Symmetry Blog

Injury of the week - High Ankle Sprain

Symmetry Physio - Wednesday, June 07, 2017

This week we are looking at Ryan Griffen (GWS) and his Ankle Syndesmosis Tear.

Injury of the week

The injury woes continue for Greater Western Sydney as they suffer another setback. Ryan Griffen, who hasn't played since round three after injuring his ankle against North Melbourne was due to return to full training but re-injured his ankle during a session with the rehab group on Saturday. It has been revealed that he has suffered a syndesmosis injury which required surgery.

The ankle syndesmosis is the joint between your two shin bones (Tibia and Fibula) and forms the upper part of the ankle joint (see image). It is supported and held together by three main ligaments, These are the anterior inferior tibiofibular ligament (AITFL), the posterior inferior tibiofibular ligament (PITFL) and the transverse ligament. There is also an interosseous ligament which is a long sheet of connective tissue that connects the entire length of the tibia and fibula, from the knee to the ankle.

An ankle syndesmosis injury involves a sprain of one or more of the ligaments that support the ankle syndesmosis and is also often referred to as a "high ankle sprain". It typically occurs when the ankle is forcefully twisted outwards, or when the foot is planted, and the leg twists inwards such as in a tackle. These injuries are less common, but more disabling and much slower to recover than traditional lower ankle sprains. The reason for this is that if the ligaments are injured and are not adequately holding the tibia and fibula tightly together, then they can start to splay apart with the high load of weight bearing, leaving the ankle unstable. X-rays should be obtained if an injury to the syndesmosis is suspected. Because normal x-rays may not show a syndesmosis injury, a stress x-ray is often necessary and/or MRI.

Mild syndesmosis sprains usually involve a stretch or slight tear in only one of the ligaments and moderate tears of the ankle syndesmosis may lead to ankle joint instability. In these cases, a period of non-weight bearing is often required and/or immobilzation to let healing occur. In severe tears of the ligaments, the ends of the tibia and fibula actually spread apart and in these cases, surgery is often necessary to stabilise the joint with screws so that healing can occur.

If Ryan has no setbacks during his recovery, he is expected to be fit again on the eve of the finals.

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