Musculoskeletal system

Anterior talofibular ligament

The anterior talofibular ligament is one of the ligaments which support the ankle joint. Do you know what a ligament is? The ligament is a structure which connects two bones in the body. An anterior talofibular ligament connects talus and fibula.

Anterior talofibular ligament, abbreviated as ATFL ligament arises from the fibular malleolus, which is located at the lateral part of the ankle. It connects the talus with the anterior part of the fibula, which is located laterally in the leg.

An anterior talofibular ligament tear is very common. It is one of the most commonly injured ligaments amongst the ligaments supporting the ankle. The thickness of AFTL ligament is 2 millimeters, the width is about 10 millimeters and the length is about 20 millimeters.

AFTL ligament is located just beside the posterior talofibular ligament. Other ligaments which are commonly injured in the ankle apart from AFTL ligament are the calcaneofibular ligament, posterior talofibular ligament, deltoid ligament and the anterior inferior talofibular ligaments. Sometimes these ligaments are injured or torn along with the anterior talofibular ligament.

anterior talofibular ligament

Anterior talofibular ligament tear or injury causes:

There are many different causes of anterior talofibular ligament tear or injury. People who participate in sports activities and the people who accidentally twist their foot or ankle suffer from AFTL injuries more commonly. Let us look at some of the most common causes of AFTL injury.

  • If you place your foot on the ground in a such a way that your ankle is placed in an abnormal position or awkward position, it might twist your ankle and cause anterior talofibular ligament tear or injury.
  • AFTL injuries can occur when you participate in some sport involving jumping and then you place your foot on the ground in an abnormal position.
  • It can happen when you walk on uneven areas and then suddenly twist your ankle.
  • Anterior talofibular ligament tear can also happen when you put your feet accidentally into a hole or depression on the land.
  • It can also occur if someone pushes you accidentally and then you end up twisting your ankle.
  • The anterior talofibular ligament can also happen if you wear high heeled shoes or footwear, as they can’t balance your foot properly.
  • It can also occur if you wear shoes which don’t provide sufficient support to the heels.
  • People involved in certain sports like football, basketball, and soccer are more prone to develop these injuries than the people involved in other sports.
  • Also, a younger population that is between 15 to 25 years of age are more commonly affected by anterior talofibular ligament tear than other age groups ass per a survey.
  • People with previous anterior talofibular ligament tear or history of AFTL injury are also more susceptible to develop anterior talofibular ligament tear again.
  • In any activity involving sudden inversion or inward movement of the ankle, anterior talofibular ligament tear can occur. In such an injury, the anterior talofibular ligament is displaced or torn away from the fibula or talus.
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Anterior talofibular ligament tear or injury grades:

There are three different grades of anterior talofibular ligament injury or tear. These grades are classified based on the extent of tear or injury and also the symptoms seen in the affected person.

Grade 1 AFTL injury:

In grade 1, no visible tear or injury of the anterior talofibular ligament is seen. It can have a mild degree of pain which doesn’t interfere with your daily life activities.

Grade 1 AFTL tear can also cause some degree of tenderness, that is pain upon the palpation of the lateral aspect or part of the ankle. There is no mechanical instability or laxity in the ankle joint when a person suffers from grade 1 anterior talofibular ligament tear.

Grade 2 AFTL injury:

In Grade 2 anterior talofibular ligament injury, a minor or partial tear can be seen in the ligament. Pain is severe in comparison to the grade 1 anterior talofibular ligament injury.

Also, tenderness is more when pressed over the lateral part of the ankle. Also, mild to moderate degree of joint laxity or mechanical instability can be seen.

Grade 3 AFTL injury:

In Grade 3 anterior talofibular ligament injury, a complete tear of the anterior talofibular ligament from the fibula can be seen. People affected with the grade 3 anterior talofibular ligament tear suffer from severe pain that is intolerable.

They also experience severe tenderness when palpated over the lateral part of the ankle. The joint instability or the laxity of the ankle are also very prominent.

Diagnosis of anterior talofibular ligament tear:

Let us look at the main ways to diagnose anterior talofibular ligament injury or tear.

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Physical examination:

Physical examination is the most important part of diagnosing anterior talofibular ligament tear. Anterior drawers test and talar tilt test are conducted to diagnose anterior talofibular ligament tear. If they are positive, we can suspect anterior talofibular ligament injury.

Also, the decreased joint stability or laxity on physical exam is suggestive of AFTL tear. The pain and tenderness on physical exam are some other features which point towards anterior talofibular ligament tear.

The patient cannot bear the weight of body due to pain in the ankle joint. Standing on the feet produces severe pain. There is decreased the range of motion of the ankle joint.

Radiographic studies:

Radiographic studies like X-ray, USG or ultrasound, MRI are used when the anterior talofibular ligament tear cannot be diagnosed by physical examination alone. But, these tests are used very rarely.

Some differential diagnosis of anterior talofibular ligament injury:

Many other ligament injuries and some other problems produce symptoms similar to an anterior talofibular ligament tear.

A physician needs to carefully evaluate all the possible causes of ankle pain and tenderness before coming to a conclusion about the diagnosis. Let us look at some of the most common differential diagnosis of anterior talofibular ligament tear.

  • Calcaneofibular ligament tear
  • Achilles tendon rupture
  • Achilles tendonitis or Achilles’ tendon inflammation
  • Ankle impingement syndrome
  • Ankle fracture

Anterior talofibular ligament tear treatment:

People suffering from Grade 1 anterior talofibular ligament injury recover very fast from the injury and resume normal activities.

Usually, they return to normal daily activities within a week. People with grade 2 and grade 3 anterior talofibular ligament tears require more time to recover. Let us explore all the possible treatment options for anterior talofibular ligament injuries.

Initial management:

The initial management protocol of the anterior talofibular ligament tear requires you to follow the “RICE” regimen. It is the abbreviation of Rest, Ice, compression and elevation. You need to apply ice over the lateral part of the ankle to reduce the swelling.

You can use compression bandage over the ankle to diminish the pain. You also need to place your ankle and foot at an elevation. Place few pillows on your bed and then place your foot over them. This reduces the accumulation of blood and fluid in the ankle and reduces the swelling.

There are some triggers which can aggravate the pain and swelling in anterior talofibular ligament injury. They are taking hot water bath, consumption of alcohol or standing on your feet excessively. You also shouldn’t apply heat to the affected area in the initial stages as it can aggravate the swelling.

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Therapy to reduce pain and swelling:

You will need to take analgesics like aceclofenac, diclofenac which is NSAIDS or non-steroidal anti-inflammatory drugs to reduce the pain and swelling. You also will have to take the help of some sort of electrical stimulation to reduce the pain and inflammation.

Such electrical stimulation includes TENS, magnetic therapy, etc. You only need to avoid weight bearing during the initial 2 days after the injury. During the initial 2 days, you will need to use crutches if needed. After 2 days or 48 hours, you need to start moving to reduce the swelling and pain.

Restoring complete range of motion:

As we have already mentioned, you can start weight bearing or moving after 48 hours after anterior talofibular ligament tear. You can use a strap or brace to support your ankle while moving.

When your pain and swelling reduces and you can walk properly, you need to perform exercises to increase the range of motion of your ankles. These include bicycling or cycling on a stationary bicycle.

Conditioning of muscles with exercises:

Now you also need to do exercises to strengthen the muscles around your ankle. You will need to do exercises like an inversion of the foot, eversion, dorsiflexion and also plantarflexion of the foot. Gradually you will need to perform more weight bearing exercises to restore normal activity of the ankle and foot.

Restoring proprioception:

Anterior talofibular ligament tear impairs the proprioception or balance of the body. You need to try to restore the proprioception of the body by doing some exercises. Try to balance yourself on one foot. Then try to use a rocket board to balance yourself.

Perform functional exercises:

First, you need to reduce the pain and swelling. Then you need to restore the range of motion and strengthen your muscles. Then you need to restore your proprioception. Later on, you will need to do functional exercises too.

Examples of functional exercises are jumping, twisting your body, hopping on one foot, etc. They restore the motion of the ankle joint completely.

Return to sports:

When you can perform functional activities without any discomfort, you can return to your favorite sporting activities. But, be careful while participating in sports. Try not to place your ankle and foot in abnormal or awkward position again. People who have suffered anterior talofibular ligament tear once are more prone to suffer from it again.

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