The syndesmosis, also known as the anterior tibiofibular ligament, is the thick ligaments which connects the distal heads of the tibia and fibula.


In complex ankle sprains, especially inversion sprains, the syndesmosis may be compromised. Involvement of the syndesmosis is referred to as a high ankle sprain and increases injury recovery time.

Involvement of the syndesmosis in an ankle sprain may be determined by two tests. For the first test, squeeze the tibia and fibula together in the midcalf region and assess the level of pain the patient feels near the distal tibiofibula junction. For the second test, put the patients foot into dorsiflexion and externally rotate the ankle, again testing for pain near the distal tibiofibula junction. A positive result for either test suggests the involvement of the syndesmosis.