Anterior talofibular ligament injury symptoms

During sporting or leisure activities,¹lateral ankle sprains, or rolling over on the outside of your ankle, are among the most frequent injuries that people get.

The anterior talofibular ligament is the name of the ligament on the outside of the ankle that is most often damaged (ATFL).

The most typical scenario for an anterior talofibular ligament rupture is a sprained ankle with an inversion injury, either with or without plantar flexion. 

If concomitant bone avulsion occurs, it often occurs at the fibular malleolus rather than the talar end of the anterior talofibular ligament and is accompanied by the recognisable brilliant rim sign.

The most frequently injured ligament in ankle inversion injuries is the anterior talofibular ligament, one of the lateral stabilising ligaments of the ankle. It is also the weakest of the lateral collateral ligament complex.

Anatomically speaking, the anterior talofibular ligament is a flat quadrilateral ligament that inserts into the talar body immediately anterior to the lateral malleolar articular surface of the talus. It starts from the inferior oblique segment of the anterior border of the lateral malleolus.

Anatomical literature 3 states that most anterior talofibular ligaments have two or more bands. The anterior talofibular ligament and calcaneofibular ligament are the weakest lateral ankle ligaments, respectively, according to biomechanical tests.

A surgical approach, such as reapproximation of the torn ligament or reconstruction of the ligament repair, may be considered as a treatment option for persistent or residual ankle disability even though most ankle sprains are treated conservatively with functional rehabilitation or an Aircast or Air-Stirrup ankle brace.

Ankle sprains are a frequent injury; in the UK and the USA, new occurrences are recorded at a rate of 5000 and 27000 each day, respectively.

Despite the fact that they may happen in daily life, they are especially typical in sports like basketball and soccer 8. The anterior talofibular ligament, the weakest part of the lateral ligament complex around the ankle joint, is the site of the majority of ankle sprains.

The anterior talofibular ligament runs roughly horizontally when the foot is in its natural position, but when the foot is plantarflexed, the ligament is almost parallel to the long axis of the leg.

The ligament is only strained and at risk of damage in the latter posture, especially when the foot is inverted.

Approximately two-thirds of ankle sprains are isolated injuries to the anterior talofibular ligament, according to Broström and Lindstrand.

Soft tissue tears or avulsion fractures could be the injuries. There is widespread agreement that avulsion occurs more frequently at the fibular end of the ligament than the talar end, but the cause of this is unknown.

Avulsions are paradoxically more frequent at the talar end, according to laboratory tests on isolated bone ligament bone samples.

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Symptoms

Depending on the severity of the injury, there are different signs and symptoms of a sprained ankle. They may consist of:

• Pain, especially when you bear weight on the affected foot
• Tenderness when you touch the ankle
• Swelling
• Bruising
• Restricted range of motion
• Instability in the ankle
• Popping sensation or sound at the time of injury

CAUSE OF ATFL INJURIES

Ankle joints are not just simple hinge joints. There is a mix of rolling and sliding along its arc of motion.

Due to their capacity to try to prevent you from pointing your toes and rotating your foot inward, the ligaments on the outside of the ankle, especially the ATFL, are the most significant ankle joint stabilisers.

When you land with your ankle bent and your foot turned in, you are overstretching the ATFL and risk suffering a lateral ankle sprain.

Running on uneven ground, stepping in a hole, stomping on another athlete’s foot while they are playing, or landing from a leap into an imbalanced stance are common causes of these injuries.

The anterior talofibular ligament is therefore subjected to the whole power of the body’s motion in this situation. This might stretch with just a little fibre breaking or it could fully rip.

WHAT TYPE OF PAIN WOULD I EXPECT IF I INJURED MY ATFL?

As your ATFL is situated directly in front of and below the bone that protrudes on the outside of your ankle, you would typically anticipate experiencing pain and tenderness there. You might also experience difficulty walking, and swelling and bruising may also develop.

WHO IS MOST AFFECTED?

Both athletes and non-athletes, kids and adults, may sprain their ankles. Simply stepping on an uneven surface or stepping down at an angle might cause it to happen to persons who participate in sports and physical fitness activities.

Two-thirds of the time, a Grade I or Grade II sprain, or mild to moderate, is present. A Grade II means that the ligament has been partially torn with moderate laxity, while a Grade I indicates that the ligament is slightly overstretched with no laxity. (A full ligament rupture in Grade III)

25% of sports-related injuries are ankle-related, including 21% – 53% of injuries in basketball and 17% – 29% of injuries in soccer. In the UK alone, there are thought to be 42,000 severe ankle sprains every year.

WHAT TREATMENT WOULD I NEED?

After a comprehensive evaluation at Alpha Physio, we would aim to reestablish your ankle’s complete range of motion with a lot of massage and mobilizations, and we would utilise ultrasound to promote the healing of any injured tissues.

Correcting proprioception (balance), regaining strength, and regaining any lost mobility would be the main goals of adequate rehabilitation. Although there is a lot of data to back it, there are situations when we may advise against using ankle support and instead recommend that you bear weight without one.

WILL PHYSIO DEFINITELY FIX IT?

Due to our extensive participation with soccer teams, we have treated many ankle injuries at Alpha Physio throughout the years. As previously mentioned, around one-third of all soccer injuries may often be ankle injuries. The most frequent ankle injuries would be lateral ones.

Depending on the severity of the injury, we have always had great success in getting people back to sports relatively quickly.

Ankle sprains rarely require surgical intervention. Since the beginning of Alpha Physio, we have only ever had one or two patients who needed ankle surgery after years of ongoing instability and repeated bouts of treatment with other physiotherapists.

The ATFL ligament is usually tightened or rebuilt during surgery in an effort to help the patient avoid rolling their ankle in the future.

Any of our patients who, regrettably, had to undergo ATFL reconstruction responded very well to postoperative care and eventually resumed participating in sports.

Conclusion:

One of the three ligaments that make up the Lateral Collateral Ligament of the Ankle is the Anterior Talo-Fibular Ligament (ATFL). The ATFL is a thin ligament with a modest top-to-bottom widening.

Additional resources and citations

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  lateral ankle sprains