Often with a syndesmosis injury, there tends to be less swelling and it can mask as being something less in severity. Things to look out for are pain higher up in the ankle, shin, or knee, pain with lunging, pain on palpation over the AITFL, and pain with dorsiflexion and external rotation test. Additionally, you should be wary of a syndesmosis injury if an ankle injury is not progressing and pain does not settle even weeks after the trauma.
On assessment, once a syndesmosis injury is suspected it is important to attain further imaging to confirm the diagnosis. Once an MRI is attained and confirms a syndesmosis injury, management is either conservative or surgical. This depends on the severity of the syndesmosis injury, the damage to the surrounding structures, and the stability within the joint.