Letters to the Editor

Tibiofibular Diastasis in the Injured Ankle


Am Fam Physician. 1998 Sep 15;58(4):864-866.

to the editor: Dr. Wexler's article,1 “The Injured Ankle,” should have mentioned that tibiofibular diastasis, which is easily seen on the anteroposterior view of the ankle (compare with the normal side if necessary), is a common cause of “late” ankle sprain pain. Also, early magnetic resonance imaging (MRI) of the talus can help in the diagnosis of undisplaced talus dome fractures.


1. Wexler RK. The injured ankle. Am Fam Physician. 1998;57:474–80.

in reply: I agree with Dr. Tom that tibiofibular diastasis is a cause of “late” ankle sprains. Not only may it be noticed on routine radiographs, but clinically it may be inferred on physical examination. Pain elicited by placing pressure on the distal portion of the tibiofibular complex can signal such a condition, and it can be confirmed with diagnostic imaging.

I disagree, however, with the suggestion that an “early” MRI is appropriate in the evaluation of ankle injury. The physical examination, history and radiographs are adequate initial components in the diagnosis of an injured ankle. Expensive diagnostic tests should be reserved for difficult and refractory cases.

Send letters to afplet@aafp.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680. Include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.

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This series is coordinated by Kenny Lin, MD, MPH, Associate Deputy Editor for AFP Online.



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