When A Sprain is not a Sprain…Syndesmosis and Mid-foot Injuries

By Peter H. Edwards, Jr., M.D.

A sprain is a generic term for an injury to a ligament. Sprains are graded first degree, second degree and third degree. First degree sprains are mild, and minimal ligament damage occurs. Swelling is mild, and bruising usually does not occur. Second degree sprains are moderate, and some, but not all, ligament fibers are torn. At least some bruising and moderate swelling are normal. Grade three sprains are severe, and the ligament is completely torn. Extensive bruising and marked swelling occur.

Among soccer players, any foot or ankle injury often is lumped into the “it’s just a sprain” category. Many sprains can heal well without surgery or even medical care, but certain “sprains” can be much more serious. The high ankle or syndesmosis sprain and the mid-foot sprain are two such injuries. When serious injury occurs to these joints, detailed specific care and often surgery are needed.

The syndesmosis sprain occurs above the “normal” ankle sprain at the level of the lower leg and ankle junction. These sprains swell higher in the ankle and often are more painful than regular ankle sprains. X-rays should be obtained to evaluate for fracture, but also to determine if a ligament tear allowed the bones to slip apart. If slippage has occurred, surgery will be needed. Terrell Owens and Kellen Winslow both required surgery for this injury in the N.F.L. Soccer players are more at risk of this injury than athletes playing other sports due to the nature of the game.

Mid-foot sprains are a similarly serious injury. This sprain results from a fall forward over the flexed foot or from a direct blow. Even slight slippage of the bones in this area results in long-term problems unless treated surgically. Often, this injury’s severity is not picked up on first evaluation. Significant swelling and/or bruising in the mid-foot should prompt evaluation by a specialist. Again, soccer players frequently injure this area in ground strike or 50/50 situations.

In conclusion, sprains often are more serious than soccer players usually believe. If you experience significant swelling and bruising after injury, seek an evaluation from a sports orthopedist. Initial treatment with R.I.C.E. and crutches is recommended prior to evaluation.