Ankle Ligament Injuries : Symptoms, Diagnosis & Treatment
Medically Reviewed By : Dr Sravya, MBBS, MS
Introduction
Ankle ligament injuries are one of the most common issues among people. It can affect any individual regardless of age and gender. Ankle injury is also known as an ankle sprain. It occurs when the ligaments around the ankle joint get stretched or torn. It can also happen during, jumping or running. Besides this, it can arise from accidental falls or missteps on uneven surfaces.
In this blog, we’ll learn about ankle ligaments. We will also understand what causes ankle injuries, their symptoms, and treatments. First, let’s understand what the ankle ligaments are.
Ligaments are strong bands of connective tissue. This tissue is made up of collagen (protein). This tissue helps connect bones. They provide support and stability for the joint. In the case of the ankle, several ligaments connect the bones of the lower leg (tibia and fibula) together with the foot bone (talus).
These ligaments in the ankle and foot allow you to stand, walk, run, and jump. They restrict ankle movement in unnatural directions. Let’s discuss the main types of ligaments in the ankle.
Types of Ankle Ligaments
The ankle is a complex joint. This joint has three main bones: the tibia, talus, and fibula. These bones are connected and stabilized by various ligaments. These ligaments provide support and limit excessive movements.
There are several types of ankle ligaments, such as,
1. The anterior talofibular ligament (ATFL)
It connects the talus bone to the fibula bone which is present at the front of the ankle. This ligament prevents the foot from moving too far forward. Additionally, it is the most commonly injured ligament.
2. Calcaneofibular ligament (CFL)
It connects the calcaneus bone to the fibula bone which is present at the back of the ankle. In addition, the CFL prevents the foot from twisting too far inward.
3. The posterior talofibular ligament (PTFL)
It connects the talus bone to the fibula bone at the back of the ankle. It helps prevent excessive backward movements of the ankle. Moreover, it is less commonly injured than the ATFL and CFL.
4. Deltoid Ligament
It is a strong ligament on the inner side of the ankle. It is less frequently injured than the lateral ligaments (ATFL, CFL, and PTFL) because it is broader and more stable.
There are also subparts of some of these ligaments. They all work together to provide stability and support to the ankle joint and prevent excessive movement in any direction.
Ankle ligament injury can be of three types
The most common ankle ligament injury is an inversion injury. This injury happens when the foot rolls too inward. It causes tearing of the lateral ligaments (ATFL, CFL, and PTFL), because lateral ligaments are weaker as compared to other ankle ligaments.
- In less common cases, eversion injuries can also occur. It happens when the ankle rolls outward and damages the deltoid ligaments. This type of ankle injury is rare. However, it can happen while jumping, and running.
- When syndesmotic ligaments get damaged then a high ankle sprain occurs. It happens when your ankle gets extremely twisted. This type of injury usually happens in competitive athletes who play soccer, hockey, basketball etc.
Now let’s discuss the most common ligament injury symptoms.
As we have mentioned above ATL (Anterior Talofibular Ligament) is the most common ankle injury. So let’s discuss its symptoms.
What are the Anterior Talofibular Ligament Injury Symptoms?
When this ligament gets stretched or torn, it can cause various symptoms, Such as:
- Pain: It is the most common symptom of an ATFL injury. Commonly, the pain is felt on the front and outer side of the ankle, near the ligament area.
- Swelling: An ATFL injury can also lead to inflammation in the ankle, which can result in swelling around the injured ligament.
- Bruising: An anterior talofibular ligament (ATFL) injury can cause bruising by damaging the blood vessels in the ankle joint. Because when the ATFL gets stretched, it can cause bleeding under the skin which can lead to discoloration and bruising.
- Stiffness: When the ATFL injury occurs, it can lead to instability and inflammation in the joint, which can make it difficult to move or bend the ankle. Over time, the ankle joint may become stiff and less flexible, thus it is difficult to perform everyday activities with the affected joint.
- Instability: The ATFL is responsible for preventing the foot from moving too far forward, and when an injury occurs, the ankle joint can become unstable. It can make it difficult to walk with affected feet thus chances of falls also increase. As time passes, the ankle joint may become more prone to further injuries as the weakened ligament can't provide adequate support and stability.
- Limited Range of Motion: When damage to the ATF ligament occurs, it can lead to instability and inflammation in the joint. Which makes it difficult to move or bend the ankle, resulting in a limited range of motion. Additionally, it will also cause stiffness and discomfort.
- Snapping or Popping Sensation: ATFL injury can cause the bones to shift or move out of place. Thus, it can cause a snapping or popping sensation in the ankle, especially when you try to walk with the affected foot.
Other types of ligament injuries, for example, the Calcaneofibular ligament (CFL) and posterior talofibular ligament (PTFL), also have similar symptoms. However, it’s important to note that the severity of the symptoms can vary depending on the grade of the ankle sprain.
Let’s discuss the grades in detail to make it understandable,
Grade 1
It is a mild stretching of the ligament. It causes minimal pain, swelling, and no significant loss of function.
Grade 2
It is a partial tearing of the ligament. It causes moderate pain, swelling, and some loss of function.
Grade 3
It is the complete tearing of the ligament, leading to severe pain, extensive swelling, and complete loss of function.
Diagnosis: How to Identify an Ankle Injury Ligament
These types of injuries can be diagnosed through a combination of methods such as physical examination, medical history, and imaging tests.
- During a physical examination, the doctor or therapist will examine the affected ankle for signs of swelling, bruising, and tenderness. They may also perform specific tests, such as the talar tilt test or anterior drawer test, to check the stability of the ankle joint.
- The doctor or therapist may also ask about the patient's medical history and any previous injuries to the ankle or foot.
- Imaging tests, such as X-rays, MRIs, and ultrasounds may also be used to check the level of the injury and affected ligaments. Thus these tests can help in appropriate treatment.
What is the Ankle Ligament Injury Treatment?
The treatment of ankle ligament injuries depends on the severity of the injury. The main targets for treatment are to reduce pain and promote healing. According to this goal, the treatment approach can be divided into several stages:
Such as,
1. Immediate Care (RICE)
- Rest: You should rest to treat the affected ankle. Also, avoid putting weight on the injured ankle. You can use crutches to reduce the weight on an injured ankle.
- Ice: Applying ice packs to the injured area for 15-20 minutes every 2-3 hours reduces swelling and inflammation. However this method only works during the first 48 hours of injury.
- Compression Bandage: A compression bandage helps control swelling. However, make sure not to wrap it too tightly to avoid restricting blood flow.
- Elevation: Elevation is helpful for immediate treatment of ankle sprain. For example, to minimize swelling, keep the injured ankle elevated above the level of the heart whenever possible.
2. Medications
Medications reduce pain in the affected area. For example, painkillers like ibuprofen or acetaminophen, can help reduce pain and swelling in the ankle joint. They also make the ankle easier to move and bear weight on the affected foot. In some severe cases, the doctor may also suggest stronger pain medications, such as opioids, to help manage severe pain.
However, these medications must be used with caution, as they can be addictive and have other side effects.
3. Immobilization
Immobilization may also help in ankle ligament injury treatment. It limits movement in the affected joint. It will give relief from pain. Moreover, it will prevent further damage and promote healing. Depending on the severity of the injury, the doctor may recommend immobilization of the affected foot using a cast, brace, or splint.
4. Physical Therapy
This method is helpful to treat ankle ligament injuries. This method helps restore strength, flexibility, and range of motion in the affected joint. Because after an ankle ligament injury, the muscles and ligaments in the affected foot may become weak or stiff, which makes it difficult to move or bear weight on the foot.
By using a variety of exercises and techniques you can tackle these issues that arise by injury. Additionally, physical therapy also promotes healing and improves function in the affected joint.
5. Gradual Weight-Bearing
Complete immobilization of the joint can lead to muscle weakness and stiffness, which make it difficult to regain full function in the affected joint.
Thus, gradual weight bearing can help address this issue. It allows the joint to gradually adapt to the demands of weight-bearing activities. You can also use crutches or other assistive devices to gradually increase the weight bearing on the affected foot over time.
6. Proprioceptive and Balance Training
Proprioceptive and balance training can be effective treatments for ankle ligament injuries. This method helps to improve the patient’s balance, coordination, and proprioception (the sense of where the body is in space), which are often reduced after the injury.
Specific exercise can help in improving the patient’s proprioception and balance. For example, the therapist may use exercises that involve standing on one leg or standing on an unstable surface, such as a foam pad or balance board.
7. Supportive Footwear
Supportive footwear provides additional support and stability for the foot and ankle. For example, shoes with a wide base can help distribute the weight of the body more evenly across the foot. It reduces the pressure on the ankle joint.
Wrapping Up
Thus, ankle ligament injuries are common injuries that can happen due to various reasons such as, sports, exercise, or everyday activities. Although the injury can range from mild to severe. It may also involve one or more ligaments in the ankle joint. However various treatments are available for this condition such as rest, ice, compression, and elevation, as well as physical therapy and rehabilitation exercises. These treatments work best for mild injuries.
Surgery may be necessary to repair damage to the ankle joint in severe injuries. So, with proper treatment and rehabilitation, most patients recover from ankle ligament injuries and return to normal activities.