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  • E-Young Khoo

The 'Up Yours' Ankle Test

What is the syndesmosis?

The Syndesmosis is made up of 4 ligaments in the ankle: the anterior inferior tibiofibular ligament, posterior inferior tibiofibular ligament, transverse tibiofibular ligament, interosseous membrane. It is responsible for keeping the 2 bones (fibula and Tibia) together for stability in the ankle.

How Syndesmosis injuries occur:

- Syndesmosis injuries or a high ankle sprain usually occur when the foot is trapped, forced in an upward and/or outward direction. In severe cases, a fibula fracture can occur.

- Examples of syndesmosis injuries usually occur in contact sports such as NRL (hip drop tackle) and sports where there is a boot immobilisation such as skiing.

- A person is considered to have a greater risk of a syndesmosis injury if they have had previous ankle ligament tears.

Symptoms of a Syndesmosis Injury

- Pain in the ankle when putting weight on affected leg

- Swelling on outside of the ankle

- Hearing a pop or crack when the injury occurred

- Difficulty walking

- Pain on the front and inside of the ankle

How its treated:

Grade 1 injuries are usually treated non-surgically. Patients would be placed into a immobilisation boot for 2 weeks and be on crutches for that period. Over the next 4 weeks, the boot will be weaned off and be replaced with a stirrup brace.

Grade 2 and 3 injuries usually require surgery due to the instability of the injury. Surgeons would perform either a tightrope or fixation screw surgery on the ankle to regain such stability. Following surgery, patients will be in a boot and crutches for 2 weeks, before it is weaned off.

Tightrope vs Fixation screw:

- There has been a recent shift towards tightrope surgery due to the fact that none required a 2nd surgery for hardware removal compared to 75% of patients who went with screw fixation. Patients who chose tightrope surgery also returned to sport/work on average a week earlier.

Why Physio and What will a physio do:

- Physiotherapy is needed after such an injury to assist with the recovery process.

- In the early stages, the goal is to reduce inflammation and pain, whilst restoring your ROM.

A physiotherapist will assist in prescribing ROM exercises, whilst also providing hands on treatment to assist in the reduction of inflammation and pain.

- In the 2nd stage, the goal is to improve the strength around the ankle. A physio will prescribe strengthening and proprioception (control) exercises to assist you in this goal, whilst also maintaining hands on treatment to help maintain ROM.

- The last stage of the treatment aims to return you to a pre-injury functional status. A return to run protocol, followed by a return to sport protocol if required will be drafted to help return you to your goals. In this stage, a physio would progress you through the stages of a return to run protocol as needed. A return to sport protocol will also be drafted to help you return to the sport which you desire to get back to. This would also involve sport specific drills.

Recovery times

- Most patients will require 2-6 months to fully recover from such an injury

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