A High Ankle Sprain in the News: What a Syndesmosis Injury Actually Involves

Arizona Cardinals rookie running back Jeremiyah Love, the No. 3 overall pick in this year's draft, went down with a high ankle sprain during the team's preseason opener against the Las Vegas Raiders on August 13. Reports indicate he's unlikely to play again this preseason, with the team hopeful he can return for Week 1.¹ We have no involvement in his care and no independent knowledge of his imaging or prognosis — but his injury is a good opportunity to explain what a "high ankle sprain" actually is, since it's a meaningfully different injury from the far more common lateral ankle sprain.

Two Very Different Ligament Groups

Most ankle sprains are lateral ankle sprains — the foot rolls inward and stretches or tears the ligaments on the outside of the ankle joint itself. A high ankle sprain, more precisely called a syndesmotic injury, involves a different set of ligaments entirely: the syndesmosis, which binds the tibia and fibula together just above the ankle joint. Rather than the ankle rolling, a high ankle sprain typically happens when the foot is forced outward (external rotation) or the ankle is pushed into excessive upward flexion, prying the two lower leg bones apart.²

Why It's Less Common but More Disruptive

Syndesmotic sprains make up a minority of ankle sprains overall, but they're disproportionately common in collision and cutting sports like football, where direct contact or a planted foot under load can drive the mechanism.² A study of syndesmosis and lateral ankle sprains in NFL players over a 15-year period found that syndesmosis sprains kept players out roughly 2.4 times longer than lateral ankle sprains — a mean of about 15 days lost compared with about 6.5 days for a typical lateral sprain, even when treated without surgery.³ The syndesmosis ligaments simply have a harder job stabilizing the lower leg during push-off and cutting, and irritation there tends to limit those same motions.

How Severity Is Judged

Syndesmotic injuries are generally graded by how much the tibia and fibula have separated, assessed through physical exam maneuvers and imaging. Sprains where the bones remain stable typically respond to bracing, a period of protected weight-bearing, and structured physical therapy. Injuries where the bones have shifted out of position (diastasis) are a different situation and more often require surgical stabilization.⁴ That range is part of why return-to-play timelines for "high ankle sprain" in news reports can vary so widely from one athlete to the next — the label covers a spectrum of severity, not one single injury.

The Takeaway

When you read that an athlete has a "high ankle sprain," it's worth knowing that's a different, often slower-healing injury than a routine rolled ankle — not a more serious way of describing the same thing. For the athletes we see in our own Bloomingdale and Schaumburg clinics, distinguishing a syndesmotic sprain from a lateral ankle sprain on exam is one of the more consequential calls in ankle injury care, since it changes both the treatment plan and the realistic timeline for getting back to sport.