{"id":1231,"date":"2024-07-25T17:15:39","date_gmt":"2024-07-25T15:15:39","guid":{"rendered":"https:\/\/kineaphp.fr\/?p=1231"},"modified":"2025-03-05T22:09:57","modified_gmt":"2025-03-05T21:09:57","slug":"lesion-de-la-syndesmose","status":"publish","type":"post","link":"https:\/\/kineaphp.fr\/?p=1231","title":{"rendered":"L\u00e9sion de la syndesmose"},"content":{"rendered":"\n<div class=\"wp-block-media-text has-media-on-the-right is-stacked-on-mobile\" style=\"grid-template-columns:auto 37%\"><div class=\"wp-block-media-text__content\">\n<p><strong>D\u00e9finition<\/strong><br>L\u00e9sion du ligament tibio-fibulaire inf\u00e9rieur<br>Epid\u00e9miologie<br>1 \u00e0 24% de toutes les entorses<\/p>\n\n\n\n<p>Facteurs de risque<br>&#8211; Sports de pivots, surface de jeux, sports de collision \u00e0 haute intensit\u00e9<\/p>\n<\/div><figure class=\"wp-block-media-text__media\"><img loading=\"lazy\" decoding=\"async\" width=\"219\" height=\"230\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2024\/07\/image-8-png.avif\" alt=\"\" class=\"wp-image-2935 size-full\"\/><\/figure><\/div>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<p><strong>Physiopathologie<\/strong><\/p>\n\n\n\n<p>&#8211; LTFAI (ligament tibio-fibulaire ant\u00e9ro-inf\u00e9rieur) : le premier touch\u00e9 en raison de sa position ant\u00e9rieure et de son r\u00f4le dans la r\u00e9sistance des forces en rotation lat\u00e9rale. Il est vuln\u00e9rable au rotation lat\u00e9rale forc\u00e9 coupl\u00e9 \u00e0 une flexion dorsale de cheville.<br>&#8211; MIO (membrane interosseuse) : c&rsquo;est une l\u00e9sion plus grave car elle stabilise longitudinalement l&rsquo;articulation <br>&#8211; LTFPI (ligament tibio-fibulaire posto-inf\u00e9rieur) : rare, il est plus r\u00e9sistant mais impliqu\u00e9 dans des l\u00e9sions plus graves.<br>Si le compartiment m\u00e9dial est atteint, c&rsquo;est un crit\u00e8re de gravit\u00e9 car cela entra\u00eenerait une instabilit\u00e9 majeure.<\/p>\n\n\n\n<div class=\"wp-block-media-text is-stacked-on-mobile\" style=\"grid-template-columns:20% auto\"><figure class=\"wp-block-media-text__media\"><a href=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2024\/07\/image-png.avif\"><img loading=\"lazy\" decoding=\"async\" width=\"271\" height=\"360\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2024\/07\/image-png.avif\" alt=\"\" class=\"wp-image-2916 size-full\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2024\/07\/image-png.avif 271w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2024\/07\/image-226x300.avif 226w\" sizes=\"auto, (max-width: 271px) 100vw, 271px\" \/><\/a><\/figure><div class=\"wp-block-media-text__content\">\n<p><strong>M\u00e9canisme l\u00e9sionnel<\/strong><br>Rotation lat\u00e9rale forc\u00e9e, flexion dorsale forc\u00e9e, avant pied fix\u00e9<\/p>\n<\/div><\/div>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<p class=\"has-text-align-center\"><strong>Les tests<\/strong><\/p>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p>Test de tension en rotation externe et dorsiflexion<br><\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Dorsiflexion External Rotation Stress Test | Syndesmosis Injury\" width=\"925\" height=\"520\" src=\"https:\/\/www.youtube.com\/embed\/s53uzyUv0bc?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<p>Squeeze test (compression tibio-fibulaire)<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"The Syndesmosis Squeeze Test | Syndesmosis Injury\" width=\"925\" height=\"520\" src=\"https:\/\/www.youtube.com\/embed\/ANgWSz0UoDg?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p>Test de Kleiger (test de provocation en rotation lat\u00e9rale)<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Kleiger&#039;s Test for Syndesmosis Injury | Clinical Physio Premium\" width=\"925\" height=\"520\" src=\"https:\/\/www.youtube.com\/embed\/bT47TuAtVjg?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<p>Le Heel Thumb test<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Heel Thump Test | Syndesmosis Sprain\" width=\"925\" height=\"520\" src=\"https:\/\/www.youtube.com\/embed\/NaU0-SyaZaw?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n<\/div>\n<\/div>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<p><strong>Therapeutique<\/strong><br><strong>Conservateur<\/strong><\/p>\n\n\n\n<div class=\"wp-block-media-text is-stacked-on-mobile\" style=\"grid-template-columns:30% auto\"><figure class=\"wp-block-media-text__media\"><img loading=\"lazy\" decoding=\"async\" width=\"260\" height=\"277\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2024\/07\/image-9-png.avif\" alt=\"\" class=\"wp-image-2941 size-full\"\/><\/figure><div class=\"wp-block-media-text__content\">\n<p>&#8211; L\u00e9sion stable : grade I et II stable (LTFAI + MIO) sans atteint du ligament delto\u00efde<br>&#8211; Immobilisation de la cheville quelques jours\/semaines dans une botte d&rsquo;immobilisation (maintien de la pince tibio-fibulaire)<br>&#8211; Renforcement des muscles de la cheville et de la jambe pour la force et la stabilit\u00e9<br>&#8211; Exercices de proprioception pour l&rsquo;\u00e9quilibre et la coordination<br>&#8211; 3 mois : introduction progressive de l&rsquo;activit\u00e9 sportive (course l\u00e9g\u00e8re, mouvement de pivot mod\u00e9r\u00e9s)<\/p>\n<\/div><\/div>\n\n\n\n<p><strong>Chirurgical<\/strong><\/p>\n\n\n\n<div class=\"wp-block-media-text is-stacked-on-mobile\" style=\"grid-template-columns:26% auto\"><figure class=\"wp-block-media-text__media\"><img loading=\"lazy\" decoding=\"async\" width=\"229\" height=\"394\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2024\/07\/image-10-png.avif\" alt=\"\" class=\"wp-image-2943 size-full\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2024\/07\/image-10-png.avif 229w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2024\/07\/image-10-174x300.avif 174w\" sizes=\"auto, (max-width: 229px) 100vw, 229px\" \/><\/figure><div class=\"wp-block-media-text__content\">\n<p>&#8211; Pour l\u00e9sion instable, incluant le ligament delto\u00efde<br>&#8211; Si non trait\u00e9, peut entra\u00eener des limitations fonctionnelles prolong\u00e9es et des complications (douleurs chroniques)<\/p>\n<\/div><\/div>\n\n\n\n<p><br><\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<p><strong>Les grades<\/strong> <strong>des l\u00e9sions de la syndesmose<\/strong><\/p>\n\n\n\n<p><strong>Stable : traitement conservateur<\/strong><br>&#8211; Grade I : l\u00e9sion partielle ou total du LTFAI uniquement<br>&#8211; Grade IIa : l\u00e9sion du LTFAI + MIO mais pas d&rsquo;atteinte du ligament delto\u00efde<\/p>\n\n\n\n<p><strong>Instable : traitement chirurgical<\/strong><br>&#8211; Grade IIb : l\u00e9sion du LTFAI + MIO + atteinte confirm\u00e9e du delto\u00efde<br>&#8211; Grade III : instabilit\u00e9 nette impliquant tous les ligaments + compartiment post\u00e9rieur, le ligament delto\u00efde et potentiellement la pr\u00e9sence d&rsquo;une fracture<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<p><strong>Vid\u00e9o<\/strong><br><em>Et si on parlait des atteintes de la SYNDESMOSE ? &#8211; Explications &amp; traitement<\/em> par NeuroXTrain<br>&#8211; Mobilit\u00e9 globale : flexion dorsale, flexion plantaire, circumduction<br>&#8211; Renfo triceps sural<br>&#8211; Renfo tibial ant\u00e9rieur<br>&#8211; Renfo fibulaires et tibial post\u00e9rieur<br>&#8211; Stabilit\u00e9 et proprioception<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Et si on parlait des atteintes de la SYNDESMOSE ? - Explications &amp; traitement\" width=\"925\" height=\"520\" src=\"https:\/\/www.youtube.com\/embed\/fdS8G2FcZF8?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<p><strong>Ankle mobility impact high ankle sprains<\/strong><br>Par Rehab-U<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Ankle mobility impacts high ankle sprains\" width=\"925\" height=\"520\" src=\"https:\/\/www.youtube.com\/embed\/9IUZ2cx3OFc?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<p>La stabilit\u00e9 c&rsquo;est aussi regagner en mobilit\u00e9. Avoir de bonnes amplitudes en dorsiflexion permet d&rsquo;absorber le m\u00e9canisme l\u00e9sionnel de l&rsquo;entorse de la syndesmose<\/p>\n\n\n\n<p>Exercices propos\u00e9es :<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Dorsiflexion isom\u00e9trique<\/strong> : assis au sol, \u00e9lastique autour du pied en dorsiflexion, reculer au maximum pour mettre en tension l&rsquo;\u00e9lastique et maintenir la dorsiflexion contre r\u00e9sistance en isom\u00e9trique pendant 2mn<\/li>\n\n\n\n<li><strong>Dorsiflexion dynamique sur \u00e9version du pied <\/strong>: poser le pied sur un plan inclin\u00e9 induisant l&rsquo;\u00e9version du pied avec un \u00e9lastique qui tire le pied en arri\u00e8re et en dehors. Faire des flexion du genou pour induire une dorsiflexion pendant 2mn<\/li>\n\n\n\n<li><strong>Travail de la proprioception avec le syst\u00e8me visuel et vestibulaire <\/strong>: appui unipodal, passer une balle d&rsquo;une main \u00e0 l&rsquo;autre en faisant de grands cercles au-dessus de la t\u00eate et en suivant des yeux et de la t\u00eate la balle.<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>D\u00e9finitionL\u00e9sion du ligament tibio-fibulaire inf\u00e9rieurEpid\u00e9miologie1 \u00e0 24% de toutes les entorses Facteurs de risque&#8211; Sports de pivots, surface de jeux, sports de collision \u00e0 haute intensit\u00e9 Physiopathologie &#8211; LTFAI (ligament tibio-fibulaire ant\u00e9ro-inf\u00e9rieur) : le premier&hellip;<\/p>\n<p class=\"more-link-wrapper\"><a href=\"https:\/\/kineaphp.fr\/?p=1231\" class=\"more-link\">Continue Reading<span class=\"screen-reader-text\"> \u00ab\u00a0L\u00e9sion de la syndesmose\u00a0\u00bb<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[358],"tags":[],"class_list":["post-1231","post","type-post","status-publish","format-standard","hentry","category-pathologie-cheville-pied"],"_links":{"self":[{"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/posts\/1231","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1231"}],"version-history":[{"count":18,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/posts\/1231\/revisions"}],"predecessor-version":[{"id":3865,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/posts\/1231\/revisions\/3865"}],"wp:attachment":[{"href":"https:\/\/kineaphp.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1231"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1231"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1231"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}