The syndesmosis is the strong ligament complex holding the two lower leg bones together just above the ankle joint. An injury here typically requires a longer non-weight-bearing period than an ankle fracture without this involvement, to protect healing.
This page explains how a ankle fracture with syndesmotic injury is commonly managed, in plain language, based on Dr. Kee's typical approach to this injury.
Every fracture is different. Treatment varies based on the exact fracture pattern, displacement, age, whether surgery is needed, bone quality, other injuries, and how an individual heals. This page is general education, not your personal treatment plan — always follow the specific instructions given to you by Dr. Kee's office.
The syndesmosis is the strong ligament complex holding the two lower leg bones together just above the ankle joint. An injury here typically requires a longer non-weight-bearing period than an ankle fracture without this involvement, to protect healing.
Syndesmotic injuries usually recover more slowly than an isolated ankle fracture.
This fracture may be treated with or without surgery, depending on the specific fracture pattern, how much the bone has shifted (displacement), and your individual situation. Your surgeon will determine the best approach for you.
A short-leg splint (SLS) for about 2 weeks, then transition to a CAM boot (controlled ankle motion boot).
No weight bearing (NWB) for about 6 weeks. Patients with diabetes are generally kept non-weight-bearing longer — about 12 weeks — given the higher risk of bone-healing complications.
For a full explanation of what these weight-bearing terms mean, see our Weight-Bearing Guide.
No resistance or strengthening (NRM) for about 6 weeks (12 weeks for patients with diabetes). If treated with surgery, motion (ROM) may begin around 2 weeks once the skin has healed, as you transition to a CAM boot while weight-bearing restrictions continue.
Structured ankle motion, gait, calf strength, and balance rehabilitation after stability permits.
A 6–8 week X-ray to confirm healing and clear the weight-bearing restriction. An optional 3–6 month X-ray may be used to monitor final healing.
Every fracture moves through the same general phases, though the exact timing is different for every patient:
Work or School: Desk work early; standing/manual work delayed until stable gait and healing.
Sports or High-Risk Activity: Often 4–6 months, depending on syndesmotic healing and functional testing.
Mortise widening, wound problems, calf pain, neurovascular symptoms, hardware pain, or persistent instability.
See our full When to Call page for the difference between routine office contact and emergency evaluation.
A short-leg splint (SLS) for about 2 weeks, then transition to a CAM boot (controlled ankle motion boot).
Your surgeon will guide when it's safe to return to these activities based on how your specific fracture is healing. Follow the instructions given specifically to you.
Every fracture heals differently. If you have questions about your treatment plan, reach out to Dr. Kee's office.