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 by an impact/twisting injury to the ankle. It can occur in conjunction with ankle fractures (see
Ankle Fractures). It is sometimes called a ‘high ankle sprain’ and is much less common than a normal ankle sprain.
The syndesmosis joint is crucial for maintaining the alignment of the tibia and fibula during movement. When injured, this joint becomes unstable, leading to:
Syndesmosis injuries often occur in people who engage in high-impact or contact sports. Those most at risk include:
Syndesmosis injuries are usually caused by external forces or sudden twisting movements that stress the ligaments connecting the tibia and fibula. Common causes include:
Syndesmosis injuries can range from a minor sprain of a ligament to a life-changing fracture dislocation of the ankle joint. If the syndesmosis is injured 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:
While some injuries are unavoidable, especially in high-risk activities, several strategies can minimise the risk of syndesmosis injuries:
Syndesmosis injuries can vary in severity and are typically classified into three types:
Syndesmosis injuries progress through stages depending on their severity and the healing process:
Syndesmosis injuries usually occur after an injury. Diagnosis involves taking a history, examining the foot, and getting X-rays.
Isolated syndesmosis injuries may have normal X-rays, as the ligaments are not visible. Weight-bearing X-rays may reveal the instability, and comparing it to the ‘normal’ foot is often helpful. In more severe injuries, X-rays 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 the x-rays are normal, Dr Graff may request an MRI or a weight-bearing CT of both ankles (or both) to diagnose a syndesmosis injury.
Management of syndesmosis injuries often requires surgery. Only ‘sprains’ of the syndesmosis ligament or injury of only part of the syndesmosis can be managed non operatively. Non-operative measures include:
Most syndesmosis injuries require surgery to stabilise the joint between the tibia and fibula at the ankle level and prevent chronic pain and deformity (see Syndesmosis stabilisation surgery). Even after surgery, arthritis may develop in the ankle, which may feel different from before the injury. The surgery aims to stabilise the ankle, prevent deformity, and slow the progression of arthritis.
Failure to treat syndesmosis injuries can lead to serious complications, including:
Timely diagnosis and appropriate management are essential to ensuring full recovery from syndesmosis injuries and preventing long-term complications.
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