following are some conditions that are oftentimes bettered or totally eliminated with the use of orthotic devices.

Achilles Tendonitis and Plantar Fasciitis

Pain on the bottom of the heel is referred to as plantar fasciitis. It’s one of the most common problems to be treatable. Tendon on the backside of your heel or running up the Achilles tendon, is, oftentimes, Achilles tendonitis. Orthotics can treat this a great deal. In many cases, treatment options such as anti-inflammatory stretching and physical therapy just don’t knock it away.

Bunions and Foot Deformities That Are Treated With Custom Orthotics

Bunions are a prime example of this, especially if it’s in early stages and not painful yet. There is a chance of a foot deformity where you can feel growth on the back of your heel; also called the Haglund’s deformity or pump bump. Patients can benefit from orthotics in this situation. In both cases, the biomechanics of your foot might allow you to have a progression of a bunion or progression of the bump on the back of heel.

Stiff Toe Joint

Also referred to as hallux limitus or hallux rigidus, this is an arthritic condition in its early stages and can be healed with orthotic devices.

The ankle in itself can have arthritis and orthotics may benefit that. There are stabilizers or stirrup tendons that help stabilize the outer side and the inner side of the ankle. If you have overpronation, these tendons tend to have to be overused because they’re trying to stabilize the foot that is unstable.

Knee Pain

Orthotics have a proven track record of helping what is called chondromalacia patella, which occurs when the kneecap is not centered over the knee joint, thereby causing arthritis between the knee joint and the femur bone. There are instances when people have a higher Q-angle and their knee angulates inward so the thigh and lower leg are not in a straight line. By supporting the foot more this can lessen the angulation at the knee with every step that is taken. The patella can then stay in better alignment and may be less likely to wear down the cartilage. If you have any of the above conditions or just simply have a problem that persists for a long time, orthotics may be just the way to go for you.

Finally if you find yourself in pain in the ball of your foot maybe you’re feeling like your sock is wrinkled but it isn’t. You may be suffering from a nerve enlargement called a neuroma (mortens neuroma) . Orthotics can help as they support the area to lessen the rubbing of a ligament against the nerve.

This blog will serve as a guideline for your consideration of custom orthotics for foot problems and what they are useful for. Depending on your condition, orthotics may be a part of the solution or the only treatment that is needed. So remember to consider if you think you’re an overpronator and are having difficulty getting rid of a chronic problem in the foot or ankle.