Chronic injury of distal tibiofibular syndesmosis is the result of improper management of acute injury of thesyndesmosis. Acute syndesmotic injury is often accompanied by ankle fractures. As ankle fractures are healing, the symptoms of chronic syndesmotic injury begin to appear. With manual stress test, plain radiographs, and CT or MRI when necessary, the diagnosis seems a little complex but not difficult. Arthroscopic findings are the direct evidence of chronic syndesmotic injury. Because of insufficient recognition to this injury, the treatment techniques vary considerably without a golden standard for the treatment. Distal tibiofibular ligaments reconstruction and distal tibiofibular arthrodesis are the two main treatment strategies, while the latter one is still controversial, though the short-term follow-up has shown a good result. This paper is going to elaborate the diagnosis of chronic syndesmotic injury systematically and summarize the treatment concepts critically through a literature review.