A high ankle sprain involves tearing the ligaments connecting the tibia and fibula bones of the ankle. These ligaments are called the syndesmotic ligaments. A high ankle sprain occurs when the foot is twisted outward. This often happens when an athlete is tackled from behind as the athlete’s foot is planted on the ground and is turning towards the opposite side. Swelling and pain develop at the front and outer side of the ankle. It is painful to stand on the affected leg. The pain and swelling in a high ankle sprain occur higher up on the leg than the more common lateral ankle sprain. Lateral ankle sprains occur when the foot rolls over and the ankle is twisted inward. High ankle sprains take a longer time to heal than lateral ankle sprains. X-rays are obtained to look for fractures or widening of the space between the tibia and fibula. The space between the bones may be wide with a severe high ankle sprain if the syndesmotic ligaments are completely torn. Sometimes surgery is required to repair the syndesmotic ligaments. Usually there is no widening of the space so the ligaments will heal in a boot or cast. Most athletes can return to sports in 6 to 8 weeks.