Ankle syndesmosis injury
An injury to the ligaments connecting the tibia and fibula above the ankle. The syndesmosis helps stabilize the ankle and the injury is often called a high ankle sprain.
Milder syndesmosis injuries may cause pain above the ankle, particularly with rotation or loading. Swelling may be limited.
The syndesmosis is often injured when the foot is forced outward while the ankle is loaded. In football, this can occur during tackles, landings or when the foot is caught in the ground while the body continues to rotate.
Common situations
- •External rotation of the ankle under load
- •Tackle or collision
- •Landing with the foot in an awkward position
- •The foot becoming stuck in the ground while the body rotates
Good ankle and leg strength together with balance and control training may improve the ability to handle loading and changes of direction.
- •Train calf and ankle strength
- •Develop balance and single-leg control
- •Practice landings and changes of direction
- •Increase load gradually after previous ankle injuries
Stop football activity and avoid movements that provoke pain. Reduce load as needed and have the injury assessed if pain persists or there is significant tenderness above the ankle.
Symptom control and mobility
Control pain and swelling and restore ankle mobility.
Goals
Normal walking and improved ankle function.
Progression criteria
Able to walk and load the ankle without significant worsening.
Strength and control
Progressive training of the calf, ankle and single-leg control.
Goals
Restore strength and stability.
Progression criteria
Able to perform calf raises, balance exercises and gradual running without significant pain.
- Minimal or no swelling
- Good ankle range of motion
- Adequate calf and ankle strength
- Able to tolerate running and changes of direction
- No significant pain above the ankle during football-specific loading
The information in the Injury Center is for educational purposes and does not replace professional medical advice. Always consult a qualified healthcare professional for diagnosis and treatment.
Ankle syndesmosis injury
An injury to the ligaments connecting the tibia and fibula above the ankle. The syndesmosis helps stabilize the ankle and the injury is often called a high ankle sprain.
Mild — Lättare skador kan kräva flera veckor. Syndesmos-skador tar ofta längre tid än vanliga laterala fotledsstukningar.
Symptoms
Milder syndesmosis injuries may cause pain above the ankle, particularly with rotation or loading. Swelling may be limited.
Acute Treatment
Stop football activity and avoid movements that provoke pain. Reduce load as needed and have the injury assessed if pain persists or there is significant tenderness above the ankle.
Rehabilitation
Control pain and swelling and restore ankle mobility.
Goals
Normal walking and improved ankle function.
Progression criteria
Able to walk and load the ankle without significant worsening.
Progressive training of the calf, ankle and single-leg control.
Goals
Restore strength and stability.
Progression criteria
Able to perform calf raises, balance exercises and gradual running without significant pain.
Return to Play
- ☐ Minimal or no swelling
- ☐ Good ankle range of motion
- ☐ Adequate calf and ankle strength
- ☐ Able to tolerate running and changes of direction
- ☐ No significant pain above the ankle during football-specific loading
Moderate — Måttliga syndesmos-skador kan kräva flera veckor till några månader beroende på stabilitet och omfattning.
Symptoms
More pronounced pain above the ankle, swelling and reduced load tolerance may occur. Pain may increase with rotation and push-off.
Acute Treatment
Stop football activity and reduce loading. Medical assessment is recommended because syndesmosis injuries can be more extensive than they initially appear.
Rehabilitation
Loading is adjusted according to pain and stability while mobility and basic function are restored.
Goals
Reduce symptoms and restore normal walking.
Progression criteria
Able to load the ankle during daily activities without significant worsening.
Progressive strength, balance, running, jumping and changes of direction.
Goals
Restore full load tolerance for football.
Progression criteria
Able to tolerate football-specific movements without pain or post-exercise reaction.
Return to Play
- ☐ Good range of motion
- ☐ No significant swelling
- ☐ Adequate calf and ankle strength
- ☐ Good single-leg and balance control
- ☐ Able to tolerate running, jumping and changes of direction
- ☐ No significant pain above the ankle
Severe — Allvarliga eller instabila syndesmos-skador kan kräva flera månader, särskilt om kirurgisk behandling behövs.
Symptoms
Severe injuries may cause significant pain, marked swelling and a clear inability to bear weight. Instability between the tibia and fibula may occur.
Acute Treatment
Stop all sports activity and seek medical assessment. Suspected unstable syndesmosis injuries may require imaging and specialist assessment.
Rehabilitation
The stability and extent of the injury are assessed. Loading is adapted and early rehabilitation focuses on mobility and basic function.
Goals
Protect the injury and restore basic function.
Progression criteria
Good function and sufficient healing for progressively increased loading.
Strength, balance, running, jumping and changes of direction are progressively rebuilt.
Goals
Restore full stability and load tolerance.
Progression criteria
Able to complete relevant functional testing and tolerate full football-specific loading without pain or instability.
Return to Play
- ☐ Good range of motion
- ☐ No significant swelling
- ☐ Adequate strength and control
- ☐ Good balance and single-leg function
- ☐ Able to tolerate jumping, running and changes of direction
- ☐ Medical assessment and individualized return-to-play plan
When to Seek Medical Care
Syndesmosis injuries should be medically assessed after significant trauma, marked pain above the ankle or difficulty bearing weight.
- Significant pain above the ankle
- Difficulty bearing weight
- Significant swelling
- Pain with external rotation of the foot
- Persistent symptoms despite reduced loading
References
- Syndesmosis and high ankle sprain — American Academy of Orthopaedic Surgeons (https://orthoinfo.aaos.org/)