Lateral ankle ligament injury

Symptoms of lateral ankle ligament injury normally occur in three stages:

At the time of the injury you may experience:

• A popping or cracking sound
• Severe pain
• Rapid swelling in the first twenty-four hours
• Bruising may develop over the following days

A few weeks after the initial injury you may have:

• Mild pain and swelling
• Ankle stiffness especially after periods of rest

Long-term symptoms may include:

• A cracking noise when walking
• Your ankle may 'give way' and roll inwards
• Pain and tenderness in your ankle, especially when walking or weight bearing

Chronic lateral ankle ligament injuries may have similar symptoms to other ankle conditions such as:

Ankle osteoarthritis

A common condition where joint cartilage wears down over time resulting in pain and swelling in your joint.

In chronic lateral ankle ligament injury, pain is usually felt around the outside of your ankle, whereas osteoarthritis pain normally occurs across a wider area, including the top of your foot and the outside and inside of the ankle.

Osteoarthritis symptoms typically develop gradually, while chronic lateral ankle injury symptoms occur soon after injury.

Chronic lateral ankle injury tends to affect younger, active people whereas osteoarthritis is more common in people over fifty.

Sinus tarsi syndrome

This is a condition where the membrane around the sinus tarsi (a tunnel between bones in your feet) becomes inflamed, causing pain and tenderness on the outside of your ankle joint. Like lateral ankle ligament injury, it is often caused by a previous injury to the ankle.

Midfoot osteoarthritis

This is a condition where osteoarthritis affects the bones of your midfoot, causing pain, stiffness, and deformity

Ankle fracture

This may be a break in one or more bones of your ankle. Symptoms include severe pain, swelling and inability to put weight on your affected ankle.

Damage to the medial ligament

This is a sprain affecting the deltoid ligament on the medial (inside) side of your ankle. It typically causes pain, swelling and bruising of your whole ankle, but is usually worse on the inside of the joint. Medial ligament injuries are less common than lateral ligament injuries.

Dislocated ankle

The separation or dislocation of the bones in your ankle joint. This causes pain, swelling, deformity of your ankle, and inability to put weight on your ankle.

Other soft tissue damage to muscles or tendons in your ankle may also cause pain, swelling, bruising, and make it hard for you put weight on your ankle.

At your first consultation, you will be seen by a consultant orthopaedic surgeon, a doctor specialising in problems with the bones and joints.

Your consultant will ask you about your symptoms and whether you have injured your ankle before.

They will examine your ankle to look for outward signs such as bruising, swelling, tenderness or deformity.

We offer a series of tests to assess the ligaments of the ankle. They may include:

• An anterior draw test and talar tilt test, which assess the function of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL)
• A proprioception test, which assesses your body`s ability to know where it is in the environment by assessing your balance, body positioning, and awareness of movement

Your consultant may ask you to perform a range of movements such as walking, standing on one leg, hopping, and running to check your sense of balance and see how your ankle works when you are moving.

Will they need tests or scans?

Lateral ankle ligament injuries can often be diagnosed from your medical history, symptoms, physical examination, and the results of your special tests. Your consultant may order diagnostic scans if other injuries are suspected, or to plan your surgery. These may include:

• X-ray - to check the ankle joint and bones for signs of injury
• Ultrasound - to assess the degree of swelling and inflammation in the ankle joint
• Magnetic resonance imaging (MRI)- to check for injuries to the ankle joint or talus bone

How is a diagnosis made?

A diagnosis is made using a combination of your symptoms, physical examination, and the results of your tests and scans.

Why is this first consultation so important?

At Circle Health Group, your first appointment is very important as it's where your consultant will ask you about your symptoms, perform a physical examination, order any necessary tests, provide a diagnosis, and discuss possible treatments.

Your first consultation is also where we get to know you, discuss your expectations for treatment and encourage you to ask any questions you may have. It is important to us that you are as well-informed and comfortable as possible during your time with us, so please ask your consultant any questions you may have.

After making a diagnosis, your consultant will discuss possible treatment options with you and decide on the best option based on your symptoms and diagnosis.

Treatment for lateral ankle ligament injury is divided into nonsurgical and surgical treatments. Nonsurgical treatments include:

Acute phase management

In the hours and days after the initial injury, treatment is aimed at reducing pain and swelling. This will allow rehabilitation and physiotherapy to start as soon as possible and reduce the risk of chronic injury.

Treatment in this stage is known as RICE therapy

• Rest - rest your ankle to allow the ligament to heal
• Ice - apply ice packs to reduce swelling
• Compression - apply a compression bandage to your ankle to support your joint and reduce swelling
• Elevation - keeping your ankle elevated as much as possible helps reduce swelling

Other treatments during the acute phase may include:

• Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen to help with pain and swelling
• Your ankle may be immobilised in a boot cast
• If your pain is severe you may be given crutches and instructed not to weight bear for twenty-four hours
• A corticosteroid injection into the joint may be given to reduce swelling and inflammation

Ongoing management

In this stage of treatment, you will start a supervised rehabilitation programme of exercises to strengthen your muscles, increase your range of motion and proprioception, and restore function to your joint.

If your injury is severe or is not responding to nonsurgical treatments, your consultant may recommend surgery, such as arthroscopy or lateral ankle ligament reconstruction.

Arthroscopy

During arthroscopy surgery, a flexible camera is inserted through small incisions in the skin allowing your consultant to examine your ankle joint and assess the damage to the ligaments. During ankle arthroscopy, your consultant can also remove any damaged tissue, loose cartilage, or bone.

Ankle arthroscopy is normally performed under general anaesthetic, but in some cases may be done under spinal or regional anaesthesia. This means you'll be awake for the procedure but will be given a sedative to relax you and your ankle will be numb, so you won't feel any pain.

Lateral ankle ligament reconstruction

Like ankle arthroscopy, this type of surgery is also performed laparoscopically through small incisions in the skin. It may be performed under general or regional anaesthesia.

There are two types of lateral ankle ligament reconstruction surgery:

• Brostrom-Gould technique - is a procedure where the ligaments on the outside of your ankle are tightened up with sutures
• Tendon transfer - the damaged ligament is replaced with a tendon from another part of your body

Preparing for ankle ligament surgery

Your consultant will tell you everything you need to do to prepare for your surgery. If there's anything you're not sure about, or if you have any questions about how to prepare for your surgery, speak to your consultant or call the hospital for advice. Being well-prepared for your surgery will help to ease any anxiety you may have as well as allow your surgery and recovery to go more smoothly.

Try to be as healthy as possible before your operation by eating a healthy diet, taking regular exercise, not smoking, and drinking alcohol within safe limits. Being in optimal health before your surgery can reduce the risk of complications and speed up your recovery.

You may find it hard to get around for a couple of weeks after your surgery. If possible, ask someone to help with household tasks like cooking and cleaning during your recovery.

Before your surgery, tell your consultant about any medical conditions or allergies you have and any medication, including over-the-counter medicines you are taking.

Your consultant may tell you to stop taking some medications like blood thinners before your operation. This is to reduce the risk of bleeding during and after your surgery.

You will not be able to eat or drink anything from midnight on the day of your operation.

Potential risks and complications of ankle ligament surgery

Arthroscopic surgery is a safe procedure that has a much lower risk of complications than other types of surgery. As with all surgery, there is a small risk of complications including:

• Bleeding
• Infection
• Blood clots
• Adverse reactions to the anaesthetic
• Numbness

Your consultant will explain all the possible risks and complications before your surgery and answer any questions you may have about your procedure. Being as well-informed as possible about what to expect from your surgery will help put your mind at rest, allowing you to make an informed decision.

Recovery from surgery is different for everyone and depends on many factors including your age, general health, the type of procedure you had and your personal circumstances.

Talk to your consultant about what you can expect after your surgery.

We answer your most commonly asked questions about the procedure.

How many nights will I have to stay in hospital?

Ankle ligament surgery is normally done as an outpatient meaning you'll be able to go home the same day. In some cases, you may need to spend one night in hospital after your surgery.

Will I be able to drive home?

After your surgery, your ankle will be immobilised in a cast or boot, and you will not be able to drive home. Ask someone to collect you after your surgery, or we can arrange a taxi if you prefer.

How soon can I go back to work?

How soon you can go back to work depends on your individual recovery and the type of job you do. You will probably have your leg in a boot or cast and will need to use crutches for two weeks after your surgery. You will also need to keep your ankle elevated as much as possible for the first two weeks. If you have a sedentary job like office work, where you can elevate your leg, you may be able to return to work around two weeks after your surgery. If your job is physically active or strenuous, you will need to take longer off work. Talk to your consultant about when you can expect to return to work after your surgery.

How soon can I drive?

You will be able to drive when you can walk comfortably in your own footwear and perform an emergency stop safely. Talk to your consultant about when you can expect to drive after your surgery.

When will I be back to normal?

Everyone recovers from surgery differently and when you will be back to normal after your procedure can vary from a few weeks to a few months. Follow your consultant's instructions carefully after surgery and call the hospital if you have any questions.

You will have follow-up appointments with your consultant to check your progress after your procedure.

Talk to your consultant about when you can expect to be back to normal after your surgery.

How can I strengthen lateral ankle ligaments?

There are many exercises you can do to strengthen your lateral ankle ligaments. Which exercises are right for you depends on your injury and stage of recovery. Your consultant or physiotherapist will show you some appropriate exercises based on your individual needs.

What are the lateral ankle ligaments?

Ligaments are tough bands of connective tissue that join bone to bone. There are three lateral ligaments in the ankle, the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL) and the posterior talofibular ligament (PTFL). The lateral ligaments hold the ankle joint together and support and stabilise the joint.

How is ankle lateral ligament injury diagnosed?

Ankle lateral ligament injury is diagnosed using a combination of your medical history, symptoms, physical examination and in some cases tests and scans.

Should you use crutches for a lateral ankle ligament sprain?

If your pain is severe after spraining your ankle, you may be given crutches and instructed not to put any weight on your ankle for around twenty-four hours. After this, you should try to put some weight on your ankle, as this helps it to heal and reduces pain and swelling.

At Circle Health Group we have the experience and expertise to ensure the best possible care and outcome for our patients. As a patient with Circle Health Group you can expect the highest standards of care including:

• Flexible appointment times and locations that are convenient for you
• The freedom to choose which hospital and consultant best suit your needs
• Personalised, consultant-led treatment plans tailored to your individual needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private ensuite rooms as standard
• A range of delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to see a consultant or learn more about treatment for lateral ankle ligament injury book your appointment online today or call a member of our team directly on 0141 300 5009.

Content reviewed by Circle in-house team in January 2023. Next review due January 2026.

1. Lateral Ligament Injury of the Ankle, Physiopedia
2. Lateral ankle Ligament Reconstruction, John Hopkins Medicine
3. Sprained Ankle, OrthoInfo
4. Acute Ankle Sprain, PubMed