Syndesmosis Management & Surgical Decision Making

Syndesmosis injuries, commonly known as high ankle sprains, are among the most frequently missed and mismanaged injuries in sports medicine. In this episode of the How I Rehab podcast, host Nick Kane sits down with Melbourne orthopedic surgeon Dr Sasha Roshan, a foot and ankle specialist with a particular focus on sports-related injuries, to break down everything clinicians need to know about syndesmosis injury recognition, decision-making and rehabilitation. Sasha walks through the on-field and clinical signs that separate a syndesmosis injury from a standard ankle sprain, the investigations that actually change management (and the ones that don't), when surgery is warranted versus a structured period of conservative care, and how modern fixation techniques, from traditional screws to TightRope and internal brace augmentation, have changed return-to-play timelines. The conversation closes with a detailed walkthrough of post-operative rehabilitation, from wound-focused early management through to safe return-to-running criteria. Whether you're a physiotherapist, athletic trainer or S&C coach working pitch-side or in private practice, this episode gives you a surgeon's-eye view of a diagnosis you cannot afford to miss. Want to go deeper? Sports MAP's Masterclass platform features a full Syndesmosis Injury and Management Masterclass with Stuart Imer, covering classification, surgical management and rehabilitation in detail — start your 7-day free trial and watch it today. Topics covered: Dr Sasha Roshan's background and international fellowship training Insights from the 2026 AOFAS/NZOFAS Combined Annual Scientific Meeting in Singapore On-field and clinical signs that distinguish syndesmosis injury from lateral ankle sprain Why missed syndesmosis injuries lead to long-term joint damage and premature arthrosis Weight-bearing X-ray, MRI and ultrasound: what to order and when Determining stability vs instability and when to refer for surgery Weight-bearing CT and diagnostic arthroscopy for grey-zone cases Evolution of surgical fixation: screws, TightRope and internal brace Combined medial (deltoid) ligament injuries and surgical decision-making Post-operative rehabilitation: wound care, early ROM, weight-bearing progression Dorsiflexion range of motion and safe return-to-running criteria Follow-up imaging philosophy and tightrope button removal https://www.youtube.com/watch?v=9wsTP8x-uxg Do you want to go deeper with your rehabilitation skills? ⁠ Explore the full library of practical sports physio and rehabilitation-based Masterclassesfor all your CPD/CEU needs with a free 7-day limited-access trial. ⁠⁠ Explore the Masterclasses HERE