Superior Tibiofibular Joint Injury

STFJ - Superior Tibiofibular Joint Injury

Article by John Miller

What is the Superior Tibiofibular Joint?

Your superior tibiofibular joint (STFJ) is also known as the proximal tibiofibular joint. It is the joint between your tibia and fibula (lower leg bones) immediately below the outside of your knee. The STFJ joint is essential in allowing twisting movements of the leg, as well as load transfer between your feet and your leg.

Ligaments and joint capsules surround the joint to offer stability during movement and weight-bearing.

Importantly, the peroneal nerve (a nerve that supplies the lower leg and toes) wraps around the top of the fibula and can be compromised if there is an injury to the superior tibiofibular joint.

What Causes a Superior Tibiofibular Joint Sprain?

The superior tibiofibular joint injury commonly occurs following a traumatic incident involving the knee.

Other causes of dysfunction in this area include:

  • Osteoarthritis
  • Poor biomechanics of the knee or ankle joints
  • Repetitive forces going through the knee and ankle
  • Muscle imbalances in the lower limb
  • Presence of other physical lesions, e.g. ganglion, neoplasms
  • Hypomobility (not enough movement) of the tibiofibular joint
  • Hypermobility (too much movement) of the tibiofibular joint
  • Fatigue

What are the Symptoms of a Superior Tibiofibular Joint Sprain?

Injuries affecting the superior tibiofibular joint may or may not occur in conjunction with injuries to other joints in the knee. Symptoms of superior tibiofibular joint injury commonly include:

  • Pain over the outer aspect of the knee
  • A localised STFJ swelling.
  • Pain that is aggravated by weight-bearing activities, especially those involving high loads going through the lower limb such as running, quick direction changes or jumping
  • Feelings of weakness or giving way around the knee

If you have an injury to the superior tibiofibular joint and the peroneal nerve is affected, you may also experience pins and needles or numbness in the lower leg and foot. You may also experience foot or ankle weakness.

How is a Superior Tibiofibular Joint Sprain Diagnosed?

On examination, your physiotherapist or sports doctor will assess your superior tibiofibular joint. A palpation examination that tests the stability of the joint is usually all that is required to diagnose a superior tibiofibular injury. An MRI may be used to confirm the diagnosis.

What is the Treatment for a Superior Tibiofibular Joint Sprain?


Most patients with a superior tibiofibular injury start to recover within a few weeks of the damage with the appropriate rehabilitation.

Your physiotherapy treatment will aim to:

  1. Reduce pain and inflammation
  2. Normalise joint range of motion
  3. Strengthen the muscles of your lower limb
  4. Improve patellofemoral (knee cap) alignment
  5. Normalise your muscle lengths
  6. Improve your proprioception, agility and balance
  7. Improve your technique and function, e.g. walking, running, squatting, hopping and landing
  8. Minimise your chance of re-injury

We strongly suggest that you discuss your knee injury with a knee injury clinician such as a sports physiotherapist, sports physician or knee surgeon. This assessment will provide you with the most accurate information regarding your specific injury and rehabilitation program.


Most injuries to the superior tibiofibular joint successfully resolve with conservative treatment. In severe cases, you may require surgery. Risks of surgery include infection, persistent instability and pain, stiffness, and difficulty returning to your previous level of activity. The good news is that better than 90% of patients have no complications post-surgery.

Post-Surgical Rehabilitation

Post-operative knee rehabilitation is one of the most important, yet too often neglected, aspects of knee surgery. The most successful and quickest outcomes result from the guidance and supervision of an experienced Sports Physiotherapist.

Your rehabilitation following knee surgery focuses on restoring full knee motion, strength, power and endurance. You’ll also require balance, proprioception and agility retraining individualised towards your specific sporting or functional needs.

Please contact your trusted physiotherapist for specific rehabilitation advice.

How to Prevent a Superior Tibiofibular Joint Sprain?

There are several things you can do to reduce your risk of sustaining a superior tibiofibular injury. These include:

  • Correcting poor biomechanics of the knee or ankle joints
  • Adequate warm-up and stretching program before and after exercise
  • Correcting muscle imbalances in the lower limb
  • Adequate footwear during exercise
  • Avoid sudden increases in training frequency or intensity.

Return to Sports with a Superior Tibiofibular Joint Sprain

Athletes sometimes have particular difficulty returning to their sport once they have sustained a superior tibiofibular joint injury. It is crucial to complete your full, specialised rehabilitation program as prescribed by your physiotherapist to return to sport as quickly and safely as possible.

Common Causes - Knee Pain

Knee pain can have many origins from local injury, referred pain, biomechanical issues and systemic issues. While knee pain can appear simple to the untrained eye, a thorough assessment is often required to ascertain the origin of your symptoms. The good news is that once a definitive diagnosis is determined, most knee pain quickly resolves with the correct treatment and rehabilitation.

Knee Ligament Injuries

Knee Meniscus Injuries

Kneecap Pain

Knee Arthritis

Knee Tendon Injuries

Muscle Injuries

Knee Bursitis

Children’s Knee Conditions

Other Knee-Related Conditions

Knee Surgery

Knee FAQs

For specific information regarding your knee pain, please seek the assistance of a healthcare professional with a particular interest in knee condition, such as your knee physiotherapist.

Acute Injury Signs

Acute Injury Management.

Here are some warning signs that you have an injury. While some injuries are immediately evident, others can creep up slowly and progressively get worse. If you don't pay attention to both types of injuries, chronic problems can develop.

For detailed information on specific injuries, check out the injury by body part section.

Don't Ignore these Injury Warning Signs

Joint Pain

Joint pain, particularly in the knee, ankle, elbow, and wrist joints, should never be ignored. Because these joints are not covered by muscle, pain here is rarely of muscular origin. Joint pain that lasts more than 48 hours requires a professional diagnosis.


If you can elicit pain at a specific point in a bone, muscle, or joint, you may have a significant injury by pressing your finger into it. If the same spot on the other side of the body does not produce the same pain, you should probably see your health professional.  


Nearly all sports or musculoskeletal injuries cause swelling. Swelling is usually quite obvious and can be seen, but occasionally you may feel as though something is swollen or "full" even though it looks normal. Swelling usually goes along with pain, redness and heat.

Reduced Range of Motion

If the swelling isn't obvious, you can usually find it by checking for a reduced range of motion in a joint. If there is significant swelling within a joint, you will lose range of motion. Compare one side of the body with the other to identify major differences. If there are any, you probably have an injury that needs attention.


Compare sides for weakness by performing the same task. One way to tell is to lift the same weight with the right and left sides and look at the result. Or try to place body weight on one leg and then the other. A difference in your ability to support your weight is another suggestion of an injury that requires attention.

Immediate Injury Treatment: Step-by-Step Guidelines

  • Stop the activity immediately.
  • Wrap the injured part in a compression bandage.
  • Apply ice to the injured part (use a bag of crushed ice or a bag of frozen vegetables).
  • Elevate the injured part to reduce swelling.
  • Consult your health practitioner for a proper diagnosis of any serious injury.
  • Rehabilitate your injury under professional guidance.
  • Seek a second opinion if you are not improving.