📝 Part 1: What Is a Syndesmosis Injury? (And Why It’s Not Just a Normal Ankle Sprain)

🦴 What Is a Syndesmosis Injury?

A syndesmosis injury, often called a high ankle sprain, involves damage to the ligaments that connect the two long bones of the lower leg — the tibia and fibula — just above the ankle joint. Unlike a typical lateral ankle sprain, which affects the ligaments on the outside of your ankle, syndesmosis injuries occur higher up and tend to be more complex, particularly in athletes.

⚽ How Do Syndesmosis Injuries Happen?

These injuries typically occur in sports involving:

• Tackling or twisting (e.g. AFL, rugby)
  
  

• High-speed change of direction
  
  

• Awkward landings in basketball or netball
  
  

• Forced dorsiflexion — where your foot is pushed up while your ankle is twisted outward
  
  

Common mechanisms include having your foot trapped during a tackle or being landed on while your leg is rotating.

🧠 Why Are They So Tricky?

Unlike standard ankle sprains, syndesmosis injuries:

• Take longer to heal
  
  

• Cause more instability due to the involvement of multiple ligaments
  
  

• May require surgery if there’s joint widening or instability
  
  

• Often don’t respond well to generalised rehab programs
  
  

If you’re still limping or unable to jog 3–4 weeks after an ankle sprain, a syndesmosis injury could be the reason.

🔬 Symptoms to Watch For

• Pain above the ankle, especially when walking uphill or pushing off
  
  

• Swelling and bruising that extends up the shin
  
  

• Pain with twisting or squeezing the lower leg
  
  

• A feeling of instability or “widening” in the ankle
  
  

🧪 Do You Need Scans?

In many cases, yes — especially if a high ankle sprain is suspected. A physiotherapist can perform tests like the squeeze test or external rotation test, but MRI or weight-bearing X-rays are often needed to assess the severity and determine if surgery is required.

🏥 What Are the Grades of Injury?

• Grade I – Minor ligament stretching, stable joint
  
  

• Grade II – Partial ligament tear, may or may not be stable
  
  

• Grade III – Complete ligament tear, joint instability, often surgical
  
  

👣 Can You Walk on It?

Sometimes, yes — which is why syndesmosis injuries are often missed or under-rehabbed. However, walking without pain doesn’t mean you’re ready to run, jump, or play sport again.

✅ When Should You See a Physio?

If you’re:

• Still limping 7–10 days after your injury
  
  

• Not progressing with typical ankle rehab
  
  

• Preparing to return to high-level sport after an ankle sprain
  
  

• Recently had ankle surgery (tightrope or screw fixation)
  
  

Then it’s time to get assessed properly.

Coming next week:
👉 Part 2: How We Rehab Syndesmosis Injuries (What Elite-Level Rehab Looks Like)

Need an expert assessment in Ringwood or Bundoora?
📞 Book your appointment at Pivot Sports Performance today.