A Walk-Through of Syndesmosis Injuries

In the world of sports injuries, ankle sprains are very common. Most people are familiar with the typical inversion sprain, where the foot rolls inwards, causing damage to the ligaments on the outside of the ankle. However, there’s another type of ankle injury that’s less well-known but equally significant: syndesmosis injuries, often referred to as high ankle sprains. You may have heard of these injuries when you were watching the footy on TV, listening to the commentators query every ankle injury as a syndesmosis injury. In this blog, we are going to discuss all things syndesmosis, and how physiotherapists play a role in managing such injuries.

What is a Syndesmosis Injury?

Unlike the more common lateral ankle sprains, syndesmosis injuries involve damage to the syndesmosis, which is a group of ligaments that hold the lower leg bones (tibia and fibula) together. These ligaments are located above the ankle joint and are crucial for stabilising the joint during weight-bearing activities and movements.

Syndesmosis injuries typically occur when there is excessive outward rotation or a sudden force that spreads the tibia and fibula apart while the foot is planted. Athletes involved in sports that require sudden changes in direction or jumping, such as basketball, soccer, or football, are particularly prone to these injuries. Some research suggests that 5-8% of acute ankle injuries involve the syndesmosis, which is far more common than most people realise.

Signs and Symptoms

Recognising a syndesmosis injury can be challenging because the symptoms can mimic those of a traditional ankle sprain. However, some distinguishing features include:

• Pain and tenderness above the ankle joint rather than just on the sides.
• Swelling that may extend up the leg.*
• Pain with rotation of the ankle or when squeezing the calf muscles.
• Difficulty during weight bearing or walking due to instability.

*If you are experiencing swelling and/or tenderness above the ankle, this could also be indicative of a Deep Vein Thrombosis (DVT), so it is imperative that you consult your healthcare practitioner regardless.

Diagnosis and Treatment

Prompt and accurate diagnosis is crucial for effective treatment. A physiotherapist or sports medicine professional will typically perform a thorough physical examination and may recommend imaging tests like X-rays (most likely a weight-bearing view if tolerable) or MRI scans to assess the extent of the injury.

Treatment for syndesmosis injuries varies depending on the severity but often includes:

• Rest, Ice, Compression, Elevation (RICE): Initially managing swelling and pain.
• Immobilisation: Using a boot or brace to restrict movement and promote healing.
• Physical Therapy: Exercises to restore strength, flexibility, and proprioception (balance).
• Gradual Return to Activity: Progressively reintroducing weight-bearing activities and sports-specific movements.

In some cases, severe syndesmosis injuries may require surgical intervention to stabilise the joint if conservative measures are inadequate.

Rehabilitation and Recovery

Rehabilitation following a syndesmosis injury is critical to ensure full recovery and reduce the risk of recurrence. Physiotherapy plays a central role in this process, regardless of whether or not surgery is involved, to focus on:

• Range of Motion Exercises: Restoring normal ankle movement.
• Strengthening Exercises: Targeting muscles around the ankle and lower leg, progressing from non-weightbearing to full-weightbearing which are crucial for dynamic control.
• Balance and Proprioception Training: Improving joint stability and reducing the risk of future injuries.
• Sport-Specific Rehabilitation: Gradual progression to activities that mimic the demands of the athlete’s sport.

Preventing Future Injuries

While some syndesmosis injuries are unavoidable due to the nature of sports, there are measures athletes can take to reduce their risk:

• Proper Warm-Up: Dynamic stretching and warm-up exercises before activity.
• Footwear: Using supportive shoes and orthotics appropriate for the sport.
• Strength and Conditioning: Building strength in the muscles that support the ankle joint.
• Technique: Ensuring proper technique during athletic manoeuvres.

Conclusion

Syndesmosis injuries, or high ankle sprains, are a significant concern for athletes and active individuals alike. Understanding the symptoms, diagnosis, and treatment options is essential for timely intervention and optimal recovery. By following a comprehensive rehabilitation program and taking preventive measures, athletes can minimise the impact of these injuries and return to their chosen activities stronger than before. If you suspect a syndesmosis injury, don’t hesitate to consult with a healthcare professional for a thorough assessment and personalised treatment plan.