A high ankle sprain or syndesmosis injury is an injury to the ligaments that hold the fibula and tibia of the lower leg together. This injury often results with an impact that involves landing and twisting on the ankle. This injury can be managed both conservatively or with surgery depending on the severity of the sprain. In less severe cases physiotherapy, rest and anti-inflammatories can be used. In more severe cases a screw to hold the two bones of the lower leg together is required. Weight bearing x-rays which show the degree of sprain are required to determine the severity of the injury.