Syndesmosis Sprain

By Matt P. Juber

What is a Syndesmosis Sprain?

Quick answer, a syndesmosis sprain is a “high ankle sprain.”  This often happens in high-impact sports when a player is pivoting and rotating their ankle to attempt an athletic move.

Syndesmosis Sprains can occur while playing soccer

Syndesmosis Sprain

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. The 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 use to directly absorb the stress or impact that a bone-like femur or tibia absorbs. It is primarily used to reinforce the stability of your ankle.


  • Pain above the ankle
  • Tenderness to the touch
  • Pain when you flex or rotate your foot
  • Unable to put your full wait on your ankle
  • Pain that increases when you walk


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 pushes them 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 syndesmosis sprain.


Syndesmosis Sprain injury should be iced during first days after injury

Ice treatment for high ankle sprain

Treatment for syndesmosis sprain can be conservative (non-surgical) or non-conservative (surgical). A medical professional can determine this 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 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 a surgical intervention was required or not, the patient must 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 to begin regaining the motion lost due to the injury.

Recovery from a syndesmosis sprain is typically excellent, of course, pending the severity of the injury. However, in a common cause 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 

JOI - Book an Appointment

Image of Book an Appointment



Skip to content