A retrospective analysis of the ankle radiographs of 86 patients with disruptions of the distal tibiofibular syndesmotic ligaments and comparison with radiographs of 100 patients with normal ankles revealed several findings useful in identifying these lesions. These observations included location and character of lateral malleolar or fibular fractures, avulsions of the tibial or fibular syndesmotic attachments, talar tilt or displacement, and distortion of the normal tibiofibular and tibiotalar relationships. Injuries to the ligamentous support of the ankle may be subtle and overlooked. Recognition of these findings and an understanding of the mechanisms of injury will facilitate radiologic diagnosis of syndesmotic injuries and will allow for surgical repair to prevent potential complications.