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
- 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
- Grade I:
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.