Ankle syndesmosis injuries are common in change of direction and contact sports. The syndesmosis is a strong ligamentous structure that connects the bottom portion of the fibula and the tibia. The syndesmosis also has attachments to the AITFL, IOL and the PITFLT, and the TIFL (ligaments that support the ankle complex). The role of the syndesmosis is to prevent the spreading of the tibia and the fibula during weight-bearing. 

The mechanism of injury is hyper-dorsiflexion (foot pointing upwards), pronation, and external rotation (foot twisted outwards). The second mechanism is extreme plantarflexion (foot pointing downwards) and external rotation.

Grading and management of syndesmosis injuries: 

Grade 1: 

– No widening of the tibia and fibula on x-ray 

– Able to weight bear fully 

– Pain with a squeeze or external rotation test 

Management: 

– Cam-boot until pain free

– Return to sport at 3 weeks 

 

Grade 2: 

– No widening of the tibia and fibula on x-ray 

– Difficult to weight bear 

– Moderate tenderness 

– Pain with a squeeze or external rotation test 

– Large amount of swelling

Management: 

– Surgical for unstable injuries (deltoid ligament involvement)  

– Conservative management for isolated (AIT)

 

Grade 3: 

– Widening of the tibia and fibula on x-ray 

– Unable to weight bear

– Pain with a squeeze or external rotation test 

– Large amount of swelling

Management: 

– Operative management

 

Physiotherapy is recommended in all grades (1,2 and 3) for proper management of the injury. Visit Set In Motion Physiotherapy and book your appointment now