What is a syndesmosis injury that I keep hearing about?
You’re watching the footy on TV, and all of a sudden a player is clutching at his ankle. One of the commentators who assumes he has superior injury knowledge to the others tosses out the line “oh no, looks like he could have a syndesmosis injury there”.
What the heck is a syndesmosis you wonder?
The syndesmosis is the term used to describe a component of the distal tib-fib joint. Its also referred to as a “high ankle sprain”. It is when you injure part of the complex that holds the two bones in your ankle together, the tibia and fibula.
The ankle syndesmosis consisting of the 3 main ligament components- the AITFL, PITFL and interrosseous membrane (IOM).
In summary there’s three main components to the syndesmosis, the anterior (front) ligament, the posterior (back) ligament and the middle interroseus membrane. Injury to any one of these components is referred to as a syndesmosis injury, with an athlete who has injured 2 or more of the structures more than likely requiring surgery to stabilise the joint. Syndesmosis injuries most commonly occur through an eversion, or external rotation force to the ankle.
In the past, medical professionals struggled to identify syndesmosis injuries, and often people would end up having chronic ankle pain and instability, dramatically affecting their ability to perform sports and activities they love. Thankfully, due to improvements in imaging and a better understanding of how they occur, they are now rarely missed.
Often, impact weight bearing, such as running, and any movement where your knee shifts forward over your toes, will cause pain. This is because these activities encourage separation of the two bones that make up the lower leg. It is a characteristic sign of syndesmosis injuries and is different to the normal symptoms of a “traditional” ankle sprain, which is located lower on the outside of the ankle.
There are a number of tests a physio can perform to determine if you have injured your syndesmosis, and if you may possibly require imaging to evaluate this further. After orthopaedic surgeons, physio’s are probably the next most skilled health practitioners able to detect syndesmosis injuries.
Physio Assessment
Minor syndesmosis injuries can be managed with immobilisation in either a boot or with strapping, and specific exercises/rehab programs designed to target the deficits in your ankle. If the injury prevents as more severe, then your physio can help identify who the best ankle specialist may be to assist in your recovery.
If you are struggling with persistent ankle pain, weak ankles, or feelings of instability, book in today for an assessment to figure out the best way to address what’s causing your specific issue.
