While COVID-19 continues to disrupt our lives and wreak havoc all over the world, keen AFL fans might be mistaken for thinking there is another pandemic ripping through the playing ranks: ankle syndesmosis injuries.
In the first few months of this season alone we saw Patrick Dangerfield (Geelong), Adam Treloar (Bulldogs), Adam Cerra (Fremantle), Zak Butters (Port Adelaide), Sam Docherty (Carlton), Sam Taylor (GWS) and Noah Balta, Bachar Houli and Nathan Broad (Richmond) all having long layoffs due to this injury.
Fifteen years ago, seemingly every club was missing a few stars with the dreaded ‘osteitis pubis’, but now in 2021 the most common diagnosis seems to be a ‘syndesmosis’.
But what is ankle syndesmosis and why do injuries to this location seem to be popping up more and more?
Our lower leg consists of two long bones that run from our knee to our ankles: the tibia and fibula.
The ‘syndesmosis’ refers to the joint between these two bones at the front of our ankle, including the ligaments and membrane that holds the bones together.
These ligaments can be stretched or torn, and this joint ‘stretched open’ when the ankle is twisted with a lot of force.
We often see this happening in contact sports such as Australian Rules football when the player is tackled or tacking, and their leg gets caught under an opponent (search “Nathan Broad Syndesmosis” on YouTube to see a classic example from a recent game).
Like all ligament injuries, we grade syndesmosis injuries from one to three, pending the extent of the damage.
Our understanding of how to best manage syndesmosis injuries is evolving.
Historically, we would immobilise the lower grade injuries in a boot for a few weeks, with surgery reserved for only the most serious grade three injuries.
However, in elite sport, we are seeing clubs err on the side of caution and electing to go with surgery for seemingly all injuries to this area.
Surgery involves running a fine wire through the joint to stabilise it and allow the ligament to heal. Recovery can take anywhere from a few weeks to several months.
So why are we seeing exponential growth in the number of syndesmosis injuries diagnosed at our AFL clubs?
The first and biggest factor is that their medical teams have much better awareness of the injury then they did previously and regularly use better imaging such as MRIs.
In years gone by, a lot of syndesmosis injuries were probably missed and misdiagnosed as a standard ankle sprain.
The players likely ended up missing much longer than originally thought, or were able to return but still had a lot of pain, stiffness and weakness.
Another factor that might explain the increase in this type of injury is the way the game is played now.
Present-day players are more happy to take on the tackle as they have trained to spin/get their hands free and dish off a handball.
More of these types of situations each game increases the risk a foot can get caught as the body is spun and the syndesmosis could be injured.
Whatever the reason for the increase in numbers, given September is just around the corner, I hope no-one from your team goes down with an ankle syndesmosis for the rest of the year.
Pat is a director of Echuca Moama Physiotherapy, which has clinics in Moama, Kyabram and Rochester. For an appointment with Pat, call 5480 0860.
