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Management Of An Ankle Syndesmotic Injury

Management Of An Ankle Syndesmotic Injury
Management Of An Ankle Syndesmotic Injury

Presentation Of An Ankle Syndesmotic Injury

Most patients with a ankle syndesmotic injury will present with pain in the anterior or lateral aspect of the ankle or lower leg following a traumatic incident to the ankle. In the chronic situation or where individuals with actue injuries are still capable of physical activity there may also be feelings of instability in the ankle joint particularly with lateral or cutting type maneuvers. Individuals with chronic ankle syndesmotic injury and instability may have developed symptoms of arthritis at the ankle joint. These patients may have pain and swelling as well as stiffness and impingement signs.

Patients following an acute high ankle sprain will often report:

  • Pain felt above just above the ankle joint which increases when outward rotation is applied to the foot.
  • Pain with walking, often there is significant bruising and swelling across the higher ankle area rather than lower down around the malleolus as with the more common lateral ankle sprain.

The severity of any symptoms depend on the grade of sprain and individuals with a high ankle sprain without bony fracture may be able to bear weight on their ankle. Because missing a ankle syndesmotic injury can result in prolonged disability, assessment and investigations are necessary when a high ankle sprain is suspected.

Examination And Investigatoin Of An Ankle Syndesmotic Injury

As with most sporting injuries an ankle syndesmotic injury is ideally diagnosed early to allow the appropriate treatment to be initiated. If a high ankle sprain is suspected an MRI or weight bearing X-ray or CT scan may be ordered to help confirm the diagnosis. With a weight bearing X-ray, gapping at the inferior tibiofibular joint when compared to the non injured ankle is a signs of an ankle syndesmotic injury.

High Ankle Sprain Xray

Treatment For Ankle Syndesmotic Injuries

Treatment of acute ankle syndesmotic injuries depends on the injury severity and the stability of the joint complex.

  • Grade I injury: Stable injuries can be treated conservatively. Managed with a period of immobilizaiton, protected weightbearing and then progressed with gradual physiotherapy rehabilitation.
  • Grade II and Grade III ankle syndesmotic injuries: Individuals will be managed with either a conservative approach as discussed above with varying lengths of each phase of the rehabilitation or some form of surgical fixation where the goal is reduction of the ankle syndesmosis with some sort of internal fixation. Assessment of high ankle sprains by an orthopaedic surgeon is recommended when there is suspicion of syndesmotic injury and instability on assessment.

Disclaimer: Sydney Physio Clinic provides this information as an educational service and is not intended to serve as medical advice. Anyone seeking specific advice or assistance on Management Of An Ankle Syndesmotic Injury should consult his or her physiotherapist, general practitioner, sports doctor, orthopedic surgeon or otherwise appropriately skilled practitioner.

Hayden Latimer is the founder of and principle physiotherapist at Sydney Physio Clinic. Since graduating from Otago University, Dunedin, New Zealand he’s gained wide experience practicing across the globe for over 15 years and is now extremely knowledgeable in helping people reduce discomfort and restore function and mobility.


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