Ankle and foot

Syndesmotic injury (high ankle sprain)

Mechanism

Forced external rotation of the foot with dorsiflexion, in which the wider front of the talar trochlea drives the mortise apart. Typical in field sports and skiing.

Recognition

Tenderness high at the front of the ankle, above the joint line, while the lateral ligaments are clean. Positive external rotation stress test and squeeze test.

Course

Recovers considerably more slowly than a lateral ligament injury: expect two to three times as long. It is missed when you palpate laterally only, and that is the usual reason an ankle fails to improve.

Structures

• Tibiofibular syndesmosis and proximal/distal tibiofibular ligaments

Joints involved

• Distal tibiofibular syndesmosis (syndesmosis tibiofibularis)
• Ankle joint (talocrural joint)

Clinical tests

• External rotation stress test
• Calf squeeze test
• Fibular translation test

Sources

• Magee DJ, Manske RC. Orthopedic Physical Assessment, 7e editie. Elsevier. 2021