WHAT ARE SYNDESMOSIS INJURIES?
The syndesmosis is a key stabiliser of the ankle joint. It is the strong group of ligaments between the tibia and fibula at the ankle joint. The syndesmosis can be injured in an impact/twisting injury to the ankle. It can occur in conjunction with fractures of the ankle (see Ankle Fractures). It is sometimes called a ‘high ankle sprain’ and is much less common than a normal ankle sprain.
SYMPTOMS OF A SYNDESMOSIS INJURY
Syndesmosis injuries can range from a minor sprain of a ligament to a lifechanging fracture dislocation of the ankle joint. If the syndesmosis is injured in conjunction with an ankle fracture, it is usually too painful to walk on. If the syndesmosis is injured in isolation, most commonly, after a fall, the following symptoms are:
- Pain and/or swelling over area above the front part of the ankle joint
- Pain with walking/running/sport
- An ‘ankle sprain’ that does not improve over several weeks of treatment
DIAGNOSIS OF A SYNDESMOSIS INJURY
Syndesmosis injuries usually occur after an injury. Diagnosis include taking a history, examining the foot and getting xrays.
Isolated syndesmosis injuries may have normal xrays, as the ligaments are not visible on xrays. The instability may be revealed on weightbearing xrays, and it is often helpful to compare it to the ‘normal’ foot. In more severe injuries, xrays can show associated fractures and displacement of the bones. Other injuries may need to be identified and treated.
If there is a clinical concern of a syndesmosis injury and xrays are normal, Dr Graff may request an MRI or a weight bearing CT of both ankles (or both) to diagnose a syndesmosis injury.
MANAGEMENT AND TREATMENT OF LISFRANC INJURIES
Management of syndesmosis injuries often require surgery. Only ‘sprains’ of the syndesmosis ligament or injury of only part of the syndesmosis can be managed non operatively. Non operative measures include:
- Rest
- Elevation
- Compression with a tubigrip or bandage
- Ice
- Camboot
- Pain relief
- Blood thinners to prevent DVT
Most syndesmosis injuries require surgery to stabilise the joint between the tibia and fibula at the level of the ankle and prevent chronic pain and deformity of the ankle (see Syndesmosis stabilisation surgery). Even after surgery, arthritis may develop in the ankle and the ankle may always feel different compared with prior to the injury. The surgery aims to stabilise the ankle, prevent deformity and slow the progression of arthritis.
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