Syndesmotic Injuries of the Ankle

The syndesmosis is the name of the ligament that connects two bones of the leg. These bones, the tibia and fibula, are between the knee and ankle joints. The tibia is the larger shin bone that supports most of the weight of body, and the fibula is the smaller bone on the outside of the leg. Connecting these bones is a ligament called the syndesmosis, also called the syndesmotic ligament. Syndesmosis ligament injuries often occur in conjunction with other ankle injuries, including sprains and fractures.


Syndesmosis injuries occur when there is a disruption of the distal attachment of the tibia and fibula. These injuries occur commonly (up to 18% of ankle sprains), and the incidence increases in the setting of athletic activity (Porter et al 2014).


Many people who experience syndesmotic ankle sprains are unable fully weightbear when mobilising and require the use of an assistive device such as crutches during the initial stages of injury. Generally, people with relatively minor complaints are able to ambulate with full weightbearing, or otherwise with the use of crutches and with weightbearing as tolerated. People with more severe injuries are often treated with a short period of more restricted weightbearing (1 to 2 weeks). Full weightbearing is encouraged when patients are able to ambulate on various surfaces and ascend/descend stairs with minimal discomfort. With more severe injuries stabilisation surgery may be required.


The first phase of rehabilitation is directed at promoting healing by protecting the joint while minimising pain, inflammation, muscle weakness, and loss of motion. Patients transition from this acute phase to the subacute phase of rehabilitation when they are able to ambulate in full weightbearing with minimal discomfort. The subacute phase of rehabilitation is directed at normalising range of motion, strength, gait, and basic function in the patient’s activities of daily living (Williams and Allen 2010).


The recovery period after syndesmotic ankle sprains is highly variable. Overall, people who sustain syndesmotic ankle sprains typically experience much longer recovery periods than do those who sustain lateral ankle sprains. As a general guide, recovery can take anywhere from 6-8 weeks or in cases in which a separation of the tibia and fibula or fracture has occurred and surgery is necessary, patients will likely need to be non-weightbearing in a cast and then in a CAM (walking) boot for around 12 weeks. Full recovery itself in this case may take up to 6 months.


With so many factors that impede a successful recovery, optimal management is essential. Workplace Physiotherapy have staff who are highly skilled in the management of syndesmotic injuries.



Ref: Porter D.A, Jaggers R.R, Fitzgerald Barnes A, Rund A.M. Optimal management of ankle injuries.
Open Access Journal of Sports Medicine 2014:5 173–182.
Williams G.N and Allen E.J. Rehabilitation of Syndesmotic (High) Ankle Sprain. Sports Health, 2010: Vol 2 (6) 460-470.


The comments above are the implicit advice of Workplace Physiotherapy. The views expressed are based on current evidence-based research and accepted best practice approaches. Unless otherwise stated, these comments are not the view of WorkCover NSW or any other professional body. No reproduction or forwarding of this advice is permitted without the consent of the author.


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