Ankle

Ankle Sprain

Q: How long does it take to recover from a high-grade syndesmosis injury?

Typically 6 to 8 weeks, "but this is variable", longer than the 4 to 6 weeks of a standard sprain. Be realistic beyond that: chronic pain, instability and functional limitations are common afterwards.

Book an Assessment Ask a Question

5.0 average rating on Google

Registered NDIS Provider

SIRA Registered Provider

You stepped off a kerb, or landed from a jump with your foot turned under you, and the ankle rolled. Sharp pain on the outside, then swelling, sometimes within minutes, sometimes over the next few hours. A week or two later most of it has settled, and the plan has quietly become "rest it until it feels okay." That plan is why a lot of people are back here a second and third time.

Key Takeaways

Most ankle sprains heal in 4 to 6 weeks, though some people still feel discomfort up to 12 months later ¹.
"Rest it until it feels okay" isn't the plan. Gentle weight bearing is encouraged early ¹, and starting an exercise program in the first week improves ankle function and return to walking ².
Repeat sprains are usually driven by the last sprain not being rehabilitated properly: weak peroneal muscles and a reduced sense of where your foot is ².
Balance training cuts the risk of another sprain by about a third in people who've already had one: 13 need to train for one extra sprain to be prevented ⁴.
For a straightforward first sprain, a trial of 503 people found adding supervised physio to self-management advice made no clinically important difference ⁵. Physio earns its place with repeat sprains, ongoing instability and high ankle sprains ^2,3,4,6.

What's actually causing it

A standard ankle sprain is an overstretching of the ligaments on the outside of the ankle when the foot rolls inwards. The ankle can swell within minutes or over several hours ².

What matters more is what happens next. Sprains recur for two reasons together: the ligaments carry scarring and extra looseness from previous sprains, and those sprains were insufficiently rehabilitated ². That leaves two deficits: weak peroneal muscles (the muscles down the outside of your lower leg that stop the foot rolling in), and a "decreased capacity to judge where your foot is in relation to your leg", a proprioceptive deficit ².

In plain terms: the ankle stops knowing where it is. That costs you nothing on a footpath, and the sprain on a kerb.

When that doesn't resolve, it has a name. A first-time lateral ankle sprain and chronic ankle instability are described as distinct but related presentations: most people's symptoms settle, but where complaints of instability continue, that's chronic ankle instability ⁶, a named complication of ankle sprain alongside post-traumatic osteoarthritis ¹.

Outer ankle showing the ligaments between the outer ankle bone and the foot, one of them overstretched and torn

Lateral ankle sprain or high ankle sprain? How to tell the difference

A high ankle sprain and a syndesmosis injury are the same thing described two ways: the syndesmosis is the joint holding your two shin bones together just above the ankle, and a "high" sprain injures it rather than the outside ligaments below ³.

It's less common and it behaves differently. Syndesmotic sprains account for 11% to 17% of all ankle sprains in athletic populations, and most happen in collision sports: rugby, American football, ice hockey, wrestling ³. Recovery typically takes 6 to 8 weeks rather than 4 to 6, "but this is variable" ³.

You can't tell the difference yourself, and a hands-on test alone can't settle it either. Apart from the external rotation stress test, the movements in manual syndesmosis stress tests are so small they're unlikely to distinguish an injured syndesmosis from a normal one; examiners are advised to treat pain during the test as the indicator rather than judging any widening ³.

The outlook differs too. Chronic pain, instability and functional limitations are common afterwards: in one follow-up, more than 60% still reported chronic ankle pain, instability and hopping limitation at six months, even though all had returned to sport ³. That's the argument for proper rehabilitation, not a shorter one.

How it's diagnosed

A sprain is diagnosed from your story and an examination. Your physio or doctor will ask what happened, what you've noticed since, whether you've sprained this ankle before, and about your medical history ¹. Then they look at the ankle, feel gently around it, move it in a few directions and see whether you can put weight on it ¹.

An X-ray is there to rule out a broken bone ¹. You may need one if you can't take any weight on the foot, or can't manage four steps ². If the ankle is still giving you trouble later on, X-rays or other tests may be organised then ².

How we treat it

The shape is the same whichever sprain you've had: settle the acute phase, get you loading normally early, then rebuild the strength and balance that stop it happening again.

Assessment first. What's injured, whether it's the lateral ligaments or the syndesmosis, and whether you need an x-ray to rule out a fracture ^2,3.

Sports physiotherapy: the exercise program itself. It targets strength, range of motion, proprioception, balance and sport-specific tasks ¹, built from mobility exercises, peroneal strengthening, taping and bracing advice, and balance work on a wobble board ². Starting it in the first week improves ankle function and early return to weight bearing ².

Balance and proprioceptive training, specifically. The part most often skipped, and the part with the clearest numbers. Proprioceptive training reduced ankle sprains by 35% overall; for people who had already sprained an ankle, the risk of another fell by 36%, with 13 needing to train for one extra sprain to be prevented ⁴. In practice: single-leg balance with your eyes closed, wobble board work, and single-leg balance while catching a ball ⁴.

Loading you back towards what you actually do. Return is a capability question, not a calendar one: "you can return to physical activity or sport when you can do regular daily movements without being in pain. There is no rule to say how long it will take" ¹. For a high ankle sprain, that means sport-specific tasks at game speed, with good movement quality and no significant pain or instability ³.

Two caveats. The trials varied so much (5 to 30 minutes, one to five times a week, four weeks to a full season) that no strong conclusion can be drawn about the ideal dose ⁴. And supervised and home-based programs produced similar reinjury rates at one year, though supervised gave better early subjective outcomes ⁴.

Other treatments we may use

First aid, the first two days.

RICE (rest, ice for about 10 minutes every one to two hours, compression, elevation) alongside "NO HARM": no Heat, Alcohol, Running or Massage ¹. Bandage firmly and keep it elevated above heart height ². Anti-inflammatory medication is appropriate only in the first 48 hours ¹, a conversation with your pharmacist or GP, not something we prescribe.

Bracing.

A brace may be needed for 4 to 6 weeks ¹, and taping and bracing advice is part of a physiotherapy program ². Useful support while the ankle rebuilds, not a substitute for the strength and balance work, which is what changes your odds.

Hands-on treatment.

Range of motion is a named target of a physio program ^1,2, and manual therapy is one way we work on it alongside the exercises. To be plain about it: none of the research cited here singles out hands-on treatment as the active ingredient for an ankle sprain. Treat it as an adjunct, not the main event.

Acupuncture.

"There is not enough research to confidently say that acupuncture is effective in treating a sprained ankle" ¹. We'd rather say so than sell you something the evidence doesn't support.

Your recovery path: Reset, Rebuild, Return

Treatment for a sprained ankle follows The Well Motion Recovery Path™. You move up a phase when the ankle can do the job, not when a date arrives.

Reset: the first few days. Compression and elevation to settle the swelling ^1,2, an x-ray if the examination points to a fracture ², and gentle weight bearing as early as the ankle allows ¹. Expect the swelling and bruising to look worse before they look better. We move you on once you can walk on it without the pain building.
Rebuild: the bulk of it, and the part people cut short. Range of motion, peroneal strength and balance work, started in the first week ², with tape or a brace supporting the ankle for 4 to 6 weeks while you load it ¹. Expect it to feel strong before it feels steady: balance is the last thing to come back. We move you on when your everyday movement is pain free ¹.
Return: sport-specific tasks at game speed, with good movement quality and no significant pain or instability ³. You leave with a balance program and a brace for sport, the two things that cut repeat sprains in trials ^7,8.

How long it usually takes. Most ankle sprains heal in 4 to 6 weeks ¹. A high ankle sprain usually takes 6 to 8 ³. Some people still feel discomfort up to 12 months later ¹, which is why Return ends with a plan and not just a clearance.

Reducing the risk of it happening again

One sprain makes the next more likely ¹. This is also one of the few injuries where prevention has been put through proper trials:

Do the balance work, even at home. In a trial of 522 athletes, adding an eight-week home balance programme to usual care cut repeat sprains over the following year from 33% to 22% ⁷.
Wear a brace for sport. A second trial, in 384 athletes, put a semi-rigid brace worn for all sport for 12 months up against eight weeks of home training. 15% of the brace group sprained again, against 27% of the training group ⁸. The sprains that did happen were no milder ⁸.
Use both after a first sprain. That's what the physiotherapy guideline recommends: a brace, plus balance training aimed at whatever your examination shows is lacking ⁶. A review of 46 reviews rated the evidence for bracing as strong and for this kind of training as moderate ⁹.
Mind your shoes and the ground. Wear supportive shoes suited to the activity ¹ ², and take care on uneven or wet ground, especially in the first few weeks ².

When to get it checked properly

Get it looked at rather than managing it alone if:

You can't take any weight on the foot, or can't take four steps: get it assessed the same day, so a fracture can be ruled out ². We can assess the ankle, check for signs of a fracture and refer you for an x-ray if it's needed. After hours, on a weekend or a public holiday, our after-hours emergency physiotherapy can come to you. Call (02) 8111 5633.
The pain sits above the ankle, between the shin bones, or it happened in a collision or a twisting mechanism: that points at the syndesmosis, which needs a different plan ³
The ankle keeps giving way, or this isn't your first sprain ^2,6
Things haven't settled by around 6 weeks ¹
You're heading back to sidestepping, jumping or contact sport and nobody has tested whether the ankle is ready

Most sprains do settle. Getting it checked doesn't mean something terrible is happening. It's how you make sure this is the last one, not the first of several.

Your first appointment

We start by listening: how it began, what makes it worse, and what it's stopping you from doing. Then we examine the area, explain what we find in plain English, and agree a plan with you. Your first visit is 40 minutes at Engadine and 30 minutes at our other clinics.

We see patients at Engadine, Mount Annan, Narellan and Appin, and at home through our mobile physiotherapy service. If you have private health cover, here's how health fund rebates work for physiotherapy.

FAQs

Do I need to see a physio for a sprained ankle?

Not always. A trial of 503 people with simple grade 1 and 2 sprains compared written self-management advice against the same advice plus supervised physiotherapy: 43% versus 37% had an excellent recovery at three months, 95% CI −3% to 15%, not significant, and reversed by six months ⁵. Physiotherapy earns its place outside that trial's scope: you can't weight bear or take four steps ², the ankle keeps giving way or it isn't your first sprain ^2,4, or it's a high ankle sprain ³.

When to go to physio after a sprained ankle?

Earlier than most people think. The first 48 hours are the RICE and "NO HARM" window ¹, but starting an exercise program in the first week improves ankle function and early return to weight bearing ². Don't wait for the swelling to go.

Is it safe to walk on a sprained ankle?

Usually yes, and it's encouraged: walk as normally as you can, and ask about crutches if you can't weight bear comfortably ¹. The boundary: if you can't take any weight, or can't manage four steps, get it assessed the same day to rule out a fracture ². We can do that assessment and refer you for an x-ray if it's needed.

What is the fastest way to heal an ankle sprain?

There isn't a shortcut. "There is no rule to say how long it will take. The worse your injury, the longer it will take" ¹. Supported: RICE plus NO HARM for the first two days, early gentle weight bearing ¹, and the exercise program in the first week ². Not supported: acupuncture, where there isn't enough research to say confidently that it works ¹.

How do I tell if my ankle sprain is grade 2 or 3?

You can't tell reliably from home, and that's not a dodge: grading needs a physical examination and sometimes an x-ray to rule out a fracture ^1,2.

Should you wrap a sprained ankle overnight?

Worth asking whoever assessed you. Compression reduces swelling ¹, and the advice is to bandage firmly, extending up the calf and down the foot, and elevate above heart height ². Neither source addresses overnight specifically, so we'd sooner set that up with you in person than invent a rule.

How long does it take to recover from a high-grade syndesmosis injury?

Typically 6 to 8 weeks, "but this is variable" ³, longer than the 4 to 6 weeks of a standard sprain ¹. Be realistic beyond that: chronic pain, instability and functional limitations are common afterwards ³.

More Ankle conditions