The ankle syndesmosis is a joint at the distal (bottom end) of your shin which joins the fibula to the tibia above the ankle with a group of ligaments. The typical mechanism of syndesmosis injuries or “high ankle sprains”, is usually a combination of ankle dorsiflexion and external rotation (upward and outward movements of the foot) along with compression, whilst the foot is fixed to the ground. This may or may not also involve an opponent, classifying it as a contact or non-contact injury. Syndesmosis injuries will usually not display a large amount of swelling on the outside of the ankle (like a lateral ankle sprain); however, patients will complain of pain above the outside of their ankle.
Syndesmosis injuries are described as grade 1, grade 2a, grade 2b and grade 3. Grade 1 and 2a injuries are usually classified as stable, whereas grade 2b and grade 3 injuries are unstable. This classification is determined by what specific ligaments forming the ankle syndesmosis are damaged which in turn, determine the stability of the joint. In some cases, you may be required to undergo certain imaging to aid this classification.
The stability of the syndesmosis guides the treatment of such injuries. Stable syndesmosis injuries can be treated with conservative management alone. This usually involves an initial immobilisation and non-weightbearing period with a CAM/moon boot followed by rehabilitation. If the syndesmosis injury results in an instability, surgery is usually required to restore the stability of the ankle syndesmosis followed by rehabilitation.
If you have sustained an ankle syndesmosis injury or have an ankle injury which is taking a longer period of time to improve, touch base with one of our physiotherapists to help with the assessment and treatment of your ankle injury.