A syndesmosis injury, commonly known as a high ankle sprain, is a significant injury often seen in Australian Rules Football (AFL). Unlike a typical ankle sprain that affects the ligaments on the outside of the ankle, a syndesmosis injury involves the strong ligaments that connect the tibia (shin bone) and fibula just above the ankle joint. These ligaments help keep the ankle stable during running, jumping, and changes of direction.
In AFL, syndesmosis injuries usually occur when a player’s foot is firmly planted on the ground and the body twists, often during a tackle, landing, or rapid change of direction. The injury can cause pain above the ankle, difficulty walking, and discomfort when pushing off, running, or pivoting. Swelling may be less obvious than with a standard ankle sprain, making the injury more difficult to recognise initially.
The key difference between a syndesmosis injury and the more common ankle sprain is the effect of weight-bearing. A normal lateral or medial ankle sprain can tolerate weight-bearing without significantly stressing the injured ligaments. However, with a syndesmosis injury, putting weight through the ankle stresses the injured ligaments that hold the tibia and fibula together. This is both painful and disruptive to the healing process.
Diagnosis is typically made through a clinical examination by a physiotherapist, often in conjunction with a sports doctor, and may be confirmed with imaging such as an MRI scan. Early diagnosis is important because untreated syndesmosis injuries can lead to ongoing pain, ankle instability, and a delayed return to sport.
Treatment depends on the severity of the injury. Mild cases may be managed with rest, immobilisation, physiotherapy, and progressive rehabilitation. More severe injuries, where the ankle joint becomes unstable, may require surgery to restore normal joint alignment.
Severe cases often involve injury to the bone, either the tibia, the fibula, or both, which can make treatment and recovery more complex.
Strapping works extremely well for lateral and medial ankle sprains because it can help control the rolling movements of the ankle. It is far less effective for syndesmosis injuries, as it must hold the tibia and fibula together during weight-bearing, which occurs with every step.
Recovery can take anywhere from several weeks to several months. A carefully planned rehabilitation program focusing on strength, balance, and sport-specific activities is essential to ensure a safe return to sport and reduce the risk of re-injury.
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