Ankle syndesmosis injury, also called a high ankle sprain, occurs just above the ankle where the long bones in the bottom of the leg meet. The syndesmosis is comprised of a fibrous band of tissue between the tibia and fibula as well as anterior and posterior tibiofibular ligaments, just above the ankle. Damage to these ligaments leads to a loss of stability of the lower leg and ankle, often resulting in reduced ankle joint movement, balance and power.
Syndesmosis injuries generally occur when the leg rotates inward forcefully with the foot planted or with the foot forced heavily into excessive dorsiflexion (toe up position). They account for 11% of ankle injuries and occur much more commonly in sports involving fast changes in direction, twisting, or cutting manoeuvres such as football, rugby and basketball.
- Pain and swelling above the ankle joint rather than the outside.
- Pain on weightbearing and walking that is decreased with compression.
- Sharp pain with turning the foot out or forcing the toe to the head (dorsiflexion).
- A feeling of instability or loss of power in the ankle.
Initial management of the injury involves offloading the injured tissue. Depending on the severity of the injury, this may involve taping, immobilisation in a boot and possibly crutches. Ice and anti-inflammatory medication are generally used to help with pain and swelling. An X-ray may be required to rule out fractures and assess stability of the joint.
After an initial period of immobilisation, your physiotherapist will provide you with rehabilitation program aimed at regaining normal joint range of motion, strength, balance, proprioception, and normal foot biomechanics. Return to sport time frames are dependent on the degree of damage to the area.
In the presence of fractures or more severe injuries with significant instability, an orthopaedic review may be required to discuss possible surgical repair, with rehabilitation to take place after this.
If you have suffered a significant ankle injury, make an appointment today to see one of our expert physios for advice on best management and a plan to get you back doing what you love.