Patients who have a high ankle ligament tear usually will have pain just above the level of the ankle. They may also have tenderness over the deltoid ligament if they have a Maisonneuve injury, as noted above. It is important to touch the area to assess whether pain is just around the lateral ankle ligaments or higher.
Two important tests also include the “squeeze test” and the” external rotation test.” The squeeze test is performed by squeezing the leg just below the knee to see if pain radiates to the high ankle ligament area, which would suggest a high ankle sprain. With the external rotation test, the knee is bent and the ankle is placed in neutral or 90 degrees with the foot in relation to the leg, and the foot is turned to the outside. If there is pain at the syndesmosis or the high ankle ligament area, then this indicates injury.
X-rays are very important. A broken bone must be assessed and ruled out. Three views of the ankle including the whole leg are needed. A fracture on the back portion of the tibia may indicate an injury to the high ankle ligaments given that this is where the PITFL attaches. It is also important to look for increased space between the tibia and the fibula because this may also indicate an injury to the high ankle ligaments. MRI is becoming very helpful in diagnosing these injuries. A CT scan can also help to assess the relationship of the tibia with the fibula.