Ankle Syndesmotic Injury With Posterior Tibial Tendon Rupture

SUMMARY: Isolated ankle syndesmotic injuries are uncommon and are typically discussed in the context of athletic high ankle sprains; however, concomitant rupture of the posterior tibial tendon represents an exceedingly rare injury pattern. This case highlights the importance of maintaining a high index of suspicion for associated soft-tissue pathology in patients presenting with syndesmotic instability in the absence of fracture. This case underscores the need for comprehensive clinical and imaging evaluation of isolated syndesmotic injuries and supports primary tendon repair when rupture is identified.