The ankle syndesmosis is made up of ligaments that hold the two lower leg bones, the tibia and fibula, together and help keep the talus and foot centered in the ankle.
An injury to these ligaments commonly occurs just above the ankle joint and is called a high ankle sprain. Although less common than a typical lateral ankle sprain, a syndesmosis injury generally requires a longer healing and rehabilitation period.
What Are Ankle Sprains and Syndesmosis Injuries?
A syndesmosis injury occurs when the ligaments connecting the tibia and fibula are sprained or torn.
The injury typically occurs when the foot rotates outward, causing the talus to place stress on the syndesmotic ligaments and push the tibia and fibula apart at the ankle.
A fracture of the fibula or posterior portion of the tibia and/or a sprain of the deltoid ligament on the inner ankle may also occur with this type of injury.
Causes and Risk Factors
A syndesmosis sprain occurs when a force exceeds the strength of the syndesmotic ligaments.
Common causes include:
- Planting the foot and twisting the body away from it, creating an outward rotational force
- Forceful landing with the feet flat, driving the ankle upward and forcing the tibia and fibula apart
Risk factors include:
- Sports involving cutting, sudden turns, or changes of direction, such as soccer, basketball, football, and skiing
- Falling or twisting while bearing weight
- Motor vehicle accidents
Symptoms
Common signs and symptoms include:
- Pain and tenderness between the tibia and fibula above the ankle joint
- Difficulty and pain with bearing weight immediately after the injury
- Pain with delayed swelling
- Pain when rotating the foot outward
- Pain and tenderness at the ankle and extending up the leg along the syndesmotic ligaments
- Pain and tenderness on the inside of the ankle when the deltoid ligament is also injured
- Pain, tenderness, and crepitation, or a crunching sensation, when an associated fibular fracture is present
Treatment
Initial treatment includes rest and reduced weight bearing with crutches. Ice and anti-inflammatory medication may be used for pain control after the injury.
Stable injuries may be treated without surgery. Physical therapy or treatment with an athletic trainer is used to restore range of motion and strength. Return to weight bearing and walking may need to occur gradually, followed by functional strengthening and proprioception exercises before returning to running and sports.
Unstable syndesmosis injuries require surgery to reduce and realign the tibia and fibula and allow the ligaments to heal in the proper position. Screws or other fixation devices may be used to stabilize the syndesmosis.
Surgical treatment is later followed by removal of the hardware and physical therapy to restore ankle range of motion, strength, and function.
Recovery and Outcomes
Stable syndesmosis injuries can return to full activity with proper rehabilitation, although healing and rehabilitation generally take longer than with a typical ankle sprain.
As a general guideline, return to activities and sports may occur after approximately three weeks plus an additional week for every centimeter of tenderness along the syndesmotic ligaments above the ankle joint.
Surgical recovery for an unstable syndesmosis injury may take approximately four to six months.
Potential complications include:
- Re-injury, particularly if the original injury has not fully healed
- Delayed healing or continued symptoms with activity
- Additional injury to surrounding muscles and ligaments because of reduced ankle stability
- Failure of the syndesmotic ligaments to heal
- Persistent widening of the syndesmosis
- Abnormal stress on the ankle joint
- Pain and limitations with activity
- Accelerated degeneration of the ankle joint
When to See Dr. Chudik
If you develop pain and tenderness above the ankle, difficulty bearing weight, pain with outward rotation of the foot, or persistent symptoms after an ankle injury, schedule an evaluation with Dr. Chudik.
Call 630-324-0402, request an appointment online, or email contactus@chudikmd.com.