Distal pain is characteristic of which injury?

• A. Fracture of the fibula
• B. Tibial fracture
• C. Syndesmosis sprain
• D. Medial meniscus tear

Answer: (C)

Distal pain points to an injury at the distal tibiofibular syndesmosis, that is, a high ankle sprain. The ligaments that hold the tibia and fibula together just above the ankle are stressed with external rotation and dorsiflexion, so you get tenderness and pain concentrated near the distal leg, around the syndesmosis. This localization helps differentiate it from other injuries: a fibular or tibial fracture causes sharp bone pain right at the fracture site with possible deformity and swelling; a medial meniscus tear involves the knee, with pain along the medial joint line and sometimes locking, not the distal ankle area. So distal ankle pain is most characteristic of a syndesmosis sprain.