Syndesmosis surface anatomy

The distal-most location of the syndesmosis, the ATiFL, is approximately 1 inch proximal and slightly medial to the anterior talofibular ligament. There is usually no landmark to palpate, as the tibiotalar joint line and tibiotalar syndesmosis are not distinct in most individuals. The recommend approach to palpate the syndesmosis is to locate the anterio-medial tip of the lateral malleolus, and move proximally about an inch and slightly medially to the ATiFL, and continue palpation proximally along the interosseous membrane.