Syndesmosis Injury

What is a Syndesmosis Injury?

A syndesmosis injury, often called a "high ankle sprain," involves damage to the ligaments that connect the two bones of your lower leg (tibia and fibula) just above the ankle joint. This injury affects the syndesmotic ligaments that hold these bones together and maintain the stability of your ankle mortise - the socket that your ankle bone sits in.

Unlike common ankle sprains that affect the outer ankle ligaments, syndesmosis injuries occur higher up and can be more complex to treat. They're often seen in contact sports and can significantly impact your ability to push off and change direction effectively.

What Causes Syndesmosis Injuries?

Syndesmosis injuries typically result from specific mechanisms that force the ankle bones apart:

Common mechanisms:

  • External rotation of the foot whilst the ankle is flexed upward

  • Landing with the foot turned outward

  • Being tackled whilst the foot is planted and turned out

  • Severe ankle sprains that involve multiple ligament structures

High-risk situations:

  • Rugby tackles, particularly when caught in rucks or mauls

  • Football tackles with foot planted

  • Skiing accidents with external rotation forces

  • Basketball or netball landing injuries

  • Motor vehicle accidents

Risk factors:

  • Participation in contact sports

  • Previous syndesmosis injuries

  • Concurrent ankle fractures

  • High-energy trauma or collisions

  • Poor landing mechanics

  • Inadequate protective equipment in contact sports

What Are the Symptoms?

Syndesmosis injuries often present differently from typical ankle sprains:

Distinctive symptoms:

  • Pain above the ankle, between the two leg bones

  • Pain that worsens with external rotation of the foot

  • Difficulty with push-off activities like running or jumping

  • Pain when squeezing the leg bones together

  • Deep, aching pain rather than sharp, localised pain

Functional symptoms:

  • Significant difficulty with single-leg hopping

  • Pain when walking on tiptoes

  • Instability during cutting or pivoting movements

  • Prolonged recovery compared to standard ankle sprains

  • Pain that may not respond to typical ankle sprain treatment

Associated symptoms:

  • Swelling above the ankle joint

  • Bruising extending up the lower leg

  • Feeling of the ankle being "loose" or unstable

  • Difficulty bearing full weight

  • Pain that persists weeks after initial injury

Concerned about a high ankle sprain injury? Our specialist team has extensive experience treating complex ankle injuries in professional athletes, from rugby players and Olympic Gymnasts. We provide comprehensive assessment using advanced testing to ensure accurate diagnosis and effective rehabilitation for optimal return to sport.