What is an ankle syndesmosis injury?
The ankle syndesmosis connects the tibia and fibula which form the top part of the ankle joint. It is comprised of the anterior inferior tibiofibular ligament (AITFL), interosseous ligament and posterior inferior tibiofibular ligament (PITFL). These ligaments are essential in contributing stability to the ankle mortise. Injury to the ankle syndesmosis can lead to instability and abnormal loading through the tibiotalar articulation which in turn, can cause premature arthritis or ‘wear and tear’ of the smooth lining of the ankle joint
What are common symptoms associated with an ankle syndesmosis injury?
Ankle syndesmosis injuries can occur in isolation or be associated with an ankle fracture. The most common mechanism is an external rotation force of the foot. Typical injury patterns include a fracture of the distal fibula above the level of the ankle joint (Weber C fracture), or a fracture through the proximal fibula (Maisonneuve fracture). Patients with a pure ligamentous injury typically report pain and swelling of their ankle or lower leg which is aggravated with weight-bearing. For patients with a chronic or occult syndesmosis injury, they can present with pain which is only brought on with impact-loading activities or increased loading through their ankle joint, such as during jumping or running
What are the management options for an ankle syndesmosis injury?
The management of an ankle syndesmosis injury can depend on multiple factors, including the presence of displacement/instability, the injury pattern and/or the extent of the ligamentous injury. For acute injuries, it is recommended that you remain non-weight-bearing through your injured ankle until you have sought specialist advice. Non-operative treatment for an undisplaced and stable ankle syndesmosis injury normally warrants immobilisation and offloading of the injured limb in a below-knee backslab/cast and/or a controlled ankle motion (CAM) boot. Surgical stabilisation is indicated for displaced or unstable ankle syndesmosis injuries to reduce the risk of post-traumatic arthritis. Methods of syndesmosis ligament stabilisation include with screws, a suture button implant and/or suture tape reconstruction using suture anchors.
What is the recovery after surgical stabilisation of my ankle syndesmosis?
After your ankle syndesmosis stabilisation, you will likely require a period of weight-bearing restriction through your injured ankle and offloading in a CAM boot for up to 12 weeks. You will need to wear your CAM boot when ambulating only, and will be instructed to do early ankle and foot range of motion and stretching exercises to reduce your stiffness. Once your surgical dressings have been removed after 2 weeks and your wounds are healed, you will also be encouraged to desensitise your surgical scars by massaging your wounds with a moisturising cream/oil, and to start exercising in the swimming pool or doing hydrotherapy. For most patients, it will take 2-3 weeks for your wounds to heal, 3-4 months for your ligaments to regain their functional strength, 6-7 months before you are reasonably comfortable jogging again, and up to 12 months for the swelling in your ankle to subside and for full recovery to your new baseline level.