Understanding Syndesmosis Injuries

Syndesmosis injuries, commonly referred to as “high ankle sprains,” are a relatively rare but debilitating condition that can affect athletes and individuals from all walks of life. As a seasoned physiotherapist with 20 years of experience, I have had the privilege of working with countless patients with syndesmosis injuries. In this blog, I aim to provide a comprehensive overview of syndesmosis injuries, their causes, symptoms, diagnosis, and treatment options, drawing from my extensive experience in the field.

Before delving into syndesmosis injuries, it’s essential to understand what the syndesmosis is. The syndesmosis is a group of ligaments that connect the tibia (shinbone) and fibula (calf bone) in the lower leg, just above the ankle joint. This connection is critical for maintaining ankle stability during activities such as walking, running, and jumping.

Causes of Syndesmosis Injuries!

Syndesmosis injuries are typically caused by one or a combination of the following factors:

  1. Ankle Sprains: These injuries often result from excessive outward (eversion) or inward (inversion) twisting of the foot, leading to stretching or tearing of the syndesmotic ligaments.
  2. Trauma: A direct blow to the ankle, such as in a car accident or a fall, can damage the syndesmosis.

Symptoms of Syndesmosis Injuries

Recognizing the symptoms of a syndesmosis injury is crucial for timely diagnosis and treatment. Common symptoms include:

Pain above the ankle, particularly when weight-bearing or during movements where the knee moves over the toes

Swelling pattern above the ankle line.

Difficulty moving the ankle or dorsiflexing the foot.

Tenderness over the syndesmosis when palpated.

Instability or a feeling that the ankle is giving way.


Accurate diagnosis of a syndesmosis injury is essential to create a suitable treatment plan. As an experienced physiotherapist, I recommend a thorough assessment to rule in or out a high ankle sprain.

  1. Physical Examination: A thorough assessment by a healthcare professional, which may include specific tests to check for syndesmosis instability.
  2. X-rays: Weight bearing X-rays can help diagnose a high ankle sprain
  3. MRI Scans: These imaging tests can provide detailed information about the ligaments and the extent of the injury.

Treatment Options!

Treatment for syndesmosis injuries may vary depending on the severity and specific characteristics of the injury. As an experienced physiotherapist, I recommend the following approaches:

  • Rest and Immobilisation: Initially, rest and immobilisation through the use of a moon-boot is essential for good long term outcomes.
  • Physiotherapy: Rehabilitation exercises aim to strengthen the muscles around the ankle and improve mobility.
  • Anti-Inflammatory Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) can help reduce pain and swelling.
  • Surgery: In severe cases, surgery may be necessary to repair or reconstruct the damaged ligaments.
  • Gradual Return to Activity: Once the injury has healed, a supervised and gradual return to physical activity is essential to prevent re-injury.

Syndesmosis injuries, though less common than typical ankle sprains, can be quite debilitating. As a physiotherapist with 10 years of experience, I emphasize the importance of early diagnosis and appropriate treatment to achieve the best possible outcome for patients. If you suspect a syndesmosis injury, consult a medical professional to determine the most suitable course of action, and consider working with a knowledgeable physiotherapist to facilitate a safe and effective recovery process. Your long-term ankle health depends on it.

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