The paucity of material on high ankle sprains (HAS) is reflected in the lack significant data relating to diagnostic testing. Only a handful of clinical tests were located that are used in HAS and none of the studies provide sensitivity or specificity information. The primary concern to the physician is to rule out fracture, which is relatively common and frank diastasis of the syndesmosis. Diagnosis can be a difficult task. Although the HAS is a more serious injury than a lateral ankle sprain, there is usually a rapid resolution of swelling and ecchymosis in HAS and the patient is able to walk pain-free within days and sometimes immediately which can lead to underestimating the injury. One distinguishing feature, especially in athletes, is pain with cutting, twisting, turning, jumping or pushing off (1). For the purpose of this monograph only sprains without frank diastasis will be discussed.
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