High Ankle Sprains

A syndesmosis ankle sprain or, as sometimes heard in sporting competitions, the high ankle sprain occurs at the front of the ankle joint, and this is notably different condition to common lateral (outside) or medial (inside) ankle ligament sprains.

A syndesmosis injury occurs when a person plants their foot (or gets caught under a tackle) and the foot gets forced into excessive external rotation and dorsiflexion of the ankle. This results in disruption to the ligaments on the front of the ankle that connect the lower leg bones known as the tibia and fibula together. These ligaments are called the anterior inferior tibiofibular ligament (AITFL), posterior tibiofibular ligament (PITFL) and the interosseous ligament. The job of these ligaments is to stabilize the ankle and stop the separation of the tibia and fibula.

Common symptoms of a syndesmosis injury include pain + swelling to both the front and outside of the ankle and potentially difficulty weightbearing on the affected leg. It is important to get a thorough assessment by your physiotherapist if you suspect this injury, but clearly this injury is also very important for any ankle injuries that happen. Assessment of the syndesmosis integrity includes palpation, special clinical testing and potentially an MRI or weight-bearing x-ray. Other differential diagnoses which physiotherapists may need to clear include an ankle fracture, mid-foot injury or lateral ankle sprain.

The severity of these injuries can vary from a mild grade 1 sprain or light ligamentous stretching all the way to a full rupture. The management of these depends upon the severity. Treatment usually commences with R.I.C.E.R protocol, protected weight bearing and taping regardless of severity. Mild syndesmosis injury cases respond well to conservative measures like relative rest, bracing or taping, sport specific exercise rehabilitation (that focuses on strength, balance proprioception) and a guided return to sport/running program. In more severe cases, a surgical opinion may be warranted to address the ligament damage. Rehabilitation post-operatively focuses on strength + flexibility, foot stability and then a guided return to sport/running program.

This is one of those injuries that is subtle in the presence of a big tackle (where everything is sore initially) and/or you just do a ‘she’ll be right’ to an ankle sprain at work or play, but we are sorry to explain that a syndesmosis ankle sprain has tricky implications if left untreated over time. To make sure you have the right treatment plan, get assessed by an expert physiotherapist by calling 9431 5955 or book via the Client Portal on our website.