High Ankle Sprain and Syndesmosis Injury Treatment in Atlanta
A high ankle sprain injures the syndesmosis—the strong ligaments that hold the tibia and fibula together above the ankle joint. The most important task is determining whether the ankle is stable and what other ligaments or fractures occurred with the injury.
What Is the Ankle Syndesmosis?
The syndesmosis is the ligament complex that connects the tibia and fibula just above the ankle. It keeps the ankle mortise properly aligned while the talus moves within the joint.
A high ankle sprain usually occurs when the foot rotates outward relative to the leg. Pain is commonly felt above the ankle rather than directly over the outer ankle ligaments involved in a typical low ankle sprain.
The Associated Injuries Matter Most
A syndesmosis injury may be isolated, but it may also occur with a lateral malleolus fracture, medial malleolus fracture, posterior malleolus fracture, deltoid ligament injury or a more complex ankle fracture-dislocation.
Treatment depends on the entire injury pattern. The key question is not simply whether the syndesmosis is torn—it is whether the ankle remains stable and correctly aligned.
How High Ankle Sprains Occur
Syndesmosis injuries range from isolated ligament sprains to complex fracture patterns.
Isolated High Ankle Sprain
The syndesmosis may be injured without a visible fracture. Some isolated injuries remain stable and can heal without surgery, while others widen under stress and require fixation.
Ankle Fracture With Syndesmosis Injury
Certain fibula, medial malleolus and posterior malleolus fractures can disrupt the syndesmosis. The fracture and syndesmosis must both be assessed.
Maisonneuve Fracture
A Maisonneuve injury includes syndesmotic disruption with a fracture higher up the fibula near the knee. The ankle may hurt much more than the upper leg, so the entire fibula must be examined.
We Evaluate the Entire Injury Pattern
The syndesmosis cannot be evaluated in isolation. We examine the ankle, the medial ligaments, the full length of the fibula and the knee area when the mechanism or examination raises concern for a Maisonneuve fracture.
Standard X-rays, stress views, full-length tibia and fibula films, CT or MRI may be used depending on the injury. The goal is to determine whether the tibia and fibula remain properly aligned around the talus.
Stress X-Rays May Be Needed to Make the Diagnosis
Standard ankle X-rays may appear normal even when the syndesmosis is unstable. In selected cases, stress X-rays are performed in the office to apply controlled force across the ankle and look for abnormal widening.
Stress views can be somewhat uncomfortable because the injured ligaments are being tested, but the discomfort is brief. These images can provide important information about whether the ankle is stable enough for nonsurgical treatment or whether fixation is needed.
Stable Syndesmosis Injury
A stable high ankle sprain without fracture displacement or abnormal widening can often be treated without surgery.
Protection and Weight-Bearing Plan
A boot, crutches and temporary limitations on weight bearing may be used depending on pain and injury severity.
Physical Therapy
Rehabilitation restores motion, strength, balance and controlled rotation before running, cutting or contact sports resume.
Longer Recovery Than a Low Sprain
High ankle sprains frequently take longer to recover because the syndesmosis is stressed with twisting and push-off during walking and sports.
Unstable Syndesmosis Injury
Surgery is generally recommended when stress imaging or the fracture pattern shows that the tibia and fibula are separating or the ankle mortise is unstable.
TightRope Versus Syndesmotic Screws
Both are accepted methods of stabilizing an unstable syndesmosis.
Suture-Button or TightRope Fixation
A suture-button construct provides strong stabilization while allowing limited physiologic motion between the tibia and fibula. The implant often does not need to be removed.
Syndesmotic Screw Fixation
Screws provide rigid stabilization and may be especially useful in selected fracture patterns. Depending on the implant, symptoms and surgeon preference, screws may be left in place or removed later.
Outcomes Are Usually Very Good
When the injury is recognized, the fractures are restored and the syndesmosis is reduced accurately, outcomes are generally very good. Stable injuries typically heal with protection and rehabilitation, while unstable injuries generally do well after appropriate fixation.
Recovery depends on whether the injury was isolated or occurred with a fracture, how long weight bearing must be limited and the patient's athletic or occupational demands. Return to sport requires restored motion, strength, balance and confidence.
Do Not Miss Pain Higher Up the Fibula
An ankle injury with pain or tenderness near the outside of the knee may represent a Maisonneuve fracture. Patients with inability to bear weight, major swelling, deformity, medial ankle pain, pain above the ankle or tenderness along the upper fibula should receive prompt orthopedic evaluation and appropriate imaging.
High Ankle Sprain and Syndesmosis Care in Atlanta
Atlanta Bone and Joint Specialists evaluates isolated high ankle sprains, fracture-associated syndesmosis injuries and Maisonneuve fractures for patients from Atlanta, Decatur, Snellville, Loganville and surrounding communities. We use the complete injury pattern and ankle stability to determine whether treatment should involve protection and therapy or surgical fixation with a TightRope, suture-button construct or screws.
This page provides general educational information and does not replace an examination or individualized medical advice. Treatment and recovery depend on ankle stability, fracture pattern, associated ligament injury and patient activity demands.