by Shawn Mcfaddin

Created on: May 17, 2009   Last Updated: May 21, 2009

The football cuts through the air, too high and hard, but the receiver has already envisioned the catch. Instantly recalculating his route to compensate for the quarterbacks error, the receiver fakes right to lose his coverage. Now in the zone, he knows exactly where the ball will land. Exploding into the cool air, his fingertips make contact with the ball's rough texture, plucking it out of the sky. The reception is perfect as his attention turns to the end zone, until his feet reconnects with the artificial turf landing awkward with tremendous force. The artificial fibers grab his ankle causing it to turn upward and outward against the receivers growing momentum. The electrical shock fires through his leg into the pit of his stomach triggering nausea. As if all his bones had disintegrated, the athlete collapses into a heap clutching the ruined ankle, ending the magnificent play. The scene just witnessed is a typical ankle injury that may be seen on any pro football Sunday.

The athlete now enters the dreaded world of rehab to quickly, as possible, regain premorbid ankle integrity and resume play. During the initial evaluation, most orthopedist, trainers and physical therapist discover a typical low ankle sprain, which is treated traditionally with appropriate low ankle sprain protocol. However, after four weeks of intense therapy, the athlete is still plagued with pain and instability during high-level, competitive play.

Why is this?

What did the trainer, orthopedic surgeon and physical therapist miss during their comprehensive physical evaluations and diagnostic tests? What they have missed is a little known injury classified as an ankle syndesmosis injury or high ankle sprain. Unlike a traditional lower ankle sprain, the syndesmosis injury involves of one or more ligaments of the syndesmosis web. Superior to the ankle joint, the syndesmosis web is divided into three primary sections comprising of the anterior inferior tibiofibular ligament (AITFL), interosseous membrane and the posterior inferior tibiofibular ligament (PITFL). This complex array of ligamentous connective tissue creates a strong, yet flexible web between the tibia and fibula bones. Misdiagnosis is very common since the lower ankle sprain may be a secondary, yet more noticeable, symptomatic injury. These more intense symptoms usually mask the high ankle sprain upon examination. This is unfortunate since a syndesmosis injury takes, at a minimum, two-three times as long to heal as the

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