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Anterior Talofibular Ligament injuries

The ATFL ligament is the most common injured ligament in the foot and ankle. It is located at the front and outer side of the foot. The ATFL stops the foot from sliding forward in relation to the shin bone. The ATFL also stop inversion of the foot (when the foot rolls inwards) and adduction of one of the ankle joints called the Subtalar joint. The subtalar joint also knows as the Talocalcaneal joint is where the talus (lower part of ankle joint, top of the foot), meets the calcaneus (heel of the foot).

The most common way to injure this ligament is by inversion, adduction and movement of pointing the toes. Which is basically what the ATFL ligament tries to with stand. These injuries can occur either with or without contact. You may feel a sense of the ankle “giving way”, and possibly hear a pop or crack. 

How is ATFL damage diagnosed? Two orthopaedic tests are commonly carried out, these are the anterior drawer test and talar tilt test. A positive indication would be laxity (increased range of motion), or pain.  Imaging is another procedure in terms of diagnosis. Plain xray may be carried out, or ultrasound and MRI is recommended for an inversion sprain in those with chronic ankle instability.  

How long will it take to recover? Depending on the severity of the injury and history of the patient.

Generally speaking, ligaments can take roughly 6 weeks to heal. 

  • Grade 1 sprain: A strain or tear involving a few fibres of the ligament. Swelling and bruising should decrease by 2 weeks, and no pain on movement at 3 weeks with low intensity movements. Up to 6 weeks may be required for more rapid movements, to ensure stability and proprioception.
  • Grade 2  sprain: This is larger than a grade 1 sprain, involving more than a few fibres in the ankle ligament. This usually takes 4-6 weeks, prior to returning to sport.
  • Grade 3 sprain: This is a complete rupture of the ankle ligament. It may require surgery, and possible associated damage such as fractures. This sever ankle sprain may take between 6 to 12 weeks, but will vary on the individuals history, the severity and associated damage. 

What is the early management of ATFL sprains or tears? Depending on the severity.

  • Crutches or a moon boot may be used to immobilise the foot.
  • Rest initially is required with mild movements back and forth at the ankle to decrease swelling. 
  • Ice to reduce swelling and inflammation.
  • Compression to reduce swelling and inflammation.
  • Elevation to decrease swelling.

After the acute phase, rehabilitation must be addressed ASAP to restore normal range of motion and functioning of the ankle. Strength in the lower leg will first be addressed, starting with the muscles surrounding the ankle, working up to the muscles around the hip and core, crucial for long term recovery. Once strength and range of motion is increased, proprioception is incorporated. Proprioception is the awareness of your body in space, basically your balance.  By incorporating all of these factors in your ankle sprain rehabilitation, you will be less likely to reinjure that ankle and improve prevention on unstable surfaces. Finally, sport specific movements are incorporated. 

If you have any concerns regarding your ankle, please come see our friendly chiropractors at Lakeside Chiropractic. Our sports chiropractors will be able to assess the pain and provide appropriate care. A multimodal approach will be used to treat an ankle sprain, depending on the individual’s needs. Here at Lakeside Chiropractic our treatment can include soft tissue therapy, rehabilitative exercises, dry needling, mobilisations, cold laser therapy, electro therapies, taping and manipulative therapy. 

Lakeside Chiropractic is located central to the northern suburbs of Perth, Joondalup 6027. Surrounding suburbs include; Currambine, Iluka, Hillary’s, Burns Beach, Ocean Reef, Kinross, Mullaloo, Alkimos, Tapping, Connolly. You can call Lakeside Chiropractic on 9300 0095 to make an appointment or book online at We accept all major health insurances and provide HICAPS with SGIO, BUPA, AHM, HBF, HIF, and Medibank. If your private health care isn’t listed please ask the reception upon making your booking.

December 19, 2017