Anterior Talo-Fibular Ligament

Lateral ankle sprains (i.e. going over on the outside of your ankle) are among the most common injuries that individuals experience during athletic or recreational activities.  The most commonly injured ligament on the outside of the ankle is referred to as the anterior talofibular ligamental (ATFL).

Cause of ATFL Injuries

The ankle joint is more than a simple hinge joint.  During its arc of motion there is a combination of rolling and sliding that occurs.  The ligaments on the outside of the ankle, particularly the ATFL, are the most important stabilisers of the ankle joint because of their ability to try and limit you to point your toes and rotate your foot inward. 

Lateral ankle sprains occur as a result of landing with your ankle in a position that your toes are pointed and your foot is turned in i.e. overstretching the ATFL.  These injuries often occur when running on uneven terrain, stepping in a hole, stepping on another athlete’s foot during play or landing from a jump into an unbalanced position.  When this happens the full force of the body’s motion is placed on the anterior talofibular ligament.  This may stretch with some tearing of the fibres or it may tear completely.

What type of pain would I expect if I injured my ATFL?

As you ATFL is located just in front of and below the bone which is prominent on the outside of your ankle, you would usually expect noted tenderness and soreness in that area, possibly a difficulty with walking, often swelling and bruising may also occur.

Who is most affected?

A sprained ankle can happen to athletes and non athletes, children and adults. It can happen to people who take part in sports and physical fitness activities when they simply step on an uneven surface or step down at an angle.

In two thirds of cases the degree of sprain is mild or moderate, what is called a Grade I or Grade II.  A Grade I is where the ligament is slightly over stretched but no laxity, a Grade II means that the ligament has been partially torn with moderate laxity. (Grade III is a complete tear of the ligament).

Ankle injuries constitute 25% of sports related injuries including 21% - 53% of basketball injuries and 17% - 29% of all soccer injuries.  There are an estimated 42,000 severe ankle sprains per year in the UK alone.

What treatment would I need?

Following a thorough assessment at Alpha Physio, we would be trying to restore all full movement of your ankle with lots of massage and mobilisations and encourage healing of any damaged tissues through the use of ultrasound.  Adequate rehabilitation would focus on correcting proprioception (balance), rebuilding strength and restoring any loss of movement.  Sometimes we may suggest the use of an ankle support, but there is a lot of research to suggest that you would be better weight bearing without.

Will physio definitely fix it?

At Alpha Physio we have treated a lot of ankle injuries over the years, due to heavy involvement with soccer teams and as previously stated, approximately a third of all soccer injuries can often be ankle injuries. Lateral ankle injuries particularly would be the most common.

We have always had great results in getting people back to sport relatively quickly dependent on the extent of the injury. 

Surgical treatment for ankle sprains is exceptionally rare.  At Alpha Physio, since our clinic opened, we have only ever had one or two patients who after years of persistent instability and after recurrent episodes of treatment with other physiotherapists have required ankle surgery.

Most surgical procedures are designed to tighten or reconstruct the ATFL ligament in order that the person may hopefully prevent going over on their ankle in the future. For any of our patients that unfortunately have had to go through ATFL reconstruction, they have had a great response to post surgical treatment and ultimately gone back to playing sport.