Ankle Syndesmosis Injuries | Expert Physio Overview

In this tutorial, we use our 3D anatomy model to show you the anatomy of the ankle and syndesmotic ligaments to explain how they can be injured, how they can be diagnosed and how to treat in practice.

References:

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*Sports Series: Ankle Ligament Injuries Webinar
*Common Ankle Conditions Q+A Webinar
*Differential Diagnosis of the Ankle Webinar

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[rhoadesian]

Informative thank you. I recently fractured my distal fibula and rupture my pitfl. I needed surgery to fix it.

[gregorya]

Two weeks ago I tripped down a gutter. Right ankle rolled like you described.

The paramedic described it as an “inversion injury” and the hospital kept this description. My doctor updated it to an “eversion injury” when I described it to her.

The result was an Avulsion fracture medial malleolus - and after a further xray a Proximal fibular fracture.

Apparently this small twist ricocheting up the leg to break the top of the fibula is a strong indicator of sydnesmotic injury - an MRI confirmed this, and I’ve had surgery Thursday to tie the tibula and fibula together.

Seems a complicated injury. All focus is on the syndesmotic injury, nothing on the ankle or fibula - apparently the Fibuka is only mildly displaced so it will heal on its own. I got DVT too.

The biggest problem for me now is that the advice I’m given assumes a high ankle sprain, and contradicts advice for Fibula fracture and DVT. Makes it hard to manage.

I’m learning. Appreciate your video. I’m not an athlete, just a 51yo teacher who didn’t look where he was stepping.

[realjay]

Brilliant video and clearly presented. Thank you, I now have more knowledge on how to recognise and treat this type of injury.

[leximorales]

I tore mine two years ago, and it was initially diagnosed as a sprain.

[Grace_]

I injured my syndesmosis and got a close bimalleolar fractured dislocation, and I did this by just falling off a skateboard and it’s commonly the back foot that lands and then gets injured I needed an ORIF surgery and a hardware removal surgery to get me walking again. I’m still recovering from the removal of syndesmosis screws

[themitchgraham]

This is so helpful - I start a new role soon in foot and ankle and this is brilliantly explained- you little lifesaver - thanks so much 🙏🏻 🇬🇧

[labelle]

Hi Khalid, what an unbelievable video. You have helped me so much, thanks a lot!!

[robs]

Have two anchors (syndesmosis) from my tib to fib from a platform fracture ORIF, thankfully they are coming out because they were suppose to break and allow more flex

[Hammer.J.Helmer]

​ @ClinicalPhysio I had a Weber C fracture, and the dr says that means I must have also torn my syndesmosis and deltoid ligaments. I had surgery to repair the broken fibula, as well as open reduction and internal fixation screwing my tibia and fibula together. The ligaments were NOT repaired through surgery. The dr says that because of the ORIF surgery that they will heal on their own over time. Is this true?

[omarabdo]

If there is fracture then it is type 4 ??

[danielward]

What about grade four😭 so frustrating cannot find anything out there for someone who’s went through tight rope fixation and aims to return to sport. Struggling with dorsiflexion and no one can give me any ideas on how to improve it other than general mobility and knee to wall exercises! So so frustrating

[mohammedramzi]

Hello,
I hope u're fine and doing okay.
Please if u may help understand my case, lately ( this past 8 months ), i've been dealing with pain in my right rib cage+ tightness and pain in the right side of my neck+ problems with my trachea+ twisted and rotated pelvis ( i'm not sure if it's rotation or a lateral tilt). I'm tired of searching for the main diagnosis and treatment.
I can't afford to go see a specialist so can u please help me?!

[befitwithbrigita]

Thank you, this helped me with the clinical conference ;)

[TutWichmach]

Hi Khalid, thanks a lot for the work you are doing, am PT student in Ethiopia. i am suffering for lower back pain for one year duration and my x ray result show that i do have a schmorl' s node, i hade try some exercise but no help, what do you think i have to do next?.

[jeza]

Hi, do you have a clinic where you provide treatment?

[eduardowong]

Hi, great video! I was wondering what app did you use for the 3d anatomy

[alejandroarias]

Hi. My name is Andrew (I was in med school for a couple years and then had to quit for many reasons so if I call something on my knowledge it comes from there, I’m not a doctor so I may be wrong, please excuse me and feel free to correct me)

I had grade 3 syndesmosis injury almost 2 months ago. The pain was incredibly terrible and I’ve had ankle injuries before due to sports but after two weeks it didn’t seem to be healing properly.
Also I may add that the space between my first two toes was numb, with time I’ve recovered the sensitivity in it, but it still feels funny. (I am assuming I somehow damaged the deep fibular nerve)

My injury was a trauma due to fall, I fell on another’s person foot and my feet had a sudden and very violent inversion (as most ankle rolls)

The Xray revealed I had an avulsion fracture the size of a needle head in the tip of the fibula.
Doctors said that was gonna hurt for a while but they couldn’t do anything about that and it would heal by itself, same as the lower ankle ligaments, they would heal by themselves.

They said I needed fixation surgery because of the syndesmosis, and the plan is 12-14 weeks of non-weight bearing after the surgery with a boot 24/7 only allowed to take it out in the shower.
After that, another surgery to take the screws out, followed by rehab training

A month after the surgery I got cleared to do physical activity as long as it didn’t involve my leg so still non-weight bearing.

My concerns/questions are…
I am really feeling the desire of walking on my feet. The pain is gone and I haven’t tried to move my ankle at all, I want to go back to sports and to my normal life so, what can I do to help the healing process during this non-weight bearing time?

And also what can I do to have a great rehab and stronger ankles after they take the screws out?

Also I feel like 12-14 weeks of absolute no use of the leg is crazy, isn’t it too much? I am at 6 weeks so far and feel like I count start doing some crutch walking or something.

Is the funny feeling of the DFN innervation something I should be concerned about?

This was a great video, very useful and complete.
Thank you.

[bretoner]

I had a grade 4 syndesmosis injury. I'm still not great on my feet now

[karinapeterson]

Would this typically show up with bruising or swelling? My ankle is sprained with the calcaneus and talus ligaments but no bruising or swelling

[blryze]

I’ve had an Syndesmosis Injury back in december 2021 and it’s healed a little bit but I still have very bad dorsiflexion and external rotation, Its been very long and nhs take long too do everything and I just want to get back to football💔.