Ankle Syndesmosis

Is it really a lateral ankle sprain?

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The lateral ankle is the most commonly sprained aspect of the body, especially in the active population.

I hear a lot;

“Oh, I rolled my ankle years ago.”

“I've sprained my ankle in a tackle.”

You don't sprain the ankle, you sprain a or a number of ligaments, which the ankle has a lot of!

Most commonly a lateral ankle sprain is caused by an over inversion of the ankle causing disruption or tear to the fibres of the ATFL and on some occasions the CFL.

However, more frequently now I'm seeing clients with chronic ankle pain and instability due to mismanagement and poor rehab of high ankle sprains or ankle syndesmosis sprain.

A high ankle sprain refers to a small ligament at the base of the leg that connects the fibula and tibia. It's main priority in terms of structural stability to to prevent too much translation of the talus (ankle). Syndesmosis sprain is graded depending on the amount of disruption or percentage of fibers torn of the Anterior Inferior tibiofibular ligament and the interosseous membrane.

Two common mechanisms of injury are; executive dorsiflexion (where the foot and toes come towards the tibia) along with excessive external rotation of the shin. And excessive plantar flexion (where the foot and toes point towards the floor) with direct force from the posterior (back) or the leg. From experience in rugby league it is a very common way of disrupting the syndesmosis complex due to the tackling techniques used in the game now

TOP TIP: A few nice easy ways on assessment to determine between the ATFL and syndesmosis is; check laxity with a PA of the distal tibiofibular, single leg standing with dorsiflexion and external rotation and a passive deep dorsiflexion and eversion.


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