Ankle Ligament Injuries

Any time that we walk, our ankle ligaments are playing crucial roles in supporting our ankle joint and keeping us stable on our feet - instead of feeling weak, wobbly, and like our ankles could roll at any second. Each of our ankles has two “sets” of primary ankle ligaments - those on the inside of our ankle (called the medial ankle ligaments) and those on the outside (the lateral ankle ligaments).

The main medial ankle ligament is called the deltoid - a broad, strong ligament that is composed of multiple bands that originate from the bony bump on the inside of the ankle (called the medial malleolus) and attach to various bones of the foot. The deltoid ligament provides stability to the inner side of the ankle and prevents excessive eversion (outward rolling) of the foot.

On the outside of the foot, which is the most commonly injured side during an ankle sprain, we have:

  • Anterior Talofibular Ligament (ATFL): The ATFL is the most commonly injured ligament in lateral ankle sprains. It connects the front of the talus bone (ankle bone) to the fibula bone (the smaller bone of the lower leg). The ATFL resists excessive inversion (inward rolling) of the foot.
  • Calcaneofibular Ligament (CFL): The CFL runs from the fibula to the calcaneus bone (heel bone) and is positioned just below the ATFL. It provides additional stability to the outside of the ankle and also helps prevent excessive inversion of the foot.
  • Posterior Talofibular Ligament (PTFL): The PTFL is located at the back of the ankle and connects the fibula to the talus bone. It provides stability and limits excessive posterior movement (backward displacement) of the talus.

What Do Ankle Ligaments Do?

Ankle ligaments play very important roles in:

  • Stability: ankle ligaments help to stabilise the ankle joint and prevent excessive movements. They act as passive restraints, limiting the range of motion and preventing the ankle from rolling or twisting too far.
  • Injury prevention: ankle ligaments are also designed to protect the ankle joints from injury. They help maintain proper alignment and joint position during activities such as walking, running, jumping, and changing direction. By providing stability, ligaments reduce the risk of sprains and other ankle injuries.
  • Shock absorption: ligaments in the ankle joint, along with other structures like tendons and muscles, help absorb and distribute forces that occur during weight-bearing activities. They contribute to the joint's ability to absorb impact and protect the bones, cartilage, and other soft tissues from excessive stress.
  • Joint integrity: the ankle ligaments are also essential for maintaining the integrity of the ankle joint. They hold the bones together and prevent excessive joint play, which could lead to joint instability, chronic pain, and degenerative conditions like osteoarthritis.
  • Proprioception: your ankle ligaments contain specialised nerve endings called proprioceptors. These proprioceptors provide sensory feedback to the brain, helping us maintain balance, coordination, and spatial awareness. They contribute to our ability to perceive joint position and make appropriate adjustments to maintain stability during various activities.

What Are Ankle Ligament Injuries?

Ankle ligament injuries refer to damage or sprains that occur to these ligaments that surround the ankle joint. These injuries often result from excessive force, sudden movements, or trauma that cause the ligaments to stretch beyond their normal range of motion. The severity of an ankle ligament injury can vary, ranging from mild stretching to partial or even complete tearing of the ligaments.

What Are The Most Commonly Injured Ankle Ligaments?

The most common type of ankle ligament injury is an ankle sprain, which typically occurs on the lateral (outside) aspect of the ankle. This type of sprain often happens when the foot rolls inward (inversion) or twists, causing stress on the lateral ligaments. 

Ankle ligament injuries can also occur on the medial (inside) aspect of the ankle, although they are less common. Medial ankle sprains usually result from excessive outward rolling (eversion) of the foot, damaging the deltoid ligament.

What Are The Common Causes Of Ankle Ligament Injuries?

Ankle ligament injuries often involve sudden or excessive forces that affect the stability of the ankle joint. Some common causes of ankle ligament injuries include:

  • Awkward landings: landing on your foot in an awkward position, especially from a height or during activities like jumping or falling, can put excessive strain on the ankle ligaments. The impact and sudden directional changes can lead to ligament stretching or tearing.
  • Sports and physical activity: sports that involve rapid direction changes, pivoting, or jumping increases the risk of ankle ligament injuries. Sports like basketball, soccer, tennis, and volleyball are particularly associated with ankle sprains due to the dynamic movements involved.
  • Uneven surfaces: walking or running on uneven or unstable surfaces increases the likelihood of ankle injuries. Stepping on a pothole, stepping off a curb unexpectedly, or tripping on an object can cause the ankle to twist or roll, leading to ligament damage.
  • Insufficient warm-up or fatigue: not adequately warming up before physical activity or performing activities when fatigued can compromise the stability and control of the ankle joint. This increases the risk of ligament injuries during sudden movements or changes in direction.
  • Improper footwear: wearing shoes that lack proper support or stability, such as high heels, worn-out shoes, or shoes without appropriate ankle support, can contribute to ankle ligament injuries. Inadequate footwear may fail to provide the necessary stability and shock absorption required during movement.
  • History of ankle injuries: a history of ankle ligament injuries or inadequate rehabilitation following a previous injury can weaken the ligaments and make the ankle more susceptible to re-injury. Particularly, it can lead to a condition called chronic ankle instability where the ankle ligaments are left in a permanently weakened state.
  • Accidents and trauma: ankle ligament injuries can also result from accidents, falls, or trauma to the ankle joint, such as a direct blow from a soccer ball or being involved in a motor vehicle accident.

What Are The Symptoms Of Ankle Ligament Injuries?

Symptoms of ankle ligament injuries may include:

  • Pain and tenderness around the ankle joint
  • Swelling and bruising
  • Difficulty bearing weight or walking
  • Instability or a feeling of the ankle giving way
  • Restricted range of motion
  • In severe cases, a popping or tearing sensation at the time of injury

Ankle Ligament Injury Diagnosis

Our podiatrists can effectively diagnose an ankle ligament injury after an assessment based on your symptoms, your injury history and your medical history. At times, we may refer you for an ultrasound or other medical injury if there is reason to believe that you may have a significant injury - like a partial or complete tear - which is often accompanied with severe pain and difficulty bearing weight on the affected ankle. We may also order medical imaging if we suspect that alongside your ankle ligament injury there has also been an injury to any surrounding structures in the ankle. 

How Do You Treat An Ankle Ligament Injury?

The best approach to treating an ankle ligament injury does vary based on your symptoms and how severely the ankle ligaments have been damaged. Very mild injuries can be treated at home using the RICE protocol (rest, ice, compression, and elevation) - as well as the use of non-steroidal anti-inflammatory medications (NSAIDs) as needed - and you should notice that your symptoms should disappear within a few days, when you should be back to full strength and function.

Moderate to severe ankle ligament injuries need care from your podiatrist so they can assess the extent of the injury and create a tailored treatment plan that offers the right support at the right time. This may include:

  • Temporary ankle strapping to help reduce pain and prevent further injury
  • Custom foot orthotics that contain special features such as a raised lateral border, that best supports the ankle, adds stability during movement, and reduces the likelihood of a sprain
  • Ankle instability exercises to work on your ankle ligament strength, as well as proprioception training (balance and stability) and neuromuscular training to help retrain how your muscles activate
  • Footwear assessment to ensure that your shoes are helping support your ankle and prevent sprains, instead of leaving you vulnerable to future sprains
  • The EXO-L anti-sprain brace - our leading slimline ankle brace that is proven to prevent up to 95% of ankle sprains, while allowing your ankle to move freely and comfortably. Think of it like a seatbelt, kicking in when you need it most - the moment just before you roll your ankle and sprain your ligaments. We would typically recommend this after your rehabilitation is complete to help prevent future sprains, especially if you have ankle weakness or a history of repeated ankle sprains
  • Laser pain relief: the MLS laser is a safe and effective way to help relieve pain and facilitate healing in ankle ligament injuries

There are very few cases where ankle ligament repair surgery would be a first line of treatment - typically only when significant ligament tears or complete ruptures have been sustained.

How Long Does It Take For An Ankle Ligament Injury To Heal?

While this can greatly vary depending on the severity of the injury and individual factors, mild sprains may heal within a few weeks, while moderate sprains may take several weeks to a couple of months. Severe sprains or ligament tears that require surgery may take several months to fully heal and undergo rehabilitation.

During the healing process, different phases occur. In the acute phase (first week), pain management, swelling reduction, and protecting the ligaments are the primary focus. In the subacute phase (weeks 2-6), healing progresses, and efforts shift towards restoring range of motion and gradually reintroducing weight-bearing activities. Finally, in the remodelling phase (weeks 6-12+), the ligaments continue to strengthen, and a gradual return to normal activities and sports-specific training takes place.

What Are The Risk Factors Of Leaving An Ankle Ligament Injury Untreated?

One of the biggest risks of leaving your ankle ligament injury untreated is that it will lead to chronic ankle instability, where the ankle ligaments stay in a weakened state and increase your risk of repeated sprains and other injuries. Alongside this, you may be at risk of developing persistent pain, a reduced range of motion that can limit your ability to participate in activities you enjoy, and even puts you at risk of ankle arthritis. 

How Can You Prevent An Ankle Ligament Injury?

  • Always take the time to properly rehabilitate ankle ligament injuries with professional help
  • Engage in exercises that focus on strengthening the muscles around the ankle, such as calf raises, ankle circles, and resistance band exercises. Strengthening these muscles helps provide better support and stability to the ankle joint.
  • Include balance and proprioception exercises in your workout routine. These exercises improve your body's awareness of position and movement, enhancing your ability to maintain stability and react to sudden shifts in weight or uneven surfaces.
  • Choose shoes that provide adequate support, cushioning, and stability for your feet and ankles. Make sure the shoes fit properly and are in good condition, as worn-out shoes can increase the risk of injury.
  • Prior to engaging in physical activities or sports, perform a proper warm-up routine to increase blood flow and prepare your muscles and ligaments for activity. Follow it with dynamic stretching exercises that target the lower limbs, including the ankles.
  • Don’t overdo it - allow for sufficient rest and recovery time between workouts or intense activities. Avoid pushing through excessive fatigue, as tired muscles and decreased focus can increase the risk of injury.
  • Ensure you use proper technique and form when engaging in physical activities, particularly those that involve running, jumping, or changing directions. Incorrect movements can place excessive stress on the ankle ligaments.
  • Stay mindful of your surroundings and any potential hazards. Watch out for uneven surfaces, obstacles, or slippery conditions that can contribute to ankle injuries.
  • When starting a new activity or increasing the intensity or duration of your workouts, progress gradually. Allow your body time to adapt and strengthen, reducing the risk of sudden overload on the ankle ligaments.
  • Use the EXO-L brace - it’s proven to prevent 95% of all ankle sprains by kicking in the moment before you’re about to sustain a sprain


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