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Foot Ankle Surg. 2019 Aug;25(4):511-516. doi: 10.1016/j.fas.2018.03.006. Epub 2018 Apr 5.

The effects of weight bearing on the distal tibiofibular syndesmosis: A study comparing weight bearing-CT with conventional CT.

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Foot and Ankle Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK. Electronic address:
Foot and Ankle Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK.



Syndesmotic injures are common and weight bearing imaging studies are often advocated to assess disruption. Although studies have examined the anatomical relationship between the fibula and incisura, the effect of weight-bearing on the syndesmosis has not been well reported. We characterise the changes which occur at the syndesmosis during weight-bearing.


In this retrospective review we analysed the position of the fibula at the syndesmosis in a cohort of patients who underwent both non-weight-bearing and weight-bearing CT scans. The relative position of the fibula to the incisura was analysed to determine translation and rotation in the axial plane.


26 patients were included. Comparison of measurements revealed statistically significant differences between groups which indicated that on weight-bearing the fibula translated laterally and posteriorly, and rotated externally with respect to the incisura.


This is the first study to measure the differences in position of the syndesmosis during weight-bearing in a population of patients that have undergone both weight bearing and non weight bearing CT. Our study confirms that weight-bearing results in lateral and posterior translation, and external rotation of the fibula in relation to the incisura and our findings should help in future studies looking at the effect of weight bearing on syndesmotic pathology.


Computed tomography; Cone beam; Distal tibiofibular joint; Syndesmosis; Weight-bearing CT

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