Pain during weight bearing due to distal tibiofibular ligament injury is characteristic of which condition?

• A. Grade I sprain.
• B. Medial ankle sprain.
• C. Grade III sprain.
• D. Syndesmosis sprain.

Answer: (D)

Pain with weight bearing from injury to the distal tibiofibular ligaments points to a syndesmosis sprain, often called a high ankle sprain. These ligaments stabilize the two bones at the ankle joint, so when they’re damaged the mortise becomes unstable and weight bearing directly stresses the injured area, causing tenderness and pain above the ankle. This pattern helps distinguish it from a mild grade sprain that involves only the superficial lateral ligaments, a grade III sprain with more extensive lateral ligament tearing and instability, or a medial ankle sprain involving the deltoid ligament. The described signs align with injury to the distal tibiofibular ligaments, i.e., a syndesmosis sprain.