Plantar Fascia Institute of MN

Foot | Ankle | Orthopedics

 
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Lateral Ankle Ligaments (outside of ankle)

  • ATFL (Anterior talofibular ligament)
    • Connects front of talus to fibula
    • Least elastic of the lateral ankle ligaments
    • Resists inversion (ankle turning in)
    • First ligament to be torn during inversion injury
  • CFL: Calcaneofibular ligament
    • Connects calcaneus (heel bone) to fibula
  • PTFL: Posterior talofibular ligament
    • Connects back of talus to fibula
    • Strongest lateral ankle ligament
    • The ligament is rarely injured, unless severe sprain occurs

Medial Ankle Ligaments (inside of ankle)

  • Deltoid Ligament or Medial Collateral Ligament
  • A thick triangular shaped structure that supports the entire inside of the ankle

Anterior Ankle Ligaments (front of ankle)

  • AITFL: Anterior Inferior Tibiofibular Ligament
    • Connects the two long bones of the shin, the tibia and fibula, on the front side.

Posterior Ankle Ligaments (back of ankle)

  • PITFL The posterior inferior tibiofibular ligament
    • Connects the two long bones of the shin on the back side
  • The Interosseous Ligament
    • Runs between the tibia and fibula from the knee all the way down to the ankle

What Does it Do?

  • The muscles and ligaments in the ankle provide stability during all static positions and dynamic movements. Muscle strains or ligament sprains can lead to instability.

How Does It Happen?

  • Ankle sprains occur when mechanical forces exceed the tensile limits of the ankle joint, capsule, and supportive ligaments
  • Ankle sprains normally occur when the foot is loading or unloading.
    • When the ankle is dorsiflexed, or fully loaded, there are articular restraints that prevent excessive motion.
  • Ankle sprains typically occur when the foot is pointed (plantarflexion) and when it is turned in (inversion).
    • Lateral ankle sprains account for 85% of sprains
  • Weakness in eversion muscles
    • Peroneus longus and brevis
  • Laxity of ligaments
  • Sequence of lateral ankle sprains
    • ATFL -> anterolateral capsule -> distal tibiofibular ligament -> CFL -> PTFL
  • High ankle sprain:
    • Also called syndesmotic sprain
    • Involves disruption/injury to ligamentous structure between the distal tibia and fibula
    • Mechanism of Injury: forceful turning out (external rotation) of foot, forceful eversion of talus, forceful dorsiflexion
    • In all injuries, the distal fibula is pushed away from the tibia.
    • Chronic instability of syndesmosis can lead to changes in pressure pattern or shearing forces which can lead to degenerative changes in the joint or cartilage.

Ankle Sprain Symptoms

  • Swelling at the time of injury or swelling up to a week later
  • May or may not be bruising depending on the severity
  • Tenderness/pain to ankle joint or ligaments around ankle
  • Changes to gait (walking) pattern
  • Feeling of instability with walking, turning, or balancing
  • Grading scale for ankle sprains:
    • Grade I:
      • Involves a stretch of the ligament with microscopic tearing, but no macroscopic tearing
      • Little to no functional loss
      • No difficulty weight-bearing
      • Minimal to no swelling
      • Localized tenderness to ATFL
      • Requires 2 weeks to return to normal
    • Grade II:
      • Involves a stretch of the ligament with partial tearing
      • Moderate functional loss. Mild-to-moderate joint instability.
      • Usually have difficulty bearing weight
      • Localized swelling
      • More diffuse tenderness to lateral ankle
      • Requires 2-6 weeks to return to normal
    • Grade III:
      • Involves complete rupture of the ligament
      • Inability to bear weight – typically, cannot bear weight without experiencing severe pain
      • Moderate-to-severe instability of the joint
      • Significant swelling
      • Bruising
      • Should seek medical attention to rule out rupture
      • Greater than 6 weeks to return to normal
    • Reasons for recurrent ankle sprains:
      • Healing of ligaments in lengthened position
      • Weakness of previously injured ligaments
      • Muscle weakness – especially peroneal group
      • Distal tibiofibular or subtalar instability
      • Genetic hypermobility
      • Loss of proprioception
      • Ankle impingement

Facts Related to Ankle Sprains & Strains

  • Ankle sprains are the most common sports injury. If left untreated, ankle sprains can lead to chronic instability and impairment.
  • Most acute ankle injuries occur in people ages 21-30 years old; however, they can happen in younger or older populations, in which case the injuries tend to be more serious.
  • Severe ankle sprains can also occur with ankle dislocation, medial malleolar fracture, or talar neck or compression fracture.
  • Talar displacement of greater than 1mm reduces the ankle weight-bearing surface 42.3% which results in asymmetrical load-bearing of the articular surface.
  • Approximately 85% of such sprains are inversion sprains of the lateral ligaments, 5% are eversion sprains of the deltoid or medial ligament, and 10% are syndesmotic injuries.

Minnesota Ankle Sprain Specialists 

If you are experiencing any symptoms of an ankle sprain please contact us today to set up your appointment with a Minnesota physical therapist. We have physical therapy clinics located in Minneapolis and Edina.

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