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Injuries to the tibioperoneal syndesmosis are more frequent than previously thought and their treatment is essential for the stability of the ankle mortise.Recognition of these lesions is essential to avoid long-term morbidity.Diagnosis often requires complete history, physical examination, weight-bearing radiographs and MRI.Treatment-oriented classification is mandatory.It is recommended that acute stable injuries are treated conservatively and unstable injuries surgically by syndesmotic screw fixation, suture-button dynamic fixation or direct repair of the anterior inferior tibiofibular ligament.Subacute injuries may require ligamentoplasty and chronic lesions are best treated by syndesmotic fusion.However, knowledge about syndesmotic injuries is still limited as recommendations for surgical treatment are only based on level IV and V evidence. Cite this article: EFORT Open Rev 2017;2:403-409. DOI: 10.1302/2058-5241.2.160084., Competing Interests: ICMJE Conflict of interest statement: None declared.