Syndesmosis injuries at the ankle are a common injury that may be missed easily as a result of the fact that normal roentgenograms fail to reveal the magnitude of soft-tissue injury. Magnetic resonance imaging or external rotational stress roentgenograms under anesthesia will assist in making the diagnosis. Syndesmosis injuries can occur with or without proximal fibular fractures, interposed deltoid ligament, or peroneal tendons. Technically demanding, accurate surgery with transfibular screw fixation, including three or four cortices, will ensure a satisfactory result.