Introduction Syndesmotic ankle sprains, or high ankle sprains, are a challenging lower extremity injury, especially among high level athletes.
Syndesmotic ankle sprains, or high ankle sprains, are a challenging lower extremity injury, especially among high level athletes. Sports medicine providers will encounter these injuries and they can be very frustrating for providers and athletes due to the variability in return to play and residual pain during rehabilitation. Syndesmotic injuries primarily occur during contact sports such as football, rugby, ice hockey, soccer, and lacrosse.
The most common mechanism of injury is direct contact to the lateral leg with the foot fixed to the ground. This valgus moment causes an eversion or external rotation force at the ankle joint with the foot placed in dorsiflexion placing excess stress on the ankle’s syndesmotic ligaments. High ankle sprains, or syndesmotic injuries, account for around 11% to 17% of total ankle sprains.
Syndesmotic sprains have unpredictable outcomes and can result in residual disability because of decreased performance, absence from competition, adverse psychological effects, and prolonged recovery times. Full recovery and return to play for syndesmotic injuries has been reported to require more than twice the time compared with lateral low ankle sprains. The ligamentous stabilizers of the distal tibiofibular joint are the interosseous membrane, posterior inferior tibiofibular ligament, and the anterior inferior tibiofibular ligament.
There are also likely contributions to the stability of the mortise from the deltoid ligament and lateral ligamentous structures of the ankle (talofibular and calcaneofibular ligaments). Illustration depricting syndesmotic ankle ligaments. Identifying a syndesmosis ankle injury is critical for developing a treatment plan to maximize the probability of a positive recovery.
Diagnosis of tibiofibular syndesmosis injury involves clinical evaluation confirmed by imaging. Differentiating between different types of ankle sprains is typically done through a multifaceted approach beginning with localizing symptoms at the first presentation. Clinical exams may reveal sensitive signs of injury with tenderness during palpation of the anterior surface of the ankle typically felt over the interosseous membrane, anterior inferior tibiofibular ligament, or posterior inferior tibiofibular ligament.
If you are experiencing symptoms that may be related to syndesmotic ankle sprain, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.
*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*
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