What is Syndesmotic Sprain or Syndesmotic Ankle Sprain (SAS)?

A Syndesmotic Sprain or Syndesmotic Ankle Sprain (SAS) is a condition where there is injury or damage to the syndesmotic ligaments which hold the ankle, tibia and fibula together. As the injury occurs in the upper part of the ankle, it is called as syndesmotic sprain or syndesmotic ankle sprain (SAS). The anterior tibiofibular ligament is the commonly injured ligament. Syndesmotic sprain or syndesmotic ankle sprain (SAS) can also occur with fracture of tibia or fibula.

Syndesmotic Sprain or Syndesmotic Ankle Sprain

Syndesmotic sprain or syndesmotic ankle sprain (SAS) is a more serious injury than the lateral ankle sprain and can be difficult to treat. The common causes of this injury are twisting and inversion movements. This injury is more common in people who are active in sports.

Classification or Stages of Syndesmotic Sprain or Syndesmotic Ankle Sprain (SAS)

Classification of syndesmotic sprain or syndesmotic ankle sprain (SAS) is based on the following:

  • Grade 1 or Stage 1 Syndesmotic Sprain or Syndesmotic Ankle Sprain: A mild pain is usually there. A minor tearing might be there with the ligaments being somewhat stretched. It will be difficult to work due to a minimal pain in the joint.
  • Grade 2 or Stage 2 Syndesmotic Sprain or Syndesmotic Ankle Sprain: It will be difficult to work owing to due to pain and instability of the joint. There will be pain that is moderate and severe sometimes, stiffness, swelling and also bruising.
  • Grade 3 or Stage 3 Syndesmotic Sprain or Syndesmotic Ankle Sprain: This type of sprain of the ankle is the most severe. Swelling that is moderate to severe swelling, extensive bruising, and pain that is severe are some of the symptoms likely to occur. The instability caused is due to total rupturing of the ligaments and symptoms in future are a possibility.

Stages of Syndesmotic Sprain or Syndesmotic Ankle Sprain (SAS)

An X-ray will be recommended in more severe injuries that are bone related so as to ascertain the likelihood of a fracture.

What is the Difference Between a High Ankle Sprain (Syndesmotic Sprain Or Syndesmotic Ankle Sprain (SAS)) and Low Ankle Sprain?

An injury that extends to the lower part of the leg is syndesmotic sprain or syndesmotic ankle sprain (SAS). Inability to push off will result, and it will be compounded by pain that is so severe. These injuries may demand that you do not move for months due to its difficulty to treat and heal. Surgery is mandatory for syndesmotic sprain or syndesmotic ankle sprain (SAS).

The difference between a low ankle sprain and a high ankle sprain is the particular structures that are affected and how the injury occurred. When the ligaments that are either on the inside or in the outside are damaged when the ankle is either inverted (rolled) or averted an ankle sprain occurs. When there is a forced hyper-plantar flexion or hyperdorsiflexion or an external rotation, high ankle sprain can occur. The tibiofibular syndenesmosis (a sheet that is fibrous between the bones of the two legs, will be injured due to this motion. (R.I.C.E) that is, rest, ice, compression and elevation can be used to treat both ankle sprain initially.

Causes of Syndesmotic Sprain or Syndesmotic Ankle Sprain (SAS)

Causes of Syndesmotic Sprain or Syndesmotic Ankle Sprain (SAS)

Rotational injuries cause syndesmotic sprain or syndesmotic ankle sprain (SAS) just like an ankle fracture. Impact sports are common avenues. The tears are commonly ceased by the rotation towards the outside from the leg (external rotation).

  • Outward twisting of the ankle commonly occurring in extreme physical sports such as wrestling, soccer, ice hockey and running.
  • Individuals who lead sedentary life and become abruptly active are more prone to this injury.

Symptoms of Syndesmotic Sprain or Syndesmotic Ankle Sprain (SAS)

Signs and Symptoms of Syndesmotic Sprain or Syndesmotic Ankle Sprain (SAS)

It will difficult for the athlete to walk and pain will result when ankle is dorsi flexed with the foot and toes and when it is rotated.

The anterior tibiofibular is the ligament that is commonly injured when a syndesmotic sprain or syndesmotic ankle sprain (SAS) occurs. The membrane that connects the fibula and the tibia called syndesmosis can be damaged due severe injuries. Following are some of the noticeable signs and symptoms of Syndesmotic Sprain or Syndesmotic Ankle Sprain:

  • Pain upon palpation of the ankle.
  • Pain upon walking.
  • Swelling is present at the anterior and external side of the ankle.
  • Bruising is present at the anterior and external side of the ankle.
  • Pain upon rotation and dorsiflexion of the ankle together.

Risk Factors for Syndesmotic Sprain or Syndesmotic Ankle Sprain (SAS)

Syndesmotic Sprain or Syndesmotic Ankle Sprain (SAS) risk factors include:

  • Participation in sports. Syndesmotic Sprain or Syndesmotic Ankle Sprain are common injuries in sports. Vulnerability of spraining the ankle can be elevated by sports like soccer basketball, tennis, and trail running which requires rolling. Those who are overweight are at more risk and engaging in sports on grounds that are not flat.
  • Prior injury on the ankle. The probability of syndesmotic sprain or syndesmotic ankle sprain (SAS) is high if have a history or another injury of the ankle.

Complications for Syndesmotic Sprain or Syndesmotic Ankle Sprain (SAS)

Your ankle can be stiffened. The nerve called superficial peroneal which provides for sense on top of the foot will be damaged if surgery is performed or infection can result. At the point where the incision is made, it is the outer part of the leg where the nerve runs. Infections can also result. Due to the severe sprain damages the cartilage at the first injury, arthritis can be developed.

Tests to Diagnose Syndesmotic Sprain or Syndesmotic Ankle Sprain (SAS)

Squeeze Test and External Rotation Tests for Syndesmotic Sprain or Syndesmotic Ankle Sprain (SAS)

''External rotation test'' and ''squeeze test'' are two important tests for syndesmotic sprain or syndesmotic ankle sprain (SAS). In order to ascertain if pain is radiating to the ligament of the high ankle, the leg is squeezed just beneath the knee during the squeeze test. This indicates syndesmotic sprain or syndesmotic ankle sprain (SAS). The foot is turned outside after being placed in a neutral 90 degrees neutral position while bent, during external rotation test. Injury will be indicated if a pain in the high ankle ligament or in the syndesmosis occurs.

It is important to have an x-ray. The possibility of a broken bone must be ruled out after being assed. The whole leg is viewed and other three ankle views. Injury to the higher ankle ligament will accrue due to a fracture on posterior part of tibia where PITFL (posterior tibiofibular ligament) attaches. Injury of syndesmotic sprain or syndesmotic ankle sprain (SAS) can be indicated by the space between fibula and tibia increasing. This injury is diagnosed through MRI helpfully. Tibia's relationship with fibula can be scanned using CT and then assessed.

Frequently Asked Questions on Syndesmotic Sprain or Syndesmotic Ankle Sprain (SAS)

Is a Cause of Alarm When My Ankle is Sprained and After Six Weeks it is Not Healing?

Yes. The duration of ligaments to heal is six weeks. If any injuries have occurred, it is better for your doctor to asses it. Despite the fact that syndesmotic sprain or syndesmotic ankle sprain (SAS) can heal in a longer duration, confirming is a wise idea that there no other injury.

Can the High and the Low Ligament be Having Tearing Simultaneously?

The rarity of such injuries is high due to dissipation of force in one location. In some instances both ligaments in syndesmotic sprain or syndesmotic ankle sprain (SAS) can be torn.

Treatment and Recovery Time for Syndesmotic Sprain or Syndesmotic Ankle Sprain (SAS)

Relocation of the tibia and the fibula to the right location and healing is the aim of the treatment for syndesmotic sprain or syndesmotic ankle sprain (SAS).

Typical ankle sprain will be healing faster than these injuries. The procedure that you should take when you have a sprained injury is to ice for at least 20 minutes after every 2-3 hours. Raise the leg higher than the nose while compressing with an ACE wrap. A walking boot that is removable may be fit due to the tenderness achieved. It is important to have aggressive therapy when you have to add weight. The peroneals have to be strengthened (outside tendons of the ankle).

Playing will resume after six weeks but the duration can be longer sometimes. Hopping on the foot for more than 15 times will indicate full recovery and you can play again. If no widening has occurred between the fibula and the tibia as shown in an x-ray will be the determiner here. If widening as occurred that is usually known as diastasis, or if a bone is broken, there is need for surgery. How the fix the injuries is the matter of concern here, but putting the fibula and tibia back together is the main idea. Or holding them with devices that are new which contains sutures (also used for wound closing). Few points to notice during the treatment for syndesmotic sprain or syndesmotic ankle sprain (SAS):

  • RICE (Rest, Ice, Compression, Elevation) technique application.
  • Plenty of rest should be taken. This is vital for healing Syndesmotic Sprain or Syndesmotic Ankle Sprain.
  • Crutches should be used to avoid weight bearing.
  • Cold therapy should be applied to the ankle immediately after the injury resulting in Syndesmotic Sprain or Syndesmotic Ankle Sprain.
  • Anti-inflammatory medications such as ibuprofen help in reducing pain, swelling and inflammation.
  • Cast or a brace can be used for support if one has encountered Syndesmotic Sprain or Syndesmotic Ankle Sprain.
  • Sports massage can be done following 72 hours after the injury. This should be done by a professional. Sports massage for Syndesmotic Sprain or Syndesmotic Ankle Sprain helps in decreasing the swelling, relaxing the muscles and prevents the developing of scar tissue.
  • Ultrasound treatment for Syndesmotic Sprain or Syndesmotic Ankle Sprain helps in healing of the ligaments.
  • Stretching exercises can be started after the pain associated with Syndesmotic Sprain or Syndesmotic Ankle Sprain subsides to increase the mobility of the ankle.
  • After the pain has subsided completely, patient should start strengthening exercises.
  • Wobble board exercises help in preventing recurrence of the injury.

Prevention of Syndesmotic Sprain or Syndesmotic Ankle Sprain (SAS)

The susceptibility of your ankle to future strain, if you have once had one, will be high for syndesmotic sprain or syndesmotic ankle sprain (SAS), due to the fact that the strength of the ligaments will be weak even after healing.

The tips below helps in the prevention of the syndesmotic sprain or syndesmotic ankle sprain (SAS):

  • Prior to exercise, stretch properly.
  • Warm up after and before exercise
  • Start in allow pace when beginning to exercise. Do not try to achieve your target you want to run for a few miles on a daily basis, is an example. Start with a few distances while you advance gradually to your target.
  • Consult a professional for guidance if you are not sure of which exercise to participate in
  • Take caution when engaging your foot in sports which involves high impact.
  • In the course of performance, you ensure that you consume plenty of fluids.

Home Treatment for Syndesmotic Sprain or Syndesmotic Ankle Sprain (SAS)

In order to reduce swelling of syndesmotic sprain or syndesmotic ankle sprain (SAS), use PRICE principle after every exercise (protection, rest, ice, compression, elevation). You can use the pack that is on retail or a towel to apply the ice because it is not recommended to apply it directly. During the initial stage of syndesmotic sprain or syndesmotic ankle sprain (SAS), it is recommended to put ice 10 minutes in each hour and as the healing progresses trice applied on a daily. In order to drain the fluids and reduce swelling, elevation of the foot will help.

Rehab or Rehabilitation for Syndesmotic Sprain or Syndesmotic Ankle Sprain (SAS)

Syndesmotic sprain or syndesmotic ankle sprain (SAS) is attributed to 11-17 percent of all ankle sprains in athletic populations. American football, rugby, ice hockey, wresting and lacrosse are the leading collision sports that these injuries occur.

Rehabilitation program is the next best method of treating syndesmotic sprain or syndesmotic ankle sprain (SAS) non-surgically. Rehabilitation guidance has not been backed with case control studies or clinical trials.

Three Phases is What is Considered in the Rehab Approach for Syndesmotic Sprain or Syndesmotic Ankle Sprain (SAS):

The aim of the first phase of rehab for syndesmotic sprain or syndesmotic ankle sprain (SAS) is to promote the aspect of healing through joint protection while pain is being minimized, muscle weakness, loss of motion and inflammation. The discomfort that is caused by adding weight is to be aim of the transition of the patient from acute to sub-acute phase.

The sub-acute phase is aimed at normalizing, gait, strength, motion and the daily activities of the patient that are basic. The progress will be realized when the patient has the ability to hop and jog without instability or pain.

The advanced rehab training for syndesmotic sprain or syndesmotic ankle sprain (SAS) is the phase is focused on the preparation of the patient to get back to sport and engage on the activity of his/her own preference. The time which athletes cannot be unstable or cannot complain of pain, is the time that engage with full speed and high quality movements. 6-8 weeks is always the recommended duration for syndesmotic sprain or syndesmotic ankle sprain (SAS) to heal fully but this varies. Little instability, chronic pain, and limitation of functions are common after rehab.

Braces for Syndesmotic Sprain or Syndesmotic Ankle Sprain (SAS)

Plastic or fiber glass splint or padded or brace plaster must be worn for a span of 10 days up to 6 weeks for syndesmotic sprain or syndesmotic ankle sprain (SAS). Movement of the injured ligaments is stopped by the splint or brace and also enhances healing, reduces pain and provides protection.

What is the Recovery Time for Syndesmotic Sprain or Syndesmotic Ankle Sprain (SAS)?

When it comes to Syndesmotic sprain or syndesmotic ankle sprain (SAS), they are considered to be more severe than a normal ankle sprain that any person can suffer with and hence Syndesmotic Sprain or Syndesmotic Ankle Sprain (high ankle sprain) takes a while longer to heal than normal ankle sprains. To facilitate expedited healing, it is essential for Syndesmotic Sprain or Syndesmotic Ankle Sprain (high ankle sprain) to be diagnosed early and adequate treatment should be started. Since recovery period of Syndesmotic sprain or syndesmotic ankle sprain (SAS) is much slower hence physicians are more concerned by this condition than normal ankle sprains. To estimate an approximate healing time, the physician or the physical therapist will first determine whether the Syndesmotic Sprain or Syndesmotic Ankle Sprain (high ankle sprain) is stable or unstable. For stable Syndesmotic sprain or syndesmotic ankle sprain (SAS), the healing time is approximately six weeks after treatment with a cast or a boot. The healing time has been approximated based on the severity of the injury into three grades.

Recovery Period or Healing Time for Grade I- Mild Syndesmotic Sprain Or Syndesmotic Ankle Sprain (SAS): These types of high ankle sprains are extremely mild and take anywhere from 4-6 weeks to completely heal but it may take a while before you can go back to normal sporting activities again, as these injuries can result in joint stiffness and muscle weakness and if it is not allowed to heal properly it may cause further injuries with passage of time.

Recovery Period or Healing Time for Grade II- Moderate Syndesmotic Sprain Or Syndesmotic Ankle Sprain (SAS): These types of high ankle sprains occur when there is substantial injury to the ligaments where it is stretched abnormally. High ankle sprain of moderate severity can take anywhere from 10-12 weeks to heal. If the injury is quite severe then it may take more time to heal and go back to normal activities. The patient should undergo thorough rehabilitation to get back full range of motion and strength.

Recovery Period or Healing Time for Grade III- Severe Syndesmotic Sprain or Syndesmotic Ankle Sprain (SAS): High ankle sprain of grade III severity are caused when there is complete tear of the ligament. These types of injuries require much more time to heal which will include a period of thorough rehabilitation. If the injury is unstable a screw will have to be placed to treat the injury and in such cases the usual healing time is around four months before the patient can return to normal activities.

Exercises for Syndesmotic Sprain or Syndesmotic Ankle Sprain (SAS):

Below mentioned are some of the stretching exercises which are found to be useful for patients with syndesmotic sprain or syndesmotic ankle sprain (SAS). These exercises should be started once the initial phase of the injury has passed and the pain and swelling has calmed down. This normally takes about a week. The first goal of the therapy is to get back normal range of motion of the ankle once weight bearing can be tolerated. Once normal range of motion is achieved, then strengthening of the ankle starts. The exercises to improve range of motion after syndesmotic sprain or syndesmotic ankle sprain (SAS) should be performed at least twice a day.

Exercises to Improve Range of Motion after Syndesmotic Sprain or Syndesmotic Ankle Sprain

Exercise #1 to Improve Range of Motion Following Syndesmotic Sprain or Syndesmotic Ankle Sprain: Sit straight and try and bring the ankle and foot up as much as possible so that a stretch to the calf is felt. Hold this position for about 10 seconds and repeat this around 10 times.

Exercise-1 for Syndesmotic Sprain or Syndesmotic Ankle Sprain

Exercise #2 to Improve Range of Motion Following Syndesmotic Sprain or Syndesmotic Ankle Sprain: In this exercise while seated bring and the ankle down and bend it inwards. Maintain this position for about 10 seconds and repeat it about 10 times.

Exercise-2 for Syndesmotic Sprain or Syndesmotic Ankle Sprain

Exercise #3 to Improve Range of Motion Following Syndesmotic Sprain or Syndesmotic Ankle Sprain: In this exercise, from a seated position bring the ankle up in an outwards position and maintain this position for about 10 seconds. Repeat this exercise again 10 times.

Exercise-3 for Syndesmotic Sprain or Syndesmotic Ankle Sprain

Exercise #4 to Improve Range of Motion Following Syndesmotic Sprain or Syndesmotic Ankle Sprain: In this exercise, while in a seated position point the toes down and maintain the position for about 10 seconds and repeat this again 10 times.

Exercise-4 for Syndesmotic Sprain or Syndesmotic Ankle Sprain

Strengthening Exercises for Syndesmotic Sprain or Syndesmotic Ankle Sprain

The below mentioned exercises should only be done once there has been substantial improvement in the ankle pain following syndesmotic sprain or syndesmotic ankle sprain (SAS).

Strengthening Exercise #1 for Syndesmotic Sprain or Syndesmotic Ankle Sprain: Stand on the edge of a stair, drop the ankles down and maintain this stretching position for about 10 seconds and repeat the exercise about 10 times.

Strengthening Exercise #1 for Syndesmotic Sprain or Syndesmotic Ankle Sprain

Strengthening Exercise #2 for Syndesmotic Sprain or Syndesmotic Ankle Sprain: Stand about 10 inches from a wall with the toes pointing towards the wall. Now squat down and maintain this position for about 10 seconds and repeat this maneuver about 10 times.

Strengthening Exercise #2 for Syndesmotic Sprain or Syndesmotic Ankle Sprain

Isometirc Exercises for Syndesmotic Sprain or Syndesmotic Ankle Sprain

After achieving near normal range of motion and strength following syndesmotic sprain or syndesmotic ankle sprain (SAS) then you can start with some isometric exercises by first pushing at a fixed object with the injured ankle. Once this is able to be done with minimal to no pain then the exercises can be advanced by placing resistance and then doing ankle range of motion.

  1. Place the ankle down and inwards against a fixed object like a couch Place your ankle in the "down and in" position against a fixed object such as a couch. Maintain this position for about 10 seconds and repeat it about 10 times.
  2. In this exercise, position the ankle upwards and bring it out against a stationary object. Maintain this position for about 10 seconds and repeat it about 10 times.
  3. This exercise makes use of a resistance band. Take a resistance band and hold the ends of the band in the hands while the band it placed around the foot. Now, try and bring the ankle down as much as possible. Do this for about 10 seconds and repeat it about 10 times. This can also be done by typing the band around a fixed object and then doing this exercise.

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: August 10, 2016

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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