Syndesmosis Sprain

by Andrew Mills


A syndesmosis sprain is a sprain involving a syndesmosis joint. This is a type of joint where the edges of two bones are connected by thick connective tissue. These joints shouldn't be confused with the synovial joints which constitute the majority of joints in the body. Synovial joints are enclosed joints that contain a lubricating fluid known as synovial fluid.

The main syndesmosis joints in the body are the ankle syndesmosis that is next to the ankle synovial joint and the syndesmosis joint in the lower spine where the sacrum bone slots in between the pelvic bones.

The ankle syndesmosis connects the lower leg bones, the tibia and the fibula. A syndesmosis ankle sprain, also known as a high ankle sprain, is a type of injury common to athletes. It occurs when one or more ligaments connecting the bottom portion of the tibia and the fibula is injured due to either over-stretching or tearing. This type of ligament injury is quite severe, taking at least double the time to heal compared to a regular ankle sprain. Treatment options may even include surgery in the case of severe sprains.

Syndesmosis ankle sprains are thought to be caused by the wrenching of the foot upwards and outwards which is why they are common amongst athletes such as footballers and skiers. This results in the tearing or stretching of the connective tissue that form the ligaments. In minor strains, the ligament is stretched while moderate sprains involve the partial tearing of the ligaments. Severe syndesmosis ankle sprains are usually caused by a major tearing of the ligaments causing the tibia and the fibula to spread apart, a condition known as diastasis. Any of these sprains will weaken the ligament and affect the strength and functioning of the joint. The degree of weakness and the time it takes to recover will depend on the degree to which the ligaments have been damaged.

Symptoms of a syndesmosis ankle sprain include:

  • Mild to moderate syndesmosis sprains can cause pain and swelling in the outer region of the ankle, similar to the symptoms of an ordinary ankle sprain
  • An inability to put weight on the joint causes an inability to perform routine actions such as jumping or running
  • Instability in the ankle joint
  • A sharp pain when attempting to twist or rotate the foot
  • Pain that radiates upwards along the leg

In cases of mild syndesmosis sprains, the treatment is similar to that of ordinary ankle sprains and follows the P-R-I-C-E principle. This includes:

  • Prevention (P) - This calls for immobilizing the ankle to prevent further strain or injury to the joint. Most cases of ankle sprains are prone to re-injury making this an extremely important rule to abide by. In case you have to move - say to visit the bathroom, use a crutch so as to avoid putting pressure on the ankle.
  • Rest (R) - This principle calls for complete bed rest. This will allow the ankle time to heal without risking further damage that may occur if the joint is stressed.
  • Ice (I) - Applying a cold compress using an ice pack will help to constrict the blood vessels, curtailing blood flow to the area. This will lessen the swelling in the joint. Ice packs should be applied for 20 minutes at a time with a two hour gap between applications.
  • Compression (C) - An elastic bandage is wrapped tight around the ankle from the foot to the lower calf. The bandage should be tightest around the foot and should loosen as it travels up the ankle. Loosen the bandage slightly if you find your toes turning blue.
  • Elevation (E) - The foot should be kept elevated, preferably above the level of the heart. While sleeping, this can be accomplished by propping the ankle and foot up using a thick pillow or a rolled up blanket. While sitting, keep your foot horizontal, above the level of your pelvis.

Rehabilitation exercises to strengthen the ankle joint may be necessary depending on the severity of the sprain.

In cases of severe sprains, surgery may be required.

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