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A syndesmosis is a fibrous joint characterized by two adjacent bones connected by ligamentous structures, including a strong interosseous membrane (IOM). [1] The distal tibiofibular syndesmosis, which is comprised of two bones, the distal tibia and distal fibula, and four stabilizing ligaments, the anterior-inferior and posterior-inferior tibiofibular ligaments (AITFL and PITFL), the inferior transverse ligament (ITL), and the interosseous ligament (IOL), a distal continuation of the interosseus membrane. The syndesmosis is responsible for the integrity of ankle mortise. The syndesmosis is susceptible to compromise during high ankle sprains, ligament tears, and ankle fractures. This article will highlight the anatomical structure and function of the distal tibiofibular syndesmosis as well as its clinical and surgical significance.