Ankle Ligament Tear | Ankle Instability

What is it?

The ankle and the foot are held together by both ligaments and tendons. The ligaments on both sides of the ankle are tightly attached to the bones. On the outside (lateral) aspect of the ankle, there are three major ligaments. On the inside (medial) aspect of the ankle, there is a complex network of several ligaments, much stronger than the lateral ligaments. They help to restrict motion of the ankle joint. The tendons that cross the joint are attached to the muscles in the leg and into the bones of the foot. When the muscle contracts, it moves the tendon that then moves the foot at the ankle joint. The ankle joint moves primarily in one direction or plane; upward (dorsiflexion) and downward (plantarflexion). The normal joint does not move front to back nor does it tilt on either side. When there is an injury to a ligament, it can be stretched out or torn, leading to a sprain and weakening it. In some cases, when the rotational forces are strong enough, there can be ankle fracture, as well. In cases that are left untreated, or in cases after many sprains in a short period of time, there will weakening of the ligaments leading to instability of the ankle. This is called lateral ankle instability. It can lead to chronic pain and loss of function, which usually will need surgical correction.


Sprains are caused by an injury to the ankle from normal walking events, to sports injuries, to falls from a height. Most sprains are of the inversion type. When a patient twists the ankle, it usually occurs with the bottom of the foot turning toward the other foot, leading the outside of the foot and ankle to roll to the ground. In some cases the foot can roll the other direction, as well. During the roll, there is rotation of the foot. These excessive motions will pull on the ligaments with great force. Although the ligaments are strong, these forces are strong enough to do damage to them. An injured ligament will either stretch out, partially tear, tear completely in the middle, pull off the bone attachment from the ankle bone or the leg bone, or pull off a piece of bone as it tears. Depending on the severity of the injury and the rotation of the foot during the injury, one, two, or all three of the ligaments can be injured. If the there are several sprains over a short period of time, it can lead to weakening or laxity of the ligaments, leaving an unstable ankle.


Most patients can recall a specific injury that occurred that caused the sprain. There will be a large amount of swelling and pain on the outside of the ankle and foot. Some patients will not be able to place the foot on the ground without a great deal of pain. Bruising and discoloration of the area will then ensue. Pain is located over the bone on the outside of the ankle, over the ligaments and the tendons all on the lateral aspect of the ankle. There can be a feeling of imbalance, as well. Patients will then have a feeling of caution and will describe an unstable ankle, as if they could roll the ankle at any time. This can also lead to chronic pain within the ankle. Some patients describe a feeling of the ankle locking or clicking when it is moved.


Clinical evaluation of the ankle is performed at the initial visit. The stability of the ankle is evaluated. The amount of abnormal rotation of the joint is determined by manipulating the ankle in certain directions. This will help identify which of the ligaments are injured and to what extent they are injured. Muscle testing is also performed to identify tendon weakness or injury. X-rays will be taken in the office to determine if there are any fractures or bone chips from the ligament tear. In some cases, usually chronic cases, special stress X-rays will be taken to determine the amount of dislocation the ankle can undergo. The more the ankle dislocates under stress, the more damage there is to the specific ligament tested. In some cases, there will be the need for an MRI to obtain an image of the ligaments, tendons, and cartilage of the joint to examine the extent of the injury and whether ankle surgery or ankle replacement is indicated.

Source: HealthSource Library:

Our instability/ligament repair patients come to us from Dallas, Plano, Frisco, McKinney, Prosper and neighboring areas.

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