High Ankle Sprain. Syndesmosis Injury

ankle sprain

For those following the return to AFL of Nic Naitanui would be happy to hear his ACL is doing fine. His ankle on the hand is NOT. He suffered a “syndesmosis”  injury over the weekend a “high ankle sprain”. Which may end his season. 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 that constantly roll their ankles are at a greater risk of injuring this structure. 

Generally we roll our ankle outwards and injury 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.  If you often experiencing roll your ankles. Or experience regular ankle pain. Can I suggest you seek help. Ask your therapist about the chance you have suffered a high ankle sprain or a Syndesmosis injury! yankle sprain

What is the Syndesmosis?

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 becomes an unstable structure. It is essential those who suffer an ankle sprain that specific tests are carried out to ensure the integrity of the Syndesmosis.

How does a High ankle Sprain Occur?

A Syndesmosis or high ankle sprain injuries generally  occur in conjunction with any of the other usual ankle injuries. These includes sprains / strains and fractures.  We generally see this type of injury occurring when our foot is twisted outwards forcefully, or as in Nic Naitanui injury – his foot was planted and forcibly twisted inwards. 

(footage Courtesy of 9 News)

If the syndesmosis is injured and left untreated the ankle may remain an unstable. This may also lead to further problems down the track. Problems such as long term instability. 

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 or your ankle and its  surrounding ligaments, joints and muscles. If a Syndesmosis injury is suspected, your therapist may request a weight bearing X-ray to CT scan to confirm this diagnosis.

How long will I be on the sidelines for?

This all depends on the severity of your injury and what else is injured. Nic Naitanui and West Coast Eagles are hoping he will be back by finals – about 5 weeks away. This time frame is a little optimistic. We generally look at about the 6-8 week return to play. But thats for us weekend warriors, Not the leading ruckman for a team sitting in 4th spot! 

If there is a fracture of the ankle bones or your ankle is unstable, generally Surgery is a likely outcome. 

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

The goals of your treatment would be:

  • Protect your Injury:

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

  • Restoring Range of Motion and Balance.

Allowing the injured ligaments to heal naturally and form scar tissue is the next step. During the phase of healing it is important to ensure the scar tissues is orientated in the right direction. Ensuring your proprioception or balance is a major focus. Too  often this step is overlooked, resulting in re occurring ankle rolls and further injury.

  • Restoring Muscular Strength and progressing Balance

Giving your ligaments time to heal and reattach conservatively requires time. During this time you may loose some muscular strength. It is vital, at the right time to regain this strength. Strength with give control and function to the ankle. Essential for long term health.

  • Return to sport

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

So as you can see its a long road back from what can seem like a simple ankle sprain. This whole process can take anywhere from 3-6 months.

Getting the right exercises, the right time frame, and guidance will all help return you to your activity safely. With a reduced likelihood of chronic instability.

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!  

Any Questions?

Feel free to email us at [email protected] .We are also more than happy to chat via our blue Drift Chat box in the bottom right hand corner. 


Ask Our Osteo

Equilibrium Sports and Spinal Clinic Logo Glen Iris


Your comprehensive guide that covers everything from the basics of back pain to tips for keeping your spine healthy.

Striving to make you feel better today, than you did yesterday!

Book online now to find a time that works for you. 

Equilibrium Sports and Spinal Clinic Logo Glen Iris


You’re one click away from obtaining your Back Pain Bible. We have also sent you a copy through your email.

Download E-book
Equilibrium Sports and Spinal Clinic Logo Glen Iris


Your comprehensive guide that covers everything from the basics of back pain to tips for keeping your spine healthy.