The High Ankle Sprain

The Syndesmosis Ligament
Image: Sports Injury Info.com

In the high ankle sprain, however, a different set of ligaments is injured, called the "syndesmosis" (pronounced SIN-des-MOE-sis). The syndesmosis is a set of ligaments that is located above the ankle joint. The syndesmosis lies between the tibia and fibula and holds these two bones together. In normal walking, with each step, the tibia and fibula are exposed to high forces that act to spread the tibia and fibula apart. The syndesmosis acts as a shock absorber between the tibia and fibula and prevents the bones from splaying. Thus, with walking, the syndesmosis is exposed to high forces; with running, even higher forces; and with running and cutting, even higher forces still. When the syndesmosis is sprained, EVERY step can be painful. What can be more frustrating for athletes and coaches is that the high ankle sprain does not typically cause a great degree of swelling or bruising locally, and generally does not "look that bad," making it more difficult to understand the severity of the injury and importance of rest and rehab necessary for complete healing. Unfortunately, no type of bracing has been shown to treat or prevent these high ankle sprains.

High ankle sprains occur from sudden twisting injuries, which occur commonly in contact and cutting sports. Athletes will typically say the pain radiates up the leg from the ankle, and is worse with cutting motions that mimic the original twisting injury. The high ankle sprain is typically treated with the same treatment principles as for the common ankle sprain: Rest, ice, compression, and elevation: the RICE protocol. However, since the syndesmosis is subjected to such high forces with each step, the amount of rest needed tends to be longer than for the common ankle sprain – nearly twice as long in most studies. If the ligament is severely sprained, or even torn, a screw is sometimes placed between the tibia and fibula to hold the two bones together to allow for the ligament to scar and heal. Athletes will typically return to play within 6 weeks, but about half will experience symptoms for up to 6 months.