If you watched Monday Night Football, you saw the repercussions of a high ankle sprain on Steelers quarterback Ben Roethlisberger.
A high ankle sprain is often called a syndesmotic ankle sprain as the injury is to structures that are much higher up, the syndesmotic ligament. This is the ligament between the tibia and fibula and is often painful higher up then just the actual ankle mortise joint.
A good test with this type of injury is to squeeze the calf muscles. If this ligament is injured there will often be pain with this. Passive dorsiflexion and passive external rotation of the foot will also often be painful. While an athlete with an inversion ankle sprain may return in a week or two, because the high ankle sprain is much deeper, it may require twice as long for this to heal enough to play on.
This year in the NFL, there have been a few high profile cases. Adrian Peterson, a very talented running back, missed 2-3 weeks. This past Monday night Ben Roethlisberger, QB for Pittsburgh, was hobbling pretty badly with a high ankle sprain.
Conservative treatment is usually the wrought taken. Immobilization in a boot, ice, and rest are the required ingredients. While soft tissue work may be helpful to the peroneal muscles, because the syndesomotic ligament is inside, manual therapy is marginally effective.