Injury to the tibiofibular syndesmosis ligaments, which bind together the distal ends of the tibia and fibula, is commonly referred to as a high ankle sprain [8]. While lateral ankle sprains are the most common injury, high ankle sprains represent a more disabling problem and require a longer recovery period [1] and different treatment [4]. The mechanism associated with a high ankle sprain is primarily thought to involve external rotation of the foot [1,7]. However, both a cadaver study [6] and a simulation study [5] show that tibiofibular syndesmosis ligaments are not stretched the most during an excessive, pure external foot rotation.

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