Syndesmosis Sprain (AITFL)

Also known as a high ankle sprain in which the Anterior Inferior Tibio-Fibular Ligament (AITFL) becomes injured, aka ‘syndesmosis’.
It is most commonly seen in tackling sports such as rugby and wrestling, where a player falls onto an opponent’s heel from behind and the toes rotate outward. This is a more complex injury as opposed to the lateral ankle sprain mentioned above, and its dependency on full return to sport/activity is appropriate intervention in the acute phase such as immobilisation (‘moon boot’), if required.

If suspected it may be useful to undergo MRI scans to assess the severity of the damage. It is also important to commence rehabilitation as soon as instructed to optimise outcomes. The rehabilitation of this type of injury in most cases requires early immobilisation, range of motion (ROM) & gait retraining, activation & strength, followed by function and return to sport rehabilitation exercises.

In the early phases of treatment, scar tissue massage, dry needling and therapeutic ultrasound therapy may be applied. It is normal to be out of your boot (if in one) and feel restricted at the front of your ankle joint and around the heel/achillies regions. If this is the case, ankle mobilisations will be used to reduce the pinching to free up your walking quicker and allow your physiotherapist to start activation and strength exercises. These two steps are crucial as it retrains the basic fundamental movements to the ankle joints so that we are able to use these improvements to retrain sport/activity specific drills. In a majority of cases, programs that are not complete increase the chance of re-injury – so book now for an assessment of your ankle injury.