Syndesmosis Injuries

What is the syndesmosis?

The 2 bones in your lower leg (the tibia and fibula) are joined by an interosseous membrane or connective tissue. At the distal end of these bones close to the ankle joint this forms a fibrous joint called a syndesmosis.

How does an injury to the syndesmosis present?

Trauma to the ankle as seen in a common ankle sprain can sometimes damage this area which is otherwise called a ‘high ankle sprain’. The mechanism of injury often involves excessive external rotation of the foot and extreme dorsiflexion i.e. as the foot and ankle are forced up and out, often with the foot firmly planted on the ground.

Common signs and symptoms can include an inability to walk or hop, pointing the foot and ankle down (plantarflexion) is restricted and pressure around the bottom of the shin can be acutely painful.

If you suspect that this was how you injured your ankle, you are finding that you are not recovering as fast as you expected, are struggling to weight bear and the pain is more around the front and top of the ankle this may be the injury you have sustained.

How is it treated?

These can be troublesome to treat and may need a period of offloading ( in an aircast boot and/or use of crutches) followed by a progressive rehabilitation programme to restore range of movement, strength and balance control. In worse case scenarios where the ankle isn’t settling or remains unstable surgery may be necessary so be sure to get this looked at as early as possible to ensure the best recovery and fastest return to sport.

What You Need To Know
  • Commonly missed on assessment.
  • Can account for persistent pain following a generic ‘ankle sprain’ diagnosis.
  • May requires a period of immobilization in an Aircast boot.
  • Pressure applied to the bottom of the shin is often acutely tender.