Syndesmosis Injuries

As a big rugby union fan, particularly the six nations, I was sad to see Billy Vunipola limping off mid way through the first half on Saturday, in England’s clash against Ireland.

We haven’t had number 8s like him and Ben Morgan for a long time, those that actually make decent yardage when they run with the ball and strike fear into the heart of opponents as they bear down on them.

Billy’s injury was atypical for an ankle injury in that he twisted it in the opposite direction to 90% of most ankle sprains. So what does this mean?..

My differential diagnosis without actually having the fortune of assessing him would be that he has most likely injured the deltoid ligament and quite possibly disrupted the syndesmosis of his ankle +/- the anterior distal tibiofibular ligament (ADTFL).

The deltoid or medial ligament is often the first tissue to be disrupted and in more severe cases this disruption continues through into the ADTFL and then into the syndesmosis.

So what is the syndesmosis I hear you ask? Well the syndesomosis is a very stable group of ligaments that hold the tibia and fibula together from the ankle all the way up to the knee. They cross over each other in a lattice type formation making them very strong. To disrupt these ligaments often takes a lot of force, so when you do disrupt them you know you have done some damage.

So how do I know if I did my deltoid ligament and syndesmosis?

Well the first thing is to think about how you did it. Most sports people have injured their ankles once or twice and understand mechanisms of injury to a degree. So if you have twisted it in an atypical way and you have pain around the medial aspect of the ankle instead of the lateral then the deltoid ligament is a possibility. Identifying the syndesmosis is more tricky, but most people describe a feeling of instability above the ankle with pain when walking, possibly radiating higher up into the mid shin between the tibia and fibula.

If in doubt and you are in pain when walking consult a specialist, either via A&E or contact one of our team for an assessment. They will be able to identify the injury and recommend the next steps for you to make the most optimal recovery.


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