High Ankle Sprain. Syndesmosis Injury

High Ankle Sprain. Syndesmosis Injury

If you have ever rolled your ankle playing netball, football or even out running, you the frustration this can bring. But has it continued to happen? Even after a period of rest, does your ankle still feel weak? It may not be a simple ankle sprain. But rather a “syndesmosis” injury. Or more commonly known as a “high ankle sprain”.

So, what exactly is a syndesmosis injury? And do you need to be an elite athlete to suffer one? The answer is a BIG NO. In fact, those of us with “weak ankles” or those that constantly roll their ankles are at a greater risk of injuring this structure. 

Generally, we roll our ankle outwards and injure the ligaments on the outside of the ankle. But, in more severe injuries the ligamentous damage is so significant that the high ankle remains unstable and unable to tolerate full weight-bearing activity due to the separation of the bones (a disruption to the syndesmosis) and surgery may be required.

Ankle Sprains

If you often experience rolling your ankles or experience regular ankle pain. Ask your medical practitioner if you have suffered a high ankle sprain or a syndesmosis injury! 

What is a syndesmosis ankle sprain?

The syndesmosis is the name of the ligament that connects two bones of the leg, the tibia and the fibula. If this structure is damaged, the ankle can become unstable. In comparison to the more common lateral ankle sprain, the high ankle sprain causes pain closer to the ankle joint and is more frequently associated with significant injury or trauma

It is essential for those who suffer an ankle sprain to undergo specific tests to ensure the integrity of the syndesmosis.


High Ankle Sprain. Syndesmosis Injury

How does a high ankle sprain occur?

A syndesmosis or high ankle sprain injury generally occurs in conjunction with any of the other usual ankle injuries. These include sprains/strains and fractures. 

We generally see this type of injury occurring when our foot is twisted outwards forcefully, or as in many sports which require a quick change of direction ( think Netball, Football or Soccer)  the foot is planted and forcibly twisted inwards. 

If the syndesmosis is injured and left untreated the ankle may remain unstable. This may also lead to further problems down the road. Problems such as long-term instability, frequent “rolling of the ankle” and scarring of the outside ligaments. 


What are the symptoms of a high ankle sprain?

  • Pain – generally above the ankle or calf
  • Calf pain
  • Pain on weight-bearing, pain with each and every step
  • Laxity of the ankle complex. 
  • Swelling


How is a syndesmosis injury diagnosed?

A thorough history of the mechanism of injury is essential. Then a specific clinical assessment of your ankle and its surrounding ligaments, joints and muscles. In athletes suffering from pain or injury around the ankle or lower leg, clinicians should consider the possibility of syndesmotic injury.

If a syndesmosis injury is suspected, your therapist may request a weight-bearing X-ray or CT scan to confirm this diagnosis.

Treatment differs from that of typical ankle sprains, and surgery may be required, making early detection critical for optimal recovery.



Can an osteopath help with a high ankle sprain?

Osteopathic treatment can help in the early diagnosis of this type of injury. We aim to restore proper joint mobility, and muscle function,  allowing for a healthy recovery of the ankle. The intervention of an osteopath is critical for the effective healing of the joint and, more importantly, for minimising the risk of recurrence.

An osteopath will apply gentle techniques that are appropriate for the severity of the sprain.

In addition, an osteopath will look into whether the sprain has affected other postural biomechanics.


An osteopathic approach to high ankle sprains

1. Protect your injury

Initially, each step you take can further aggravate the high ankle injury. So, protecting the injured structures is vital. A moon boot or crutches is often used to completely offload your foot and ankle.


2. Restoring range of motion and balance

Allowing the injured ligaments to heal naturally and form scar tissue is the next step. During this phase of healing, it is important to ensure the scar tissue is directed in the right way. Ensuring your proprioception or balance is essential. This is your body’s internal GPS system. If your brain doesn’t know how to control your foot landing properly on the ground, you are at a higher risk of reinjuring the joint. Too often this step is overlooked, resulting in repeated ankle rolls and further injury.


3. Restoring muscular strength and progressing balance

Giving your ligaments time to heal conservatively requires time. During this period, you may lose some muscular strength. It is vital to regain this strength at a later stage. The power of movement comes from muscles and joints working together – without this coordination between bones and ligaments an individual will never achieve their full potential as an athlete.


4. Return to sport

Once you have regained your muscular strength and balance, you may return to sport-specific exercise. Specific focus on factors such as speed, change of direction and jumping is assessed and implemented.

So, as you can see it’s a long road back from what can seem like a simple ankle sprain. This whole process can take anywhere from 2-4 months.

Achieving ankle stability is important for preventing injuries. This means getting the right progressive exercise program and guidance to help you get back into activity safely without any chronic instability issues.


How long does it take to heal from a high ankle sprain?

This all depends on the severity of your injury and what else is injured.

We generally look at approximately 6-8 weeks to return to play. 

If there is a fracture of the ankle bones or your ankle is unstable, this adds another layer of complexity. Not all fractures need surgery, but a correct diagnosis and understanding of what other structures have been impacted is essential.

Assuming you don’t require surgery – it is vital this high ankle injury is treated effectively to prevent chronic and repeating injury in the future. Because the ankle absorbs a large amount of force during our lives – think running, jumping, changing direction, it is important that this structure is stable.


High Ankle Sprain. Syndesmosis Injury


Final thoughts on high ankle sprain

Equilibrium Sports and Spinal Osteopaths are here to help you regain your ankle stability. If you think you may have a high ankle sprain, or repetitively roll your ankles, perhaps we can help you get back on track. 

Our osteopaths service Malvern, Glen Iris, Ashburton, Hawthorn and Caulfield. 


Book online today, and let us help you turn your weak, unstable ankles into a thing of the past! 

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