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Treating Acute Syndesmotic Ankle Injuries


Treating Syndesmotic ankle injuries with an ankle brace really took a leap forward with the invention of hinged-cuff technology.  We all know Syndesmotic or “high” ankle injuries occur when the ankle and lower leg rotate in opposite directions.  The ideal ankle brace for this condition would be one that restricts ankle and lower leg rotation.  That is what the “cuff” accomplishes in hinged-cuff  ankle brace design.

Ultra Ankle® introduced the first semi-rigid hinged-cuff ankle brace design in 2000.  Prior to that, semi-rigid ankle braces were designed with two separate side uprights that can move independently which sacrifices rotational stability.  By connecting both ankle brace side uprights together with a semi-rigid cuff, you create restriction/resistance in the rotational/horizontal plane.  Furthermore, now you have designed an ankle brace that has a solid U-shape in both the vertical and horizontal plane, creating resistance to ankle inversion “turning” and ankle rotation “twisting.”  The ultimate syndesmotic ankle brace design which we classify as hinged-cuff technology.

Since we introduced hinged cuff technology in 2000 other companies have also introduced their version of the same design.  Today, hinged cuff ankle brace design is the industry standard for designing semi-rigid ankle braces.  However all hinged-cuff ankle braces are not the same, especially when treating syndesmotic ankle injuries.  What typically accompanies rotational ankle pain with the high ankle injury is also weight bearing pain.  And if you have weight bearing pain, your chances of playing are slim.  That is why you need to select an ankle brace design that unloads the ankle in order to reduce weight bearing pain.  Lace-ups, tape as well as other semi-rigid ankle braces that have a heel opening or flexible heel cannot unload the ankle.  The ankle brace must have a solid U-shape in the vertical plain in order for the brace to absorb the impact or energy, not the sore ankle. 

At Ultra Ankle® we have developed two hinged-cuff technology ankle braces which restrict excessive ankle inversion and rotation, as well as unload the ankle.  The Ultra High-5® is a semi-rigid ankle brace designed for chronic ankle instability and reoccurring joint pain.  The Ultra CTS® is designed to treat acute syndesmotic ankle injuries by providing significant lower leg compression and stabilization to reduce ligament stress as well as unload the ankle to reduce weight bearing pain.  Last season an NFL record setting quarterback wore the Ultra CTS® for ten games for his syndesmotic ankle injury.  The Ultra CTS® is the ultimate game day ankle brace.

Rick Peters

Written by Rick Peters

Rick Peters is a Certified Athletic Trainer who has been advancing ankle bracing technology for three decades. Peters patented his first ankle brace in 1985, revolutionizing the industry by adding a hinge to traditional stirrup braces for greater mobility. In 1989 he was a founder and became President of Active Ankle Systems. In 1998 he co-founded Ultra Athlete LLC to develop the next generation of ankle bracing technology. Peters has 18 ankle brace patents and is considered an authority on ankle bracing technology worldwide.


Ultra Zoom 7"

Ultra Zoom®

Prevent & Perform

Help prevent ankle injuries all season long.

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Ultra High-5 8"

Ultra High-5®

Reinforce & Recover

Reinforce the ankle after a history of multiple ankle injuries.

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Ultra CTS 10"

Ultra CTS®

Treat & Rehabilitate

Maximum stabilization to treat acute ankle injuries.

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