Causes, Clinical Features and Treatment of Ankle Injury:

The tibiofibular syndesmosis, consisting of the anterior and posterior inferior tibiofibular ligaments and interosseous membrane, maintains the joint between the distal tibia and fibula. It plays a dynamic role in ankle function.

Causes

• Diastasis (separation) occurs with partial or complete rupture of the syndesmosis ligament.
• Ruptures of the syndesmosis are rarely isolated injuries but generally occur in association with deltoid ligament injuries or, more frequently, with fractures of either the fibula or the posterior and medial malleoli.

Clinical Features

The classic presentation includes:

• Anterior ankle pain following a moderate-to-severe ankle injury.
• Tenderness on examination located at the anterior aspect of the syndesmosis and interosseus membrane.
• Painful active external rotation of the foot. If there is severe disruption of the syndesmosis, the squeeze test is positive.

Investigations

• Plain X-rays are recommended to exclude fractures and osseous avulsions.
• Mortise views may reveal widening of the syndesmosis.
• Stress X-rays in external rotation may demonstrate the diastasis.
• CT or MRI is required to exclude osteochondral lesions.
• Isotope bone scan may reveal a focal increased uptake in the region of the anterior tibiofibular ligament and interosseous membrane.

Treatment

• Provided there is no widening of the distal tibiofibular joint, conservative management with rest, NSAIDs and physiotherapy is required.
• As the pain settles, strengthening, range of motion and proprioceptive exercises are introduced.
• In more severe cases, when there is widening of the distal tibiofibular joint, surgery and insertion of a temporary syndesmosis screw is required.

The shin and fibula are the two lengthy bone fragments of the reduced leg. Distal tibiofibular joint accidents typically happen traumatically during more serious rear-foot accidents whereby causes force the shin and fibular apart. Active Physical Therapy is recognized as a provider of superior care for orthopedic, Auto Accident, Sports Injuries / Trauma Cases, Work-related Injuries and comprehensive physical therapy services that improve function, encourage independence and better your quality of life. Call now for quick Appointment: 301-877-2323

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