Syndesmosed injuries are rare, but very debilitating and ferquently misdiagnosed. the purpose of this essay is to review the anatomy, biomechanics, mechanisms of syndesmotic injuries, clinical examination methods, diagnosis, management of the injuries, and complication of management and missed diagnosis .External rotation and excessive dorsiflexion of the foot on the leg have been reported as the most common mechanisms of injury . the injury is most often incurred by individuals who participate in skiing, football, soccer, and other sport activities played on turf . the external rotation and squeeze tests are reliable tests to detect this injury. The ability of imaging studies to assist in an accurate diagnosis may depend on the severity of the injury .In pure syndesmotic injury the intervention programs with early rigid immobilization and pain relief strategies, followed by strengthening and balance training are recommended. Heel lift and posterior splint intervention can be used to avoid separation of the distal syndesmosis induced by excessive dorsiflexion of the ankle joint. Surgical intervention is an option when a complete tear of the syndesmotic ligaments is present or when fractures are observed.The management of injury to the distal tibiofibular syndesmosis remains controversial in the treatment of ankle fractures. Operative fixtion usually involves the insertion of a metallic diastasis screw. There are a variety of options for the position and characterization of the screw, the type of cortical fixation, and whether the screw should be removed prior to weight-bearing.