Ankle Ligaments & Their Functions
Medically Reviewed By : Dr Sravya, MBBS, MS
To discuss the pathomechanics and pathophysiology of severe sprains of the lateral ankle and long-term ankle instability, as well as the physiological anatomy of the ankle as it pertains to lateral ankle instability.
A collection of ligaments that are vital in tying the bones together and offering support for the ankle joint.
These ligaments include:
These ligaments are vital for maintaining ankle joint stability and preventing injuries during activities like walking, running, and jumping. Injuries to these ligaments can vary from mild sprains to more severe tears. Proper care and rehabilitation are crucial for recovering from ankle ligament injuries. If there is a suspicion of an ankle injury, seeking advice from a medical professional is recommended for accurate diagnosis and appropriate treatment.
The distal tibiofibular syndesmosis, the subtalar joint, and the talocrural joint make up the ankle complex. Together, these three joints enable the rearfoot to move in unison. Rearfoot motion is frequently described as taking place in the following three cardinal planes:
Talocrural Joint Anatomy
The medial malleolus, the tibial plafond, the lateral malleolus, and the dome of the talus come together to create the talocrural, or tibiotalar, joint. During weight bearing, torque may be transferred from the lower leg (internal and external rotation) to the foot (pronation and supination) thanks to the configuration of the talocrural joint. When considered alone, this joint—sometimes referred to as the “mortise” joint—can be seen as a hinge joint that permits plantar flexion and dorsiflexion.
The anterior talofibular ligament (ATFL), posterior talofibular ligament (PTFL), calcaneofibular ligament (CFL), and deltoid ligament all provide ligamentous support for the talocrural joint. The medial aspect of the ankle is supported by the deltoid ligament, with lateral support provided by the ATFL, PTFL, and CFL.
At a typical angle of 133° from the long axis of the fibula, the CFL runs from the lateral malleolus posteriorly and inferiorly to the lateral face of the calcaneus. The talocrural and subtalar joints’ excessive supination is limited by the CFL. The CFL limits excessive rearfoot inversion and internal rotation, and in vitro, tests have shown that it is tautest when the ankle is dorsiflexed. The second most often damaged of the lateral talocrural ligaments is the CFL.
The PTFL extends posteriorly from the lateral malleolus to the posterolateral side of the talus. The loaded talocrural joint is restrained against inversion and internal rotation by the PTFL, which has large insertions on the talus and fibula.
Subtalar Joint Anatomy
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It is unclear how extensively the subtalar joint is supported by ligaments. There are significant differences in the vocabulary used to describe each specific ligament and the roles that these ligaments play in the literature. The lateral ligaments can essentially be classified into three groups: Deep ligaments, peripheral ligaments, and retinacula are listed in that order.
The CFL, lateral talocalcaneal (LTCL), and tibiotalocalcaneal (FTCL) ligaments are among the subtalar joint’s periphery ligaments. The CFL plays a crucial role in limiting the calcaneus’ excessive internal rotation and inversion concerning the talus. Although the CFL generally does not join the calcaneus to the talus, there have been reports of unusual CFL attachments to the talus.
Lateral Ankle Ligaments
The LTCL only crosses the posterior subtalar joint while running anteriorly and parallel with the CFL. This LTCL has been described in a variety of forms, and occasionally its fibres are continuous with those of the CFL. The FTCL, also known as the ligament of Rouviere, extends along the lateral malleolus’ posterior side through the talus’ posterolateral surface, where it meets the posterolateral calcaneus. It aids in preventing over-supination and is posterior to the CFL.
An additional static supporter of the lateral ankle complex is the bifurcate ligament. It has two branches: the dorsal calcaneonavicular and the dorsal calcaneocuboid. This ligament prevents the midfoot from supinating; therefore, lateral ankle sprains frequently involve hyper supination mechanisms in addition to this injury.
Anatomical alterations following an initial ankle sprain result in insufficiencies that predispose the ankle to subsequent episodes of instability, which causes mechanical instability of the ankle complex. Pathologic laxity, poor arthrokinematics, synovial alterations, and the onset of degenerative joint disease are some of these modifications that may take place simultaneously or separately.
Synovial and Degenerative Changes
The development of degenerative joint lesions or insufficiencies brought on by synovial enlargement and impingement may potentially result in mechanical instability inside the ankle complex. Between the posterior subtalar joint capsule and the talocrural joint capsule, synovial inflammation has been seen. The impingement of hypertrophied synovial tissue within several bones of the ankle complex causes frequent bouts of discomfort and recurring ankle instability in patients, along with synovial inflammation.
The neuromuscular system that gives the ankle its dynamic support undergoes negative modifications as a result of injury to the lateral ligaments of the ankle. In 1965, Freeman et al. (16, 17) introduced the idea of functional instability.
They concluded that damaged articular mechanoreceptors in the lateral ankle ligaments caused proprioceptive impairments, which led to decreased balance in those with lateral ankle sprains. Even if it is significant, the role that decreased proprioception plays in ankle-ligament damage predisposes athletes to functional ankle instability. Impaired neuromuscular control must be accounted for in the pathoetiologic model for the dynamic defense mechanism to be effective against hyper supination within the rearfoot.
Lateral ankle sprains are frequently not properly treated, which causes them to recur frequently. Effectively assessing and treating ankle injuries depends on an understanding of the complex structure and mechanics of the ankle joint as well as the pathomechanics and pathophysiology associated with chronic and acute ankle instability.