A syndesmotic (so-called high-ankle) sprain occurs with forced dorsiflexion and eversion that can occur when a child jumps from a height, slides into a base, or decelerates wearing rigid boots (eg, skiing). The syndesmosis is the membrane between the distal tibia and fibula. The patient reports pain along the fibula, superior to the lateral malleolus, that worsens with passive dorsiflexion or passive external rotation of the talus. A positive tibia-fibula squeeze test identifies a syndesmotic sprain and occurs when there is pain anterior and proximal to the ankle joint upon squeezing the tibia against the fibula at mid-calf. An orthopedist should be consulted for a syndesmotic sprain because surgery may be needed to maintain joint integrity and stability.
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