These pathologies should be preferentially ruled out before tx of a syndesmotic ankle sprain begins. Norwig writes “Syndesmotic ankle sprains can usually be distinguished from inversion ankle sprains by a history of an external rotation component.” Other possible pathologies are medial ankle sprain, compartment syndrome, severe joint laxity, severe contusion, dystrophic calcification, infection, or tumor. Secondly, the clinician should address concerns of a lateral ankle sprain as the mechanism of injury between the two injuries are very similar. First and foremost fractures of the tibia, fibula and/or the talus should be ruled out. ĭifferential Diagnosis īecause of the occult nature of the high ankle sprain during clinical evaluation it is important to rule out pathologies with a similar mechanism of injury (MOI). The most common MOI is when the foot is in external rotation with excessive dorsiflexion. History includes chronic pain, prolonged recovery, recurrent sprains, and the formation of heterotopic ossification within the interosseous membrane. A difficulty or inability to toe walk are often noted. Ecchymosis may appear several days post-injury due to the injury of the intereosseuos membrane.
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Observationally the Syndesmotic will show significantly less swelling than a lateral ankle sprain, as well as demonstrate a loss of full plantar flexion and an inability to bear weight.
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Incidence among professional American football players is reported to be much higher, up to 29% as documented by Boytim et al ( )Ĭharacteristics/Clinical Presentation Research has documented that syndesmosis injuries account for 1-11% of all injuries. In downhill ski racing, the boot does not allow dorsi- or plantar-flexion movement, which can result in excessive allowance of talocrural external rotation and injury to the anterior or posterior tibiofibular ligament, as well as the interosseous membrane. The injuries can also result from a blow to the lateral knee while the foot is planted and dorsiflexed, resulting in an eversion or external rotation moment at the talocrural joint. Football injuries are usually a result of forced external rotation of the foot while the athlete is prone, as in at the bottom of the pile. Syndesmotic ankle sprains commonly occur to athletes participating in American football and downhill skiing. Rupture injuries also commonly present with concomitant fractures of either malleolus (lateral being more common) or proximal fibular spiral fracture known as a Maissonneuve fracture. Sufficient distraction of the distal fibula from the tibia can cause strain or rupture of one or more of the following ligaments: the anterior inferior tibiofibular ligament, superficial posterior inferior tibiofibular ligament, transverse tibiofibular ligament, interosseous membrane, interosseous ligament and inferior transverse ligament. The dome of the Talus is wider in the anterior than in the posterior, and these movements force apart the medial and lateral aspects of the mortise, respectively the tibial and fibular malleoli. Injuries can occur with any ankle motion, but the most common motions are extreme external rotation or dorsiflexion of the Talus. 3 Characteristics/Clinical Presentationĭefinition/Description Ī syndesmotic, or ‘high’ ankle sprain is one that involves the ligaments binding the distal tibia and fibula at the Distal Tibiofibular Syndesmosis.
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