Issues with ankle bracing and taping (how we created the high ankle sprain)

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The most common way an ankle is injured is this:

We call that an inversion ankle sprain.

By taping or bracing the ankle, or maybe by wearing higher topped shoes, we lessen the mobility of the ankle. We lessen the ability of the ankle to invert or evert. That is, to sprain.

One way or another, we’re trying to block the ankle from being able to do this,

So one trait you’ll see with taping is the tape will start rather high, connecting way down. This way if the ankle rolls, the tape pulls the ankle back out of the roll.

This is what people are trying to do with higher topped shoes. Especially if they have ankle problems, they’ll tie them as tightly as they can.

They’re hoping the material will be strong enough to do what a brace or tape can do: prevent the roll from going too far.

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The progression

This is what many athletes do-

• Start out with normal footwear. Nothing noteworthy. Play enough sports and eventually you sprain an ankle.
• Either change something or not. Because ankle injuries are rarely rehabbed properly, the sprain happens again.
• If not before, now footwear changes. Often a higher topped shoe.
• Higher topped shoe, one way or another, doesn’t get the job done. The athlete still is more likely to roll the ankle. They don’t feel stable, or they have a bigger injury. The “high” ankle sprain.
• Bracing or taping gets looked at. Usually bracing first. Where you head to CVS or Dick’s and pick up something.
• At some stage, typically by college, taping sets in. Not only is it more specific as the taping is tailored to your anatomy, but taping tends to go higher and is more encompassing than bracing.

A brace might be,

But taping will go at least as high, and all around the ankle. Sometimes even around the shoe. What’s called spatting. (Common in football.)

In other words, we start out more low top oriented. For some, this might be to have a lighter shoe. For example,

We then go to a higher topped shoe,

Next a brace,

Then we say eff it. Let’s secure the hell out of that thing,

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The problem

In skiing there is an injury called the boot top fracture. Where the tibia and or fibula fractures at, you guessed it, the top of the boot.

I don’t know the skiing world well. I’ve never been on a pair, and am terrified to do so. (Because of what we’re discussing here.) Apparently lower cut, leather boots used to be worn. With these, lower limb injuries would occur, but they would be more at the ankle. With time and the advent of more rigid, higher topped boots, this injury transferred higher up, to the shin area.

Top drawing is older style boot; bottom drawing is newer style. Note the fracture occurring right at the top of the boot, which is the black outline.

(Here’s one website discussing this, along with a paper quoting the “rising incidence” of boot top fractures.)

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Again, we have our low top shoe wearer.

They sprain their ankle. They go to higher topped shoes,

Say this shoe has mitigated the risk to roll the ankle in the way it was rolled before. Now though, the stress of an ankle roll can still happen. Where is that stress going to go? Higher.

Voila. We have ourselves the high ankle sprain. This term, high ankle sprain, when put through a google scholar search, doesn’t show up until the year 2001. There is the possibility

1) We were overlooking something diagnosis wise but more likely

2) We created a new pathology by moving to fixing the ankle at a higher location. Similar to the boot top fracture.

So then we move to some other concoction. We secure the ankle even higher:

All but insuring our ankle doesn’t move. At all.

But we’ve seen what happens. You can’t avoid the energy which comes with say, landing on someone else’s foot. You can only move the location it acts through.

-> You may be reminded of high school physics and the conservation of energy.

If we prevent the lower ankle from rolling, then we might cause the higher ankle to roll. If we prevent the lower and higher ankle from rolling, then we might cause the lower shin to roll (break our leg). The shin is pretty sturdy though. If that doesn’t roll, then it might be the knee. The knee can bend laterally, barely. However, when our knee juts inward or outward, that’s usually a sprain, or some kind of tear.

It’s not a coincidence skiers, with these high ankle fixations, commonly injure their knees. There are actual centers who specialize in skiers, specifically torn ACLs. They’re located in places like Vail, because the injury is that common. Whenever you have a sport which has people specializing in one injury from that sport, that should tell you something.

-> Interesting side note / worth debating: examining Paul George’s broken leg, it looks like his leg broke exactly where a tape job would have stopped. It breaks exactly where his socks stop; usually guys pull their socks up just enough to cover the tape job. You can also see his ankle has zero give to it. Because of, or at least due in part to, how stabilized it was?

Warning, gruesome two images-

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But context

We can stabilize the ankle with these modalities. Meaning we can make a sprain less likely, but we do this at the expense of increasing injury risk elsewhere.

Initially, in the general case, you’d rather sprain an ankle than increase the odds you blow your knee out or break your leg. Meaning to start, or if you’re someone who has never had ankle problems, there is no need bothering with this stuff. You’re not preventing injury in that case. You’re changing the odds of it at different locations. Some of which risk may go down; others of which risk may go up.

That said, if you’re someone where ankle health is much more a pressing concern, or someone who cannot get your ankles healthy, that’s a different story. Steph Curry went two years rehabbing his ankles. Multiple surgeries. His career was genuinely in jeopardy due to how easily they rolled.

In that case it makes sense to increase the odds of ankle safety at the expense of breaking his leg or tearing up his knee. If he couldn’t get the ankles healthy, his career was over anyways. And in basketball, broken legs and blown out knees aren’t terribly common (whereas in football they are), but the ankles get destroyed.

So individual scenarios are still crucial. But in most cases, issues with ankle injury recurrence are due to really poor rehab. It’s too common to sprain an ankle, take a week or two off, hang out in the whirlpool, then go back out there. That’s not rehab, and it’s how you roll it again not too long after.

Avoid the band-aids when you can.