Syndesmotic ankle sprains in football: a survey of national football league athletic trainers.

OBJECTIVE: To obtain information regarding syndesmotic ankle sprains and to identify a specific treatment modality that reduces the recovery time for syndesmotic ankle sprains. DESIGN AND
SETTING: A mailed survey conducted from the Sports Medicine Department of Tufts University.
SUBJECTS: I sent a survey to the head athletic trainers of all 30 National Football League teams. Of the surveys mailed, 23 (77%) were returned. MEASUREMENTS: The survey consisted of 8 questions pertaining to syndesmotic ankle sprains with respect to mechanism of injury, playing surface, diagnostic tests, immediate and follow-up treatment modalities, best treatment, recovery time, and taping procedure.
RESULTS: A variety of causes were noted as being responsible for syndesmotic ankle sprains; the most frequently described mechanism of injury involved a rotational component. Playing surface was not thought to be a factor in the incidence of syndesmotic ankle sprains. Most athletic trainers (96%) indicated that plain radiographs were part of the diagnostic process, while 52% noted that magnetic resonance imaging was also ordered for suspected syndesmotic ankle sprains. The most frequently used modalities during the acute stage were ice, electrical muscle stimulation, casting or bracing (or both), and nonsteroidal anti-inflammatory drugs. Proprioception training, ultrasound, and taping were the most commonly used modalities during follow-up treatment. Immobilization, cortico-steroid injection, and ice and exercise were reported to be the best treatments for reducing recovery time of syndesmotic ankle sprains.
CONCLUSIONS: To date, no treatment plan or modality for syndesmotic ankle sprains has been shown to effectively provide an early and safe return to football. Therefore, the need is clear for prospective studies comparing treatment protocols and severity of injury.