Is It Really 'Just a Sprain'? Why Your High Ankle Injury Isn't Healing and How the TightRope Procedure Changes the Game
By Victor R. Prisk, M.D. Board Certified Orthopaedic Surgeon & Foot and Ankle Specialist
You rolled your ankle six weeks ago. The bruising has faded, and the swelling is down, but something still feels wrong.
Every time you pivot on the soccer field, climb stairs, or even walk on uneven ground, you feel a sharp, mechanical pain deep in the ankle. You’ve been told by urgent care or a general practitioner that it’s 'just a sprain' and to give it time. But as an athlete, you know your body—and you know this isn’t the same as the ankle rolls you bounced back from in high school.
If this sounds familiar, you likely don’t have a standard ankle sprain. You may have a Syndesmosis injury, commonly known as a 'High Ankle Sprain.'
At Prisk Orthopaedics and Wellness in Monroeville, I see this scenario constantly. Patients come to me frustrated because standard rehab isn't working. The reason is simple: a high ankle sprain is a completely different mechanical failure than a standard sprain, and it requires a completely different solution.
The Anatomy: The 'Wishbone' Effect
To understand why your ankle isn't healing, you have to visualize the anatomy.
- A 'Low' (Lateral) Sprain: This affects the ligaments on the outside of the ankle (specifically the ATFL). Think of this like stretching or tearing a rubber band on the side of a joint. It hurts, but the structural stability of the leg usually remains intact.
- A 'High' (Syndesmosis) Sprain: The syndesmosis is a complex of ligaments that holds your two shin bones, the Tibia and Fibula, together.
Think of your lower leg bones like a wishbone. The syndesmosis ligaments are the tape holding the top of that wishbone together. When you suffer a high ankle sprain, you aren’t just stretching a side ligament; you are splitting the wishbone apart.
Every time you take a step, your bodyweight drives a wedge between the Tibia and Fibula. If that ligament complex is torn, the bones spread apart (diastasis), causing pain and instability that no amount of icing or bracing will fix.
The Problem with 'The Old Way': Why Screws Fail
For decades, the standard surgical fix for an unstable syndesmosis was rigid metal screws.
Surgeons would drill a long metal screw through the Fibula and into the Tibia to hold the bones together while the ligaments healed. While this stabilizes the joint, it creates a new problem: Abnormal Biomechanics.
When you walk or run, your ankle is designed to have 'micro-motion.' The fibula naturally rotates and moves slightly away from the tibia to accommodate the motion of the ankle joint.
Metal screws do not allow for this motion. They are too rigid. This leads to two major issues:
- Hardware Failure: Because the bones want to move and the screw won't let them, the screw often snaps or breaks inside the bone.
- Required Removal: To prevent breaking, patients often require a second surgery 3 to 4 months later just to remove the screws before they can return to full activity.
This means two trips to the operating room and a significantly delayed return to sport.
The Prisk Way: Advanced Fixation with the Arthrex TightRope®
I specialize in getting athletes back to their sport—whether that’s competitive gymnastics, football, or weekend pickleball—as efficiently and safely as possible. That is why I utilize the Arthrex TightRope® system for syndesmosis injuries.
The TightRope is a game-changer because it replaces rigid screws with a heavy-duty suture button system.
Think of the TightRope like a seatbelt.
- It holds the Tibia and Fibula together securely.
- However, unlike a screw, it is flexible. It allows for the natural, physiological micro-motion that your ankle needs to function correctly.
- It 'catches' the bone if it moves too far, providing stability without rigidity.
- It allows the ligaments to heal with the expected stress of normal biomechanics and does not over constrain the ankle.
The greatest benefit? Because it mimics your natural anatomy and doesn’t risk breaking due to stiffness, there is typically no need for a second surgery to remove it. It stays in, doing its job, while you get back to yours. (unless the buttons bother you which is rare)
Your Recovery Timeline: What to Expect
Recovering from a syndesmosis repair is a journey, but with TightRope fixation, the roadmap is clearer and often faster than with rigid fixation.
- Weeks 0-2 (Protection): You will be non-weight bearing in a splint or boot to protect the incision and allow the ligaments to begin knitting together.
- Weeks 2-6 (Progression): We transition you to progressive weight-bearing in a boot. Our focus here is regaining your range of motion.
- Weeks 6-12 (Strengthening): This is where the work begins. We focus on strengthening the surrounding muscles and—crucially—proprioception (balance training). Retraining your ankle to sense where it is in space is vital to preventing re-injury.
- Return to Sport: Most athletes can expect to return to contact sports around the 3 month mark. Compare this to the 6+ months often seen with screw fixation (which includes the downtime of a second surgery).
Don't Let a 'Sprain' Sidebar You
If you are in the Pittsburgh area and have an ankle injury that just won't heal, don't settle for 'wait and see.' A missed high ankle sprain can lead to chronic arthritis and permanent instability.
I am Dr. Victor Prisk, and I am here to help you get back on your feet.
Schedule Your Evaluation at Prisk Orthopaedics and Wellness
