A syndesmosis injury, ‘high ankle sprain’ occurs usually when the foot is twisted and rotated outwards.
The ankle is formed by the Tibia and Fibula bones, held by ligaments termed the Anterior Inferior Tibiofibular Ligament AITFL, and the Posterior Inferior tibiofibular ligamen PITFL.
Once these ligments are damaged instability can develop in the Ankle Joint.
Some patients have syndesmosis injuries which need immediate surgical management. In other patients a chronic instability develops, and common complaints include pain on twisting, pivoting, stairs and an inability to return to the previous level of sport. Commonly patients present after 2-3 months of physical rehabilitation with minimal improvement.
An MRI scan is helpful to confirm the ligament injury and to assess the joint cartilage. A weight bearing CT scan can assess the degree of instability between the 2 ankle bones, and determine which patients would benefit from surgical intervention.