Evaluation and management of high ankle sprains

Smith, Kevin M.; Kovacich-Smith, Katie J.; Witt, Mark

Affiliations

¹Department of Podiatric Medicine, College of Podiatric Medicine and Surgery, Des Moines University-Osteopathic Medical Center, Iowa, USA

²Department of Podiatric Medicine, Metropolitan Medical Center, Des Moines, Iowa

Abstract

Owing to the variability of injury, a mechanism of injury other than external rotation of the foot should not rule out a high ankle sprain. One must consider syndesmotic injury in the differential diagnosis of common ankle sprains and trauma. A high index of suspicion must lead the physician through clinical and radiographic examinations. Early and appropriate treatment of a high ankle sprain can greatly decrease a prolonged return to activity. Patients, especially competitive atheletes, must be educated regarding the morbidity of the condition.

Links

PubMed: 11499173

Cited Works (41)

Year	Entry
1978	Pankovich AM. Fractures of the fibula proximal to the distal tibiofibular syndesmosis. J Bone Joint Surg. March 1978;60A(2):221-229.
1989	Boden SD, Labropoulos PA, McCowin P, Lestini WF, Hurwitz SR. Mechanical considerations for the syndesmosis screw: a cadaver study. J Bone Joint Surg. December 1989;71A(10):1548-1555.
1989	Kaye RA. Stabilization of ankle syndesmosis injuries with a syndesmosis screw. Foot Ankle. 1989;9(6):290-293.
1997	Ebraheim NA, Lu J, Yang H, Mekhail AO, Yeasting RA. Radiographic and CT evaluation of tibiofibular syndesmotic diastasis: a cadaver study. Foot Ankle Int. November 1997;18(11):693-698.
1989	Fritschy D. An unusual ankle injury in top skiers. Am J Sports Med. March–April 1989;17(2):282-286.
1995	Miller CD, Shelton WR, Barrett GR, Savoie FH, Dukes AD. Deltoid and syndesmosis ligament injury of the ankle without fracture. Am J Sports Med. December 1995;23(6):746-750.
1956	Close JR. Some applications of the functional anatomy of the ankle joint. J Bone Joint Surg. July 1956;38A(4):761-781.
1986	Manderson EL. The uncommon sprain: ligamentous diastasis of the ankle without fracture or bony deformity. Orthop Rev. October 1986;15(10):664-668.
1995	Ostrum RF, De Meo P, Subramanian R. A critical analysis of the anterior-posterior radiographic anatomy of the ankle syndesmosis. Foot Ankle Int. March 1995;16(3):128-131.
1984	Edwards GS Jr, DeLee JC. Ankle diastasis without fracture. Foot Ankle. May–June 1984;4(6):305-312.
1995	Xenos JS, Hopkinson WJ, Mulligan ME, Olson EJ, Popovic NA. The tibiofibular syndesmosis: evaluation of the ligamentous structures, methods of fixation, and radiographic assessment. J Bone Joint Surg. June 1995;77A(6):847-856.
1992	Taylor DC, Englehardt DL, Bassett FH III. Syndesmosis sprains of the ankle: the influence of heterotopic ossification. Am J Sports Med. March 1992;20(2):146-150.
1993	Taylor DC, Bassett FH III. Syndesmosis ankle sprains: diagnosing the injury and aiding recovery. Phys Sportsmed. December 1993;21(12):39-46.
1988	Sarsa IM, Hughes SPF. The role of the anterior tibio-fibular ligament in talar rotation: an anatomical study. Injury. March 1988;19(2):62-64.
1995	Spaulding SJ. Monitoring recovery following syndesmosis sprain: a case report. Foot Ankle Int. October 1995;16(10):655-660.
1993	Sarrafian SK. Anatomy of the Foot and Ankle: Descriptive, Topographic, Functional. 2nd ed. Philadelphia: J. B. Lippincott Company; 1993.
1984	Leeds HC, Ehrlich MG. Instability of the distal tibiofibular syndesmosis after bimalleolar and trimalleolar ankle fractures. J Bone Joint Surg. April 1984;66A(4):490-503.
1997	Vogl TJ, Hochmuth K, Diebold T, Lubrich J, Hofmann R, Stöckle U, Söllner O, Bisson S, Südkamp N, Maeurer J, Haas N, Felix R. Magnetic resonance imaging in the diagnosis of acute injured distal tibiofibular syndesmosis. Invest Radiol. July 1997;32(7):401-409.
1986	Marymont JV, Lynch MA, Henning CE. Acute ligamentous diastasis of the ankle without fracture: evaluation by radionuclide imaging. Am J Sports Med. September 1986;14(5):407-409.
1976	Scranton PE Jr, McMaster JH, Kelly E. Dynamic fibular function: a new concept. Clin Orthop Relat Res. July–August 1976;118:76-81.
1997	Wuest TK. Injuries to the distal lower extremity syndesmosis. J Am Acad Orthop Surg. May–June 1997;5(3):172-181.
1994	Ogilvie-Harris DJ, Reed SC. Disruption of the ankle syndesmosis: diagnosis and treatment by arthroscopic surgery. Arthroscopy. October 1994;10(5):561-568.
1985	Sclafani SJA. Ligamentous injury of the lower tibiofibular syndesmosis: radiographic evidence. Radiology. July 1985;156(1):21-27.
1995	Brosky T, Nyland j, Nitz A, Caborn DNM. The ankle ligaments: consideration of syndesmotic injury and implications for rehabilitation. J Orthop Sports Phys Ther. April 1995;21(4):197-205.
1979	Dias LS. The lateral ankle sprain: an experimental study. J Trauma. April 1979;19(4):266-269.
1977	Yablon IG, Heller FG, Shouse L. The key role of the lateral malleolus in displaced fractures of the ankle. J Bone Joint Surg. March 1977;59A(2):169-173.
1998	Teitz CC, Harrington RM. A biochemical analysis of the squeeze test for sprains of the syndesmotic ligaments of the ankle. Foot Ankle Int. July 1998;19(7):489-492.
1989	Briner WW Jr, Carr DE, Lavery KM. Anteroinferior tibiofibular ligament injury: not just another ankle sprain. Phys Sportsmed. November 1989;17(11):63-69.
1985	de Souza LJ, Gustilo RB, Meyer TJ. Results of operative treatment of displaced external rotation-abduction fractures of the ankle. J Bone Joint Surg. September 1985;67A(7):1066-1074.
1976	Ramsey PL, Hamilton W. Changes in tibiotalar area of contact caused by lateral talar shift. J Bone Joint Surg. April 1976;58A(3):356-357.
1993	Harper MC. An anatomic and radiographic investigation of the tibiofibular clear space. Foot Ankle. 1993;14(8):455-458.
1976	Guise ER. Rotational ligamentous injuries to the ankle in football. Am J Sports Med. January–February 1976;4(1):1-6.
1991	Boytim MJ, Fischer DA, Neumann L. Syndesmotic ankle sprains. Am J Sports Med. 1991;19(3):294-298.
1990	Hopkinson WJ, St Pierre P, Ryan JB, Wheeler JH. Syndesmosis sprains of the ankle. Foot Ankle. June 1990;10(6):325-330.
1975	Cedell CA. Ankle lesions. Acta Orthop Scand. June 1975;46(3):425-445.
1995	Veltri DM, Pagnani MJ, O'Brien SJ, Warren RF, Ryan MD, Barnes RP. Symptomatic ossification of the tibiofibular syndesmosis in professional football players: a sequela of the syndesmotic ankle sprain. Foot Ankle Int. May 1995;16(5):285-290.
1998	Alonso A, Khoury L, Adams R. Clinical tests for ankle syndesmosis injury: reliability and prediction of return to function. J Orthop Sports Phys Ther. April 1998;27(4):276-284.
1989	Harper MC, Keller TS. A radiographic evaluation of the tibiofibular syndesmosis. Foot Ankle. December 1989;10(3):156-160.
1992	Amendola A. Controversies in diagnosis and management of syndesmosis injuries of the ankle. Foot Ankle. January 1992;13(1):44-50.
1999	Doughtie M. Syndesmotic ankle sprains in football: a survey of National Football League athletic trainers. J Athl Train. March 1999;34(1):15-18.
1978	Whiteside LA, Reynolds FC, Ellsasser JC. Tibiofibular synostosis and recurrent ankle sprains in high performance athletes. Am J Sports Med. July 1978;6(4):204-208.