Ankle Sprains and Instability

What are the ligaments of the ankle

The ankle joint is a hinge between the leg and the foot. The bones of the leg (tibia and fibula) form a joint with the top (dome) of the talus. The bones are held in correct alignment by strong bands of collagen tissue (ligaments) and muscles attach to the bones of the foot moving the ankle and adding stability to the joint.

The deltoid ligament is on the inside of the ankle and may be torn during severe ankle fractures. The outside of the ankle has three ligaments (lateral ligament complex) and it is the front band (anterior talo-fibular ligament) that is most commonly injured during severe sprains. There are also ligaments securing the tibia and fibula together which may be injured during severe sprains or fractures.

What injuries occur

A sudden twisting injury to the foot (usually with the sole pointing inwards - inversion injury) may stretch the ligament fibres. This may cause pain, swelling and bruising. Most people are able to walk even with a limp.

Further force may cause the ligament to rupture or for a flake of bone to be pulled from where the ligament attaches It is not usually possible to put any weight on the ankle following such injuries. Further force may cause fracture of the bones surrounding the ankle and dislocation of the joint. During all these injuries the smooth articular surface of the talus may also be dented as it is forced into the tibia. Sometimes tendons around the ankle joint may be damaged.

What should I do, will it recover and will I need an operation

The majority of simple sprains recover fully within a few days without more treatment than RICE - Rest, Ice, Compression and Elevation. (Do not place ice directly on the skin but wrap crushed ice or a bag of peas within a towel and then place on the swollen area for 20 minutes 4 times a day).

The safest option for more serious sprains is to seek a professional opinion from your GP. If you are unable to put weight through the ankle or there is deformity, then you should go to your GP or A&E. Even following rupture of one or more of the lateral ligaments the majority of patients return to active sports with physiotherapy and do not require an operation. The physiotherapy is designed to regain the normal motion of the ankle whilst strengthening and improving the co-ordination of the muscles controlling the stability of the ankle. (The co-ordination of the muscles is called 'proprioception" and relies upon nerve endings which may be damaged during a severe sprain). (Click here for link to ankle sprain exercises)

Sprains that show no signs of improvement of pain by 3 months or are painful 6 months after injury may have an injury to articular surface of the talus and may require further investigation and possibly an arthroscopy. (Click here for link to Ankle Arthroscopy)

Sometimes the ankle does not stabilise even after intensive physiotherapy. If the ankle continues to feel unstable and 'gives way" (repeated inversion injuries) then it may be necessary to perform an operation to reconstruct the lateral ligaments. There are several methods for this which include repairing the damaged ligaments or transferring a tendon from behind the ankle. You will normally have to be in a cast for 6 weeks after this followed by a course of physiotherapy. (Click here for information on ankle ligament reconstruction surgery)

Fractures of the ankle may be treated in a brace or plaster cast. The more serious fractures may require an operation to correct displacement of the bones and ensure that the joint is well aligned.