What Is a Syndesmosis Injury? | High Ankle Sprain Explained
📝 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.
