The AITFL is the most commonly injured syndesmotic ligament, lying at the anterolateral ankle and visible on the lateral ankle radiograph as a ligament spanning the fibula to the tibia. Its avulsion produces the Chaput or Wagstaffe fractures at its tibial or fibular attachments. The squeeze test (compressing tibia and fibula at mid-shaft) reproduces pain from AITFL injury.
| Origin | Anterior tubercle of the distal tibia (Chaput tubercle) |
|---|---|
| Insertion | Anterior fibula above the lateral malleolus (Wagstaffe tubercle) |
| Actions | The primary anterior restraint of the syndesmosis — resists fibular external rotation and diastasis |
|---|
The anterolateral soft spot of the ankle overlies the AITFL — palpation at this point reproduces pain in syndesmotic sprains. The squeeze test is positive when compressing the mid-leg tibia and fibula reproduces ankle pain from syndesmotic ligament stretch. High ankle sprains require 2-3 times longer rehabilitation than lateral ankle sprains.
AITFL and syndesmotic ligament injury producing anterolateral ankle pain with positive squeeze test, requiring 8-12 weeks rehabilitation versus 4-6 weeks for lateral ankle sprains.
