High Ankle Sprains / Syndesmosis Injuries
Syndesmosis injuries, also known as high ankle sprains, involve damage to the ligaments connecting the tibia and fibula bones just above the ankle. These injuries tend to be more severe than standard ankle sprains and typically require longer recovery periods due to the involvement of deeper and stronger ligaments.
Symptoms of Syndesmosis Injuries
Common syndesmosis injury symptoms include:
Pain: Typically felt above the ankle, especially during movements like walking or climbing stairs.
Swelling: Significant swelling around the ankle, often extending upward along the shin.
Tenderness: Touching or pressing on the area between the tibia and fibula (the syndesmosis) causes pain.
Difficulty with Movement: Activities that involve rotation of the foot, such as walking or running, may be painful.
Positive Syndesmosis tests: A physiotherapist can conduct diagnostic tests to determine if you have injured your syndesmosis.
Imaging: If a syndesmosis injury is suspected, your physiotherapist may refer you on for further imaging such as an MRI.
Causes
Syndesmosis injuries most commonly result from:
Trauma: High-impact incidents such as hip drop tackles or ankle sprains.
Sports Activities: Sports that involve sudden twisting or changes in direction (e.g., football, basketball) often cause this type of injury.
Excessive Dorsiflexion and Rotation: Forced upward movement of the foot with outward rotation is a common mechanism, particularly in athletic settings.
Rehabilitation Strategies
Effective syndesmosis injury treatment involves several phases to ensure proper healing:
Initial Management:
Protect, Optimal Loading, Ice, Compression and Elevation (POLICE) can help reduce pain and swelling immediately after the injury.
Bracing: Your physiotherapist may recommend you wear a “moonboot” for a period of time to help your syndesmosis heal.
Gradual Loading:
Once the acute pain subsides, range of motion exercises should begin to maintain ankle mobility without causing further damage to the ligaments.
Strengthening Exercises:
After restoring mobility, exercises aimed at strengthening the muscles around the ankle, particularly the peroneals and calf muscles, help support the injured ligaments and improve stability.
Proprioceptive Training:
Incorporating balance and proprioceptive exercises, such as single-leg stands and balance board training, helps rebuild the body's ability to sense joint position, reducing the risk of re-injury.
Return to Activity:
Gradual return to sports or physical activities should be done under the guidance of a physical therapist, ensuring that strength, mobility, and balance are fully restored.
Conclusion
Syndesmosis injuries require careful management to avoid long-term complications like chronic instability. Through proper rehabilitation exercises and a structured treatment plan, most individuals can return to their regular activities. If you suspect you have injured your syndesmosis, it is essential to have a qualified health professional assess your injury.
By addressing the injury early and following a targeted rehabilitation program, athletes and active individuals can minimise the risk of re-injury and regain full function.
