Background Syndesmotic screw (SS) has been regarded as the gold standard for syndesmotic fixation. Syndesmosis surgical stabilization can also be accomplished by employing the suture button (SB) device, which consists of a fiber thread connecting two small metal buttons. This work aims to compare SB versus SS when treating distal tibiofibular syndesmotic injuries. Patients and methods The team designed a prospective randomized controlled clinical study including 42 cases, with ages between 18 and 60 years old, both sexes, developing ankle syndesmotic diastasis. Cases were categorized into two equal groups: group A, undergoing SB fixation, and group B, undergoing SS fixation. Results Visual analog scale at 6-month follow-up exhibited a significant reduction within group A as opposed to group B ( P =0.011). Range of motion showed a significant increase within group A as opposed to group B ( P <0.001). American orthopedic foot and ankle society (AOFAS) at 6 weeks exhibited a significant increase within group A as opposed to group B ( P <0.001). Postoperative complications exhibited insignificant variance between the groups. Conclusion Patients who had SB treatment had higher American orthopedic foot and ankle society scores and reduced (more favorable) visual analog scale scores for pain when walking, as well as discomfort on resting. Therefore, we can say that, as compared with the SS approach, the SB technique produces better functional outcomes and reduced incidence of damaged implants and joint malreduction. Therefore, at present moment, the SB approach is advised for the treatment of syndesmosis injury.