Diagnosis and management of syndesmotic ankle injury (high ankle sprain)

AITFL: anterior inferior tibiofibular ligament; PITFL: posterior inferior tibiofibular ligament; IOM: interosseous membrane; MRI: magnetic resonance imaging.
* AITFL tenderness and dorsiflexion-external rotation test are sensitive signs of injury; single-leg hop failure and positive squeeze test are specific signs of injury.
¶ If skilled ultrasound assessment is not available, management options include:

• Immobilization with serial reassessment
• Referral to orthopedic surgery
• MRI