THE ANKLE LIGAMENTS - CONSIDERATION OF SYNDESMOTIC INJURY AND IMPLICATIONS FOR REHABILITATION

Injury to the distal tibiofibular syndesmosis (DTFS) may be more commo n than previously reported. This injury is typically caused by externa l forces which produce sudden ankle dorsiflexion or plantar flexion in combination with external rotation of the foot Common mechanisms incl ude direct contact with another player or uneven physical terrain. Imp roper diagnosis oi this injury may greatly delay the return to normal functional status and promote the development oi chronic instability, degenerative joint changes, and pain. The purpose oi this clinical com mentary is to review the ligamentous anatomy of the ankle and the inci dence oi injury to the lateral ligaments of the ankle, with emphasis o n DTFS injury. Special tests which enhance the recognition of DTFS inj ury, such as the external rotation stress test and the distal tibiofib ular compression test, and a rehabilitation progression are presented.