A ~30 year old female suffered an ankle sprain after being intoxicated and stepped off the sidewalk poorly.
Immediate referral to a new GP, which created a cascade of events including:
For the more astute clinicians or health practitioners, many would know that I’m immediately referring to a syndesmosis injury – otherwise known as a high ankle sprain. This case was poorly managed, as the follow-up with the doctor should have included further investigation. Especially because the ankle pain wasn’t resolving. Usually, recommendations should be made to see a physiotherapist before a doctor for most simple ankle sprains.
Unfortunately for this individual, had the right assessments been completed and monitored over weeks, a surgery would have been avoided. The individual would have been able to recover in a earlier time period and eventually would have returned to her daily gym and sport routine.
Epidemiological data suggests as many as 1-2 out of 10 people will suffer a syndesmosis ankle sprain (Williams & Allen, 2010). Although it’s an injury that largely occurs in athletic populations, there have been many cases – like the one above – where syndesmosis injuries happen in every day life.
The syndesmosis joint comprised of a few structures, primarily:
Basic outline of anatomy of the ankle syndesmosis.
In a syndesmosis sprain; we are worried about the connection between the two shin bones (tibia and fibula) being pushed apart. Disruption of the ligamentous structures holding these bones can cause the ankle to have excessive movement and mobility through the bones. This is extremely detrimental to all facets of life including walking, running and any form of lower limb exercises. Therefore, recommendations to stay away from excessive weight and pain is imperative, as it allows the ligaments to heal back into it’s natural positions.
Long-term complications including chronic ankle instability and recurrent ankle sprains can arise if this is not treated properly. Other long term complications can include chronic pain in the ankle, loss of strength and range of motion in the ankle.
Therefore, the following few symptoms are indicators you should get your ankle checked ASAP by a qualified health professional:
The following guidelines for recovery are based on the recommendations suggested by Williams & Allen (2010). These are only ‘guidelines’ and do not reflect the recovery that you or anyone else may experience. A host of individual factors can influence the speed in which you recover back to your baseline and must be considered in any injury.
Progression to next stage when: Able to fully put weight onto affected leg and walk stairs and uneven ground with minimal discomfort.
Progression to next stage when: Hopping and running has minimal discomfort.
Steadily build on your fitness and strength in the ankle, as well as progress your sport specific activities. When you are able to train pain-free and minimal discomfort, then a return to sport level activity should be warranted.
A few warning signs to be wary of include:
The recommendation to go to the emergency department or your local GP is emphasised. During this stage, you must rule out an ankle fracture otherwise this will have profound long term consequences on your recovery.
This specific ankle injury can potentially have serious consequences on your long-term ankle function. If you are unsure about the severity of your ankle sprain, please seek professional advice from a healthcare professional.
This blog post is intended to make the viewer aware that a more serious type of ankle sprain exists. Syndesmosis sprains cannot be managed like a ‘usual’ ankle sprain and can take longer to heal. The main messages for this post are to contact a medical professional if:
Like any other injury, syndesmosis sprains can heal. However, proper management and a structured rehabilitation program is necessary to make sure a favourable outcome is made.
