The inferior tibiofibular joint is a fibrous syndesmosis between the fibular notch of the tibia and the medial surface of the distal fibula, stabilised by the anterior and posterior inferior tibiofibular ligaments, the interosseous tibiofibular ligament, and the inferior transverse ligament. It maintains mortise width during ankle loading and allows 1-2 mm of fibular motion.
Syndesmotic (high ankle) sprains disrupt the inferior tibiofibular joint complex, producing medial and lateral ankle pain above the joint line. The squeeze test and external rotation stress test are the primary clinical assessments. Widening of the clear space on X-ray indicates diastasis requiring surgical stabilisation with a syndesmotic screw or tightrope. Missed syndesmotic injury leads to chronic mortise instability and early ankle arthritis.
High ankle sprain disrupting the inferior tibiofibular ligamentous complex, producing pain above the ankle and positive squeeze and external rotation tests, requiring weight-bearing X-ray to exclude diastasis.
Widening of the mortise from complete syndesmotic disruption requiring surgical stabilisation with a syndesmotic screw or suture-button device to restore mortise congruence.
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