OBJECTIVE: To present a case of distal tibiofibular sprain, a rare injury among ubiquitous lateral ligament sprains of the ankle.

CLINICAL FEATURES: A 45-yr-old recreational hockey player was treated for an ankle sprain demonstrating increased translation on the drawer test and pain with inversion stress, but also pain with external rotation and dorsiflexion. X-rays demonstrated no fractures.

INTERVENTION AND OUTCOME: The conventional protocol of protect, rest, ice, compress and elevate (PRICE), employed for the more common lateral ankle sprains, was followed by early mobilization and proprioceptive training with a tilt board. Recovery was prolonged, and ossification of the ankle syndesmosis was seen in follow-up radiographs.

CONCLUSION: Because management implications and outcome sequelae of the uncommon syndesmotic sprain are more severe than the commonly seen lateral ankle sprain, simple physical examination procedures useful in identifying syndesmotic sprains in the routine examination of the injured ankle are emphasized. These include dorsiflexion and external rotation stress and the "squeeze test."

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