Objective   To employ digital optimization design in the quest for the optimal placement position of the distal tibiofibular syndesmosis tunnel. Methods   A total of 100 distal tibiofibular syndesmosis CT datasets, acquired from 95 patients with syndesmosis injuries the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, were imported into the Mimics 19.0 software for the purpose of reconstructing models. Created virtual tunnels between the tibia and fibula and overlaid them on the reconstructed models as virtual models. Additionally, 3D printing was used to create actual models. In this study, eight parameters were measured. These included the length of the bone tunnel, the distance from the center of the tibial tunnel to the anterior and posterior aspects of the tibia, the distance from the center of the fibular tunnel to the anterior and posterior aspects of the fibula, the distance from the tibial tunnel point to the medial malleolus, the distance from the fibular tunnel point to the lateral malleolus, and the angle between the bone tunnel and the horizontal plane. Results Eight parameters were compared between the virtual model and the actual model, and there was no significant difference in the all measurement results of the actual bone tunnel and the virtual bone tunnel (P>0.05). The anatomical analysis revealed a statistically significant difference in gender (P<0.05), while there was no significant statistical difference observed in the affected side (P>0.05). Conclusion Digital optimization design can provide precise and reliable bone tunnels for elastic fixation of the tibiofibular syndesmosis injury, thereby providing good stability for the surgery and helping patients recover ankle joint function as soon as possible.