A typical ankle sprain involves the lateral ligaments of the ankle, or the ligaments on the pinky toe side of the ankle. A high ankle sprain involves the ligaments between the tibia and the fibula and causes diastasis and instability as you move the ankle. So the symptoms can be much more subtle and more difficult to diagnose because the pain isn’t always where the area of injury is. It sometimes will radiate to the inside of the ankle or even up to the knee and so it can be a little more difficult to diagnose. Treatment is still typically physical therapy initially, but they do have a little bit higher propensity to need surgical intervention than the normal straight forward lateral ankle sprains.