The anterior talofibular ligament is a ligament in the ankle that is weak enough to be called the most commonly damaged ligament in that area. It is a ligament located on the lateral aspect of the ankle connecting the fibula to the talus in the ankle. It is located near the posterior talofibular ligament.

Anterior talofibular ligament begins in the lateral malleolus, which is the bony prominence on the outside of the ankle, extends down into the talus to help support the ankle. It is about 2 mm thick, about 10-12 mm wide and about 20 mm long. It helps to maintain the stability of the ankle, protecting it from inversion injuries to the ankle.

Anterior Talofibular Ligament Injury

Sprains to the lateral aspect of the ankle are extremely common during recreational activities or sports. The anterior talofibular ligament is the weakest so that it is most likely to become injured when the ankle suddenly inverts while walking.

How It Happens

Whenever there is a ligament within the ankle that becomes stretched, torn or bruised, an "ankle sprain" can occur. This causes a lack of motion about the ankle. Because of its position on the lateral aspect of the ankle, the anterior talofibular ligament takes on most of the impact when the ankle twists in such a way as to invert the foot inward.

The anterior talofibular ligament becomes stretched or torn when:

• You land your foot down onto the ground in such a way that the ankle twists inward
• You are running or walking on terrain that is uneven
• You step into a hole
• You accidentally step on another player's foot during athletics
• You land in an unbalanced way after jumping

The weight of the body then pushes down on the ligament, causing it to stretch unnaturally or to tear away from the fibula completely. It can actually take some of the bone with it and cause an avulsion fracture of the fibula.

How Bad Is the Injury?

There are three grades to an ankle sprain that you should know about. These include the following:

• Grade 1 sprain. This is a mild sprain that causes minimal pain and very little instability of the ankle. There can be stiffness of the joint and problems with pain when walking or running. It usually doesn’t interfere with the ability to play, especially when an ACE wrap is applied. It involves a bit of stretching or a small amount of tearing of the anterior talofibular ligament as well as some minor swelling on the outer aspect of the ankle.
• Grade 2 sprain. This usually causes a type of moderate to severe ankle pain that gets worse when trying to walk on it. The athlete will likely have a limp and be unable to play any further. There can be a bit of bruising just beneath the lateral malleolus of the ankle and the joint will be stiff. There is usually some joint instability because some of the fibers of the anterior talofibular ligament have become torn.
• Grade 3 sprain. When this happens, there is usually a complete rupturing of the affected ligament. The pain will be severe and there will be a great deal of bruising and swelling about the joint. The athlete will experience a severe joint instability and may not be able to walk on the foot.

Management of Anterior Talofibular Ligament Injury

The vast majority of sprains of the ankle are grade 1 sprains which will resolve spontaneously without treatment in a few days. If treatment is necessary, these are some management tips:

1. Initial Management

In the beginning stages of an anterior talofibular ligament sprain, you need to follow the RICE rules, which stand for "rest, ice, compression, and elevation". This will take care of most grade 1 and grade 2 sprains. Besides using the RICE treatment, you should avoid exacerbating the injury by taking hot showers, drinking alcohol, walking on the joint or applying heat rubs.

2. Reduce Pain and Swelling

You can use analgesics for pain or electrotherapeutic techniques such as a TENS unit, magnetic field therapy, or interferential therapy. You can perform gentle mobilization and soft tissue therapy after 48 hours have gone by. When the pain and swelling have been reduced, there will be less muscle inhibition near the joint so you can perform range of motion exercises.

3. Restore Range of Motion

Initially, you may have to be non-weight bearing—at least for the first twenty-four hours. After that you can start bearing weight on the foot. You should use an ACE wrap or brace to protect the joint and to decrease the odds of injuring the joint when walking. As soon as the pain is better, you should attempt active range of motion exercises such as stationary bicycling.

4. Start Muscle Conditioning

You should begin to strengthen the surrounding muscles when the pain is better. Start with active exercises and add increase resistance over time. You should participate in dorsiflexion, plantar flexion, eversion, and inversion of the ankle. Eversion exercises are especially important in order to prevent further injury to the ligaments. You should try to do weight-bearing exercises as soon as you can.

5. Restore Proprioception

You should begin doing proprioceptive training as soon as the pain allows. This involves learning how to balance on one leg, or using a rocker board or mini-tramp so that you can get your balance back.

6. Try Functional Exercises

These include things like figure-of-eight running, twisting, hopping and jumping. These should be done when the pain has resolved and there is complete range of motion of the ankle with good proprioceptive skills.

7. Return to Sporting Activities

You can return to play when the functional exercises can be done without pain. However, you should still tape or brace the ankle. It doesn't matter if you tape the ankle or brace it as long as it's comfortable. Keep bracing or taping even when you recover from anterior talofibular ligament to prevent further injury.