High ankle sprains (HAS) cause subtle lesions in the syndesmotic ligaments of the distal tibiofibular joint (DTFJ). Current intrinsic anatomical parameters of the DTFJ are determined based on 2D imaging and uncertainty remains whether they differ in a HAS patients. The aim of this study is therefore two-fold: radiographic parameters will be determined in 3D and compared in a healthy vs sprained group. Ten patients with a mean age of 42,56 (SD = 15,38) that sustained a HAS and twenty-five control subjects with a mean age of 47,44 (SD = 6,55) were retrospectively included. The slices obtained from CT analysis were segmented to have a 3D reconstruction. The following DTFJ anatomical parameters were computed using CAD software: incisura width, incisura depth, incisura length, incisura angle, and incisura-tibia ratio. The mean incisura depth in the sprained group was 3,93mm (SD = 0,80) compared to 4,76 mm (SD = 1,09) in the control group, which showed a significant difference (P < 0.05). The mean incisura length in the group of patients with HAS was 30,81 mm (SD = 3,17) compared to 36,10mm (SD = 5,27) in the control group which showed a significant difference (P < 0.05). The other DTFJ anatomical parameters showed no significant difference. This study shows a significant difference in both incisura depth and incisura length between HAS patients and control subjects. These parameters could be used to identify potential anatomical intrinsic risk factors in sustaining a HAS.