You planted, twisted and felt your ankle give. Now the big question is what kind of sprain it is. A low ankle sprain damages the ligaments on the outside of the ankle, usually when the foot rolls inward. A high ankle sprain damages the ligaments above the ankle that hold the tibia and fibula together, usually when a planted foot twists outward. High sprains are less common, but they take roughly twice as long to heal. Knowing which one you have shapes your whole recovery, and the right ankle pain treatment in Cherry Hill can get you back on your feet sooner.
High Ankle Sprain vs Low Ankle Sprain at a Glance
Here is the quick comparison most athletes and parents are looking for.
|
Feature |
Low Ankle Sprain |
High Ankle Sprain |
| Where it hurts | Outside of the ankle, below the joint | Above the ankle, between the shin bones |
| Ligaments involved | ATFL and CFL | Syndesmosis (AITFL, PITFL, interosseous membrane) |
| How it happens | Foot rolls inward (inversion) | Planted foot twists outward (external rotation) |
| How common | About 85 percent of ankle sprains | Far less common |
| Key signs | Swelling and bruising on the outer ankle | Pain above the ankle, worse on stairs and push-off |
| Typical recovery | About 1 to 12 weeks, by grade | About 2 weeks to 6 months, by grade |
| Surgery | Rarely needed | Sometimes needed for unstable or Grade 3 sprains |
What Is a Low Ankle Sprain?
A low ankle sprain is an injury to the lateral ligaments on the outside of the ankle, mainly the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL). It happens when the foot rolls inward, which is why it is also called an inversion sprain. About 85 percent of all ankle sprains are this type. Common causes include stepping off a curb the wrong way, landing on another player’s foot after a rebound and cutting on uneven turf. Expect pain, swelling and bruising around the bony bump on the outer ankle, and walking may feel uncomfortable for a few days.
What Is a High Ankle Sprain?
A high ankle sprain, also called a syndesmotic sprain, injures the group of ligaments just above the ankle joint that binds the tibia and fibula together. This group is the syndesmosis. It includes the anterior inferior tibiofibular ligament (AITFL), which is the one most often injured, the posterior inferior tibiofibular ligament (PITFL) and the interosseous membrane. The usual mechanism is a planted foot with the body rotating over it, or a pile-up that forces the foot outward. Because the force is high, these sprains sometimes come with a fibula fracture, including a Maisonneuve fracture near the knee. That is one reason a high sprain deserves a proper exam.
How to Tell If Your Ankle Sprain Is High or Low
Where It Hurts and Where It Swells
Location is the biggest clue. A low sprain hurts and swells on the outside of the ankle, right around and below the ankle bone. A high sprain hurts above the ankle, on the front of the lower shin, and the pain may spread up the leg. Do not judge by swelling alone. High ankle sprains can show surprisingly little swelling or bruising and still leave the ankle unstable.
Quick Clues You May Notice
- Pain when you climb stairs or push off the ball of your foot points to a high sprain.
- Pain when you rotate your foot outward also points to a high sprain.
- Trouble doing a single-leg calf raise is common with high sprains.
- Pain mainly on the outer ankle when the foot rolls inward points to a low sprain.
Tests a Clinician Uses to Confirm It
In the clinic, two quick tests help. The squeeze test compresses the tibia and fibula at mid-calf, and pain down at the ankle suggests a high sprain. The external rotation test turns the foot outward with the knee bent, and pain above the ankle is another sign. X-rays rule out fractures and show whether the tibia and fibula have spread apart, while an MRI shows ligament damage in more detail. If you are unsure where to go first, this guide to choosing between urgent care or a sports physical therapist walks you through the decision.
Ankle Sprain Grades Explained
Both types of sprain are graded by how much ligament damage there is:
- Grade 1 (mild): The ligament is stretched with tiny tears. You can usually walk with mild pain.
- Grade 2 (moderate): The ligament is partly torn. Swelling, bruising and some looseness are common.
- Grade 3 (severe): The ligament is fully torn. The joint is unstable, and putting weight on it is very painful.
For high ankle sprains, clinicians also check whether the syndesmosis is stable or unstable, because that often decides between rehab and surgery.
Low Ankle Sprain Recovery Time
Most low ankle sprains heal in about 1 to 6 weeks, while a severe low ankle sprain can take up to 3 months.
|
Grade |
Typical Recovery |
What It Usually Feels Like |
| Grade 1 (small or mild sprain) | About 1 to 3 weeks | Mild swelling, walking with little pain |
| Grade 2 (moderate sprain) | About 3 to 6 weeks | Bruising, a limp and some looseness |
| Grade 3 (severe sprain) | About 6 to 12 weeks | Major swelling, hard to bear weight, unstable joint |
The low ankle sprain recovery timeline usually moves through four stages: calming pain and swelling in the first few days, restoring motion in the first week or two, rebuilding strength and balance, and finally returning to running and cutting. The last stage is the one people skip. Without balance and strength work, the ankle stays loose, and a past sprain is the top risk factor for the next one. That is exactly why ankle sprains keep coming back for so many athletes.
High Ankle Sprain Recovery Time
High ankle sprain recovery time is usually 6 to 8 weeks for a typical case, which is roughly twice as long as a low sprain of the same grade.
|
Grade |
Typical Recovery |
Common Treatment |
| Grade 1 | About 2 to 6 weeks | A short time in a boot or brace, then rehab |
| Grade 2 | About 6 to 10 weeks | A boot, early crutches and longer rehab, with surgery if unstable |
| Grade 3 | About 3 to 6 months | Usually surgery, followed by structured rehab |
Why is it so slow? Every step, squat and push-off spreads the tibia and fibula slightly, so the healing ligaments are stressed during normal walking. Medical News Today reports that up to 40 percent of people still have instability symptoms six months after a high ankle sprain. For athletes, recovery time also has to include return-to-sport training on top of walking comfortably, because sprinting, cutting and jumping all demand a stable syndesmosis. A structured plan for sports injury rehab for athletes covers that gap.
Ankle Sprain Recovery Time for Athletes
High and Low Ankle Sprain Recovery Time in the NFL
NFL data show the gap clearly. A study of 15 years of NFL injury records found that high ankle sprains cost players an average of 15.4 days, compared with 6.5 days for low ankle sprains (Osbahr et al., Orthopedics, 2013). Many low sprains in the NFL cost a week or less, especially with taping and bracing. One recent example is Patriots wide receiver A.J. Brown, who suffered a high ankle sprain in the September 2026 season opener and was placed on injured reserve, with reports projecting about six weeks out. Running backs and wide receivers often need extra time because their jobs depend on hard cuts and explosive push-off, the exact movements that stress the syndesmosis.
Recovery for Football and Soccer Players
For football and soccer players at the high school, college and adult level, a mild low sprain often means about 1 to 4 weeks before returning to practice, while a moderate high sprain often means 6 to 8 weeks or longer. Cleats, turf and constant cutting make ankle sprains some of the most common fall sports injuries. Before returning, you should be able to:
- Hop on the injured leg without pain
- Sprint, cut and change direction at full speed
- Match strength and balance on both sides
Support such as kinesiology taping or a lace-up brace can help during the first weeks back.
Objective testing removes the guesswork from return-to-play decisions. Force plate testing measures how evenly each leg produces and absorbs force, which shows whether the ankle is truly ready.
Low Ankle Sprain Recovery Time in Basketball
Basketball produces more low ankle sprains than almost any other sport. In an NBA study covering four seasons (Herzog et al., American Journal of Sports Medicine, 2019), 56 percent of ankle sprains caused no missed games, and the median was 2 games when players did sit out. Players with a sprain in the previous year were 1.41 times more likely to sprain again, so finishing rehab matters.
When Is Surgery Needed for a High Ankle Sprain?
Surgery for a high ankle sprain is usually reserved for an unstable syndesmosis, a Grade 3 tear or a related fracture. Surgeons stabilize the tibia and fibula with either screws or a suture-button device often called a TightRope, which holds the bones in place while allowing some natural motion. Some elite athletes have returned about 4 to 8 weeks after TightRope fixation, including Tua Tagovailoa, who played 28 days after surgery at Alabama. Most people need longer, and the rehab after surgery matters as much as the procedure itself. Our post-surgical rehabilitation program works alongside your surgeon’s protocol.
How Physical Therapy Gets You Back Faster
Rest alone heals tissue, but it does not rebuild the strength, balance and confidence an ankle needs for sport. A good plan moves through clear phases:
- Protect: Control pain and swelling, using a boot or crutches if needed.
- Restore motion: Regain ankle bend, especially upward flexion, which often stiffens after a high sprain.
- Rebuild: Strengthen the calf, peroneals and hips, and retrain balance.
- Return: Progress to running, cutting, jumping and sport drills.
At Rehabletics, every session is one-on-one. Your plan may include hands-on manual therapy to restore joint motion and blood flow restriction training to build strength while the ankle is still protected. Our team is led by Dr. Jaime Mor, PT, DPT, ATC, and serves as a PT contractor for the Philadelphia Eagles and Philadelphia Flyers, so we know what a safe return to high-level sport looks like.
When to Get Your Ankle Checked
See a clinician soon if:
- You cannot take four steps on the ankle
- Pressing on the ankle bones is painful
- The ankle looks deformed or feels numb or cold
- The pain sits above the ankle or spreads up the shin
- The ankle still feels weak or unstable after two weeks
Get Back on the Field With Rehabletics
Whether you rolled your ankle on the court or twisted it under a pile, the right plan gets you back stronger. Our Cherry Hill clinic at 5 Esterbrook Lane helps athletes across South Jersey recover from high and low ankle sprains with one-on-one sports physical therapy. Call 609-354-7987 or book your free consultation to start your recovery today.
