Syndesmosis Sprain

By Matt P. Juber

Syndesmosis Sprain


Syndesmosis Sprain

A syndesmosis sprain is commonly referred to as a “high ankle sprain”. This most often happens in high impact sports when a player is pivoting and rotating thereankle to attempt an athletic move.

The anatomy of the ankle joint, or talocrural joint, is comprised of:

  • Tibia
  • Fibula
  • Talus

Your tibia is the bone located directly under your knee. Your talus is located directly underneath your tibia. Your fibula is the “floating bone” that is located on the outside of your tibia. The term “floating bone” is used because this bone does not actually used to directly absorb the stress or impact that a bone like your femur or tibia absorb. It is primarily used to reinforce the stability in your ankle.

The fibula, your floating bone, is connected to your tibia by a thick fibrous sheath that is known as your syndesmosis. Your syndesmosis is important because of the stability it provides your lower leg and your talocrural (ankle) joint during functional movements.

Not only do you have this syndesmosis between your tibia and fibula, you also have other ligaments surrounding and interconnecting your talocrural joint. A few of them are:

  • ATFL (anterior tibial fibular ligament)
  • PTFL (posterior tibial fibular ligament)

Your ATFL and PTFL also provide stability to hold your talus into the correct anatomical position in order to optimize functional mobility of your ankle.

During a syndesmosis sprain, your talus has to have enough force to wedge through your ATFL in addition to your syndesmosis. This is the reason why the injury most often occurs with impact activities.

As a player is pivoting during a high impact activity, the talus rotates out to where it wedges between your fibula and tibia and pushthem away from one another.  As your fibula and tibia are being pushed away from one another, your syndesmosis sheath is becoming stressed. Thus, leading to a syndemosis sprain.

Treatment for syndesmosis sprain can be conservative (non-surgical) or non-conservative (surgical). This can be determined by a medical professional through thorough assessment and/or imaging (x-ray or MRI) to diagnose the severity of your high ankle sprain.

Conservative treatments will involve immediate rest, ice, compression, and elevation followed by physical therapy pending the structural damage in your ankle and clearance if your ankle is stable enough for you to perform physical therapy.

Early conservative treatments will involve managing your inflammation, maintaining the range of motion that you have in the ankle and protecting your injury. These can last for as little as 3-5 days or as long as a few weeks.

Once the ankle has healed to the point where it is stable, whether surgical intervention was required or not, it is crucial for the patient to begin putting full weight on the ankle and adding resistance exercises to the ankle.

This is so the body will begin to recognize the functional mobility it has in the ankle. By your body recognizing the functional movement and mobility in your ankle, you will then be able to begin re-integrating back to the function you were previous to your injury.

In addition to weight bearing and resistance exercises, range of motion exercises will be given to the patient in order to begin regaining the motion that was lost due to the injury.

Recovery from a syndesmosis sprain is typically excellent, of course pending severity of the injury. However, in a common case without surgical intervention, most patients should be fully healed within 6-8 weeks!

If you would like to learn more about ankle injuries, go to: Ankle

By: Matt Juber, Physical Therapist, JOI Baptist South 

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