Ankle Syndesmosis Injuries 


The ‘high ankle sprain’ AKA ‘Syndesmosis injuries’ 

Everyone has known someone to ‘roll’ their ankle. Generally this is a twisting motion of the foot and damages the structures to the outer ankle, known as the lateral ligament complex. Ankle injuries involving excessive external rotation and/or dorsiflexion (toes up to shin and ankle twisting inwards) can disrupt the syndesmosis complex (pictured below). The syndesmosis is a fibrous tissue joining the shin bone with the fibular its primary role is to aid stability around the distal part of the ankle, as well as providing shock absorption when we run and jump. The syndesmosis is made up of 4 ligaments and is fundamental for good ankle function.






Tell tale signs you have a syndesmosis injury not a ‘lateral ligament’ injury!

It’s important you do not miss or confuse a syndesmosis injury with a normal ankle sprain. Early rehabilitation differs greatly and can lead to chronic issues if not managed appropriately.

The key things to remember if questioning a syndesmosis:

  1. The mechanism of injury: Hyper-dorsiflexion or forceful external rotation.
  2. The swelling pattern is above the ankle joint not laterally and below.
  3. Pain increases with walking or weight-bearing that can be reduced by squeezing the lower leg bones together.
  4. Pain increases with dorsiflexion, but can be eased with compression of the tibia and fibular junction


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Written by Patrick Lincoln



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