High ankle sprain recovery time: by grade, and when surgery is needed

Three college football stars made ankle news this week. Here’s what was reported, and what recovery looks like for everyone else.

A note first: we have no connection with these athletes or teams and haven’t examined them. Details about them come from public reports as of November 7, 2026.

What was reported about Toney, Simmons and Martin

Malachi Toney, Miami. Toney was hurt in practice on Wednesday, November 4.^[12] Sources told ESPN he had a high ankle sprain, would have surgery and would miss Saturday’s game at Notre Dame. ESPN noted that return from this injury typically takes at least four weeks, with the College Football Playoff about six weeks away.^[6] On3 reported that he would have TightRope surgery on Thursday, with a typical recovery of four to six weeks.^[7]

Colin Simmons, Texas. Simmons, who leads FBS in sacks, hurt his ankle in the fourth quarter of Texas’s October 17 loss to Florida.^[13,9] ESPN’s Pete Thamel reported a high ankle sprain and called him week to week.^[8] He returned at Missouri on November 7 after missing two games.^[9]

LJ Martin, BYU. Martin hurt his ankle in an October 3 win at TCU and was expected to miss four to six weeks. ESPN reported his return against No. 3 Utah on November 7.^[10] ESPN called it an ankle injury, not a high ankle sprain, so we do too.

High ankle sprain vs regular ankle sprain

A regular sprain tears ligaments on the outside of the ankle. A high ankle sprain injures the syndesmosis, the ligaments that tie the two lower-leg bones, the tibia and fibula, together just above the ankle.^[11] It often comes from the foot being forced to twist outward, and it is common in collision sports.^[14] In European pro soccer, these injuries were 7% of ankle ligament injuries, and 74% came from contact.^[15]

Why it matters: high ankle sprains are often missed and cause lasting pain after a “sprain.” An unstable syndesmosis left untreated can lead to ankle arthritis, and one review advises that unstable injuries be treated with surgery.^[16] Our Justin Jefferson article compares how often each kind of sprain costs players weeks.

High ankle sprain recovery time by grade

The key question in grading is whether the joint is stable or unstable.^[3]

Grade	What it means	Usual treatment	Reported return to sport
Grade I	Sprained ligaments, no widening of the joint	Rehab, then functional tests	13.4 days on average in college athletes with no widening[1]
Grade IIa	Partial tear, joint stable	Boot and rehab	About 45 days (23 to 63)[2]
Grade IIb	Partial tear, joint unstable	Surgical stabilization	About 64 days (27 to 104)[2]
Grade III	Complete tear, unstable	Surgical stabilization	First match about 103 days after surgery for IIb and III together; III took longer[17]

Across 18 studies and 1,133 high ankle sprains in athletes, 99% returned to play: surgically treated athletes at about 71 days and the others at about 39.^[18] Part of that gap is the injury itself, since surgery is the treatment for unstable ones.^[3] These are averages for athletes with daily rehab, not a forecast for any one person, including the players above.

When is high ankle sprain surgery needed?

When the joint is unstable.^[3] A positive squeeze test and an injured deltoid ligament on the inside of the ankle help pick out athletes who may benefit from early keyhole (arthroscopic) assessment and stabilization.^[2]

Stabilizing an unstable joint gets athletes back. In 110 professional soccer players who had surgery for an unstable high ankle sprain, on-field rehab began at about 37 days, team training at 72 and the first match at about 103.^[17]

Suture button or screws? A suture button, often called a TightRope, is a strong cord passed through a small drill hole across the fibula and tibia and held by a small metal button on each side.^[19] The older method is a screw across the same two bones. In a review of five randomized trials with 285 patients, suture-button patients had higher ankle function scores (95.3 vs 86.7 out of 100). None of their implants broke, compared with 25.4% of screws. Hardware came out in 6% versus 22.4%, and the joint was set out of position in 0.8% versus 11.5%.^[5]

In elite athletes, 96% returned to sport after a high ankle sprain, on average in about 58 days, including 98% after suture-button fixation.^[4]

High ankle sprain symptoms

Look for tenderness at the front of the ankle over the ligament joining the two leg bones, sometimes higher up the leg,^[1] and pain when the foot is turned outward.^[20] Being unable to hop on that leg was present in 89% of injuries, and pain out of proportion to how the injury looks is another clue.^[21]

How is a high ankle sprain diagnosed?

The squeeze test. We squeeze the leg bones together at mid-calf; pain down at the ankle points to the syndesmosis. Across four studies, the test was negative in 85% of people without the injury, so it rarely flags a healthy ankle. No single test is enough, and the exam can’t tell stable from unstable, so imaging or arthroscopy is needed.^[22]

X-rays measure the space between the two bones.^[3] A subtle unstable injury may not show on X-rays taken at rest, which delays diagnosis. MRI and weight-bearing CT (a scan taken while you stand) can help guide treatment, but looking inside the joint with a small camera remains the benchmark.^[14] See ankle arthroscopy.

The limits. Stable injuries do well without surgery: elite athletes treated without an operation also returned 98% of the time, and that review found signs of publication bias.^[4] Ten years out, suture-button and screw patients scored about the same.^[23] In one series, eight elite athletes later broke the fibula next to the button’s drill hole, at a mean of 14 months, and most had surgery to heal it.^[19] One of the main trials enrolled adults 18 to 70, some with a broken ankle bone too, so results in athletes may differ.^[24]

How we treat a high ankle sprain

Dr. Efe Ozturk is a Foot and Ankle Surgeon and podiatrist. We examine both ankles and take X-rays and ultrasound at the practice, with an MRI arranged when needed. A stable sprain gets a boot and a rehab plan through our sports medicine team. An unstable one gets a frank talk about stabilizing it early. See ankle sprains and fractures and trauma. We see patients in Lyndhurst, Paramus and Millburn, NJ.

Common questions

How long is high ankle sprain recovery time without surgery?

In athletes with a stable injury, about two weeks when the joint hasn’t widened and about six weeks for a stable partial tear.^[1,2]

What is TightRope surgery for a high ankle sprain?

It holds the tibia and fibula together with a strong cord and two small buttons.^[19] In trials it gave higher function scores and fewer broken implants than screws.^[5] After surgery in one trial, patients were allowed partial weight at two weeks and full weight at six.^[24]

Is a high ankle sprain worse than a regular ankle sprain?

It is a different injury, usually from contact, and often missed. Left unstable, it can lead to arthritis.^[15,16]

When to see a Foot and Ankle Surgeon or podiatrist