(Ankle sprain) ATFL Tear

Anterior talo fibular ligament is most common injured ligament during ankle sprain. Ankle sprain is most common injury for every individual in life time.

When your ankle suddenly twisted to inner side you feel sudden pain and feel like something tear at outer aspect of your ankle, It is known ankle sprain. You can sprained your ankle in day to day activities like walking on uneven surface or downstairs or any bike slip or any sports which need running or jumping. So ankle sprain is very common injury.

Symptoms (what you feel)

  • You feel sudden pain at outer aspect of ankle just after twisting of your ankle
  • Severity of pain depends on grade of ankle sprain
  • You may not able to bear weight if ankle sprain is severe grade
  • Your ankle get swelling, starting from outer aspect of ankle
  • You may feel something tear at outer aspect of your ankle

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Diagnosis 

Physical examination (what your doctor feel)

Clinical diagnosis is confirmatory diagnosis for ankle sprain.

Your doctor will check your foot for maximum tenderness and you feel severe pain at point of ankle when your doctor press an specific area at outer aspect of ankle.

X-ray

It is clinical diagnosis supported by X-ray so X-ray is mandatory investigation for ankle sprain and your orthopedic doctor can decide treatment on x-ray finding. An X-ray is also necessory to rule out other fractures as well.

Fig. 1 Fibular tip avulsion fracture shows detachment of ATFL and CFL from fibular attachment

In above x-ray you can see there is fracture of distal tip of fibula but don’t assume it hair line or minor fracture because it is site of ATFL and CFL attachment on fibula so in this case both ATFL Nand CFL ligaments surely injured.

if your x-ray is normal and you have severe pain and swelling your orthopedic surgeon will advise you for a MRI scan.

MRI Scan

MRI scan has role in acute ligament tear and also in chronic instability. When your X-ray looks normal and you have severe pain and swelling then your MRI scan will guide your treatment for ankle sprain.

when your ankle sprain treated conservatively and you feel pain even after 2 or 3 months then your foot and ankle specialist advise you for a MRI scan to see status of your ATFL and CFL or any other cause of pain in your ankle

Fig.2 CFL avulsion in MRI film

Treatment

conservative treatment

Conservative treatment such as medicine, rest, icing, supportive boot or plaster support, and physiotherapy is sufficient for most of patients who have grade 1 or grade 2 type of ankle sprain.

Once you begin treatment, you’ll usually see improvement within 1 to 2 weeks.

Surgical treatment

If you have avulsion type of fracture of tip of fibula or grade 3 tear of ATFL in MRI Scan or conservative treatment aren’t working after several months, your doctor might recommend surgery for ankle sprain.

What type of surgery for ankle sprain

If your injury is acute your foot and ankle specialist advise you for repaire of torn ligament or fixation of avulsed fragment of film with attached ligaments.

If your injury is chronic and you had sprained ankle long ago and your pain is still persist then your foot and ankle specialist advise you reconstruction of torn ligaments.

Acute repair done through open surgical procedure and reconstruction of ATFL and CFL can be done through key hole surgery(arthroscopic procedure) and after repair your ankle will be normal after few months and you can do all activities at pre injury level.

 

Very few people require surgery for ankle sprain as most of ankle sprain are grade 1 or grade 2. Surgery can be done with small open procedure or with arthroscope.

we are providing dedicated physiotherapy for ankle sprain and both type of surgical options (open and arthroscopic) if not relieved by conservative treatment.

Fig.3 Fibular tip avulsion fragment shows partial ATFL avulsion tear and complete CFL tear in patient who’s x-ray and MRI scan shown in fig.1 and fig.2

 

Fig.4 ATFL  and CFL repaire of same patient in fig.3

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