When your high heels and your ankle don’t play nicely

Published: 27 Jan 2021

When your high heels and your ankle don’t play nicely

A nice pair of high heels are often a go to to complete a nice dress ensemble but sadly they increase our risk of some tricky ankle injuries. After all, it is further to fall!

Rolled Ankles and High Heels

High heels.  They can look amazing and so are loved by many women.  Those of us who favour this footwear know all too well the discomfort that comes from being forced to stand on your toes for long periods of time.  Ouch, the dreaded pinch through your foot!  Standing in this position increases not only the risk of blisters and sore toes, but a nasty rolled ankle if you happen to lose our balance.


High heels place your ankles into a higher degree of plantar flexion (pointed feet) which places a few of your ankle ligaments under a higher demand – such as the bifurcate ligament. If you fall with your foot in this position it can lead to tearing of this ligament.  In more severe cases the ligament even gets pulled off the bone, taking a small piece of bone with it.

Bifurcate Ligament

The bifurcate ligament is a ligament that sits on the outside of your foot and assists in stabilising your midfoot.  It is attached to your calcaneus (heel bone) with two arms in a Y shape: one that attaches to your cuboid bone, and the other to your navicular bone.

Bifurcate Ligament

Bifurcate Ligament

When you roll your ankle from a plantarflexed position (on your toes) it is the section of the ligament attaching from your calcaneus to your cuboid that often becomes torn.  In some cases the ligament is pulled from the bone taking a small piece of bone with it. This is an avulsion fracture.

The ligament can detach from either the cuboid (midfoot) or from the calcaneus (heel).

How do I know if I have damaged this ligament?

Your physiotherapist will check this ligament after you have rolled your ankle by palpating your ankle. When the bifurcate ligament is injured your ankle will be swollen and tender around the outside of your foot further down from the ankle.

If your physiotherapist is suspicious of a bifurcate ligament avulsion injury, they are likely to send you for an x-ray to check for any severe injury. Where the injury is not severe and the bony piece is small, it often does not appear on an x-ray. Your physiotherapist will then manage your ankle based on their exam findings.

Is management different than a normal ankle sprain?

An ankle sprain involving the other lateral ligaments of the ankle is usually managed in a camboot for 3-4 weeks depending on the severity of the injury. When the ligaments have healed, rehabilitation will focus on:

  • increasing joint range,
  • strength, and
  • proprioception (I’ll let the physio explain that one).

All of this with the goal of supporting you in returning to both sport and daily function.

The management for a bifurcate ligament that is torn is much the same. However, if there is any bony involvement in the injury from an avulsion fracture then you will also need to be non-weight bearing for 4-6 weeks to allow the fracture to heal first.

I have injured my ankle. What should I do?

If you have injured your ankle it is always wise to have it checked by a physiotherapist to ensure that it is not severe and to prevent any ongoing pain or instability.

If you have any questions or require an assessment, don’t hesitate to contact one of our talented physiotherapists for a consultation!

Image Reference
: Magdalena Martin Photography (2020). High Heels Poster. [image] Available at: [Accessed 3 Mar. 2020].