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Ankle ligament repair

Ankle pain can get in the way of living life to the full – it can be distressing and reduce your mobility, confidence and quality of life. We understand that long wait times can affect your fitness, health and wellbeing, so we offer a timely pathway from investigation and diagnosis to surgery.

What is an ankle ligament injury?

An ankle ligament injury occurs when the ligaments in your ankle are torn, stretched too far, or damaged. These ligaments play a crucial role in connecting bone to bone and providing stability to your joints.

Types of Ligaments

  • The anterior talofibular ligament (ATFL).
  • The calcaneofibular ligament (CFL).
  • The posterior talofibular ligament (PTFL).

Severity of Sprains

  • Mild Sprains: These involve bruising, swelling, and limited stability in the ankle.
  • Moderate Sprains: Partial tearing of the ligament leads to moderate pain, swelling, bruising, and slight joint instability.
  • Severe Sprains: Complete tearing of the ligament results in severe tenderness, bruising, swelling, and significant joint instability.

Ankle ligament injuries are prevalent in sports and can lead to long-term discomfort and joint instability.

What are the symptoms of an ankle ligament injury?

Here are the symptoms of an ankle ligament injury, which typically occur in three stages.

At the Time of Injury

  • Popping or cracking sound.
  • Severe pain.
  • Rapid swelling within the first twenty-four hours.
  • Bruising may develop over the following days.

A Few Weeks After the Initial Injury:

  • Mild Pain and Swelling
  • Ankle Stiffness, especially after periods of rest

Long-Term Symptoms:

  • Cracking Noise when walking
  • Ankle may ‘give way’ and roll inwards
  • Pain and Tenderness in the ankle, especially during walking or weight-bearing.

Other ankle conditions that may share symptoms with chronic ankle ligament injuries:

Ankle Osteoarthritis: A common condition where joint cartilage gradually wears down over time, resulting in pain and swelling in the joint.

In chronic lateral ankle ligament injuries, pain is typically felt around the outside of the ankle. In contrast, osteoarthritis pain often occurs across a wider area, including the top of the foot and both the outside and inside of the ankle.

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

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

Sinus Tarsi Syndrome: This condition involves inflammation of the membrane around the sinus tarsi (a tunnel between bones in the feet).

It causes pain and tenderness on the outside of the ankle joint, similar to lateral ankle ligament injury.

Often triggered by a previous ankle injury.

Midfoot Osteoarthritis: Affects the bones of the midfoot, leading to pain, stiffness, and deformity.

Ankle Fracture: Occurs when one or more bones in the ankle break.

Symptoms include severe pain, swelling, and an inability to put weight on the affected ankle.

Damage to the Medial Ligament: A sprain affecting the deltoid ligament on the medial (inside) side of the ankle.

Causes pain, swelling, and bruising of the entire ankle, with more pronounced effects on the inside of the joint.

Medial ligament injuries are less common than lateral ligament injuries.

Dislocated Ankle: The separation or dislocation of bones within the ankle joint.

Results in pain, swelling, ankle deformity, and an inability to bear weight.

Other Soft Tissue Damage: Muscles or tendons in the ankle may also be damaged, leading to pain, swelling, bruising, and difficulty bearing weight.

Remember to seek professional medical advice if you experience any of these symptoms or suspect an ankle injury. Proper diagnosis and treatment are essential for recovery.

During your initial consultation with a consultant orthopaedic surgeon, you can expect a thorough evaluation. Here’s what typically happens during your first orthopaedic consultation:

Medical History Evaluation: Your consultant will take a comprehensive medical history, asking about your symptoms and any previous ankle injuries.

Physical Examination: Your consultant will examine your ankle for outward signs like bruising, swelling, tenderness, or deformity.

Diagnostic Imaging: You may undergo X-rays and/or MRI scans to assess the condition of your ankle.

Physical Tests: These may include:

  • Anterior Draw Test and Talar Tilt Test: These assess the function of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL).
  • Proprioception Test: Evaluates your body’s ability to sense its position in the environment, including balance, body positioning, and movement awareness.
  • Functional Movements: Your surgeon may ask you to perform various movements like walking, standing on one leg, hopping, and running to assess your sense of balance and how your ankle functions during motion.

Remember to discuss any concerns or questions with your consultant during the appointment.

Diagnostic Scans:

  • X-ray: Used to check for any bone injuries or abnormalities in the ankle joint.
  • Ultrasound: Assesses the degree of swelling and inflammation in the ankle joint.
  • Magnetic Resonance Imaging (MRI): Detects injuries to the ankle joint or the talus bone.

Remember, a combined approach using symptoms, physical examination, and diagnostic results leads to an accurate diagnosis.

Treatment Options: Your consultant will discuss potential treatment approaches, considering your symptoms and diagnosis.

Nonsurgical treatments play a crucial role in managing ankle ligament injuries.

Acute Phase Management (within the first 48-72 hours) is appropriate.

RICE Therapy

Rest: Allow your ankle ligament to heal by minimizing movement.

Ice: Apply ice packs to reduce swelling.

Compression: Use a compression bandage to support your joint and further reduce swelling.

Elevation: Keep your ankle elevated whenever possible to aid in swelling reduction.

Additional acute-phase treatments may include:

Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen to alleviate pain and swelling.

Immobilisation with a boot cast if necessary.

Crutches for severe pain, with instructions to avoid weight-bearing for 24 hours.

In some cases, a corticosteroid injection may be given to reduce swelling and inflammation.

Management of your injury will start with a rehabilitation programme of exercises to strengthen your muscles and increase your range of motion to restore function in your ankle.

Surgery for lateral ankle ligament injury is an important consideration when nonsurgical treatments are not responding.


A minimally invasive procedure where a flexible camera is inserted through small incisions in the skin.

The consultant surgeon examines your ankle joint, assessing ligament damage.

During ankle arthroscopy, damaged tissue, loose cartilage, or bone can be removed.

Typically performed under general anaesthetic, although spinal or regional anaesthesia may be used.

You’ll be awake but sedated, and your ankle will be numb to prevent pain.

Lateral Ankle Ligament Reconstruction

Also performed laparoscopically through small incisions.

Can be done under general or regional anesthesia.

Two common techniques

  • Brostrom-Gould Technique: Tightens the ligaments on the outside of your ankle using sutures.
  • Tendon Transfer: Replaces the damaged ligament with a tendon from another part of your body.

Preparation for Ankle Ligament Surgery

Your consultant will provide detailed instructions for preparation.

If you have any doubts, consult your surgeon or call the hospital for guidance.

Being well-prepared reduces anxiety and ensures smoother surgery and recovery.

Maintain optimal health by eating well, exercising, avoiding smoking, and limiting alcohol intake. This minimises complications and speeds up recovery.

Arthroscopy is generally safe and has a lower risk of complications compared to other surgical methods. However, like any surgery, there are still some risks.

Possible Complications

  • Bleeding: Minimal bleeding can occur during or after the procedure.
  • Infection: Although rare, infections can happen.
  • Blood Clots: A small risk exists, especially if you have other risk factors.
  • Adverse Reactions to Anesthesia: These are generally well-managed but can occur.
  • Numbness: Temporary numbness around the surgical site may occur.

Consultation with your surgeon:

Your consultant will thoroughly discuss all potential risks and complications before your surgery. Feel free to ask any questions you may have. Being well-informed will help you make an informed decision and ease any concerns.

You may be covered by private medical insurance, or you may wish to consider spreading the cost of your surgery by opting for a monthly payment plan.

We aim to make our costs as transparent as possible, but it’s important to talk everything through in detail with your consultant at the time of your appointment. Some costs may be paid directly to the hospital, while others, such as your consultant fees, may be paid directly to the consultant.

Treatment Overview

Combining a calming hospital environment with outstanding patient care so you can recover as quickly as possible.

  • Covered by health insurance? Yes

  • Can I pay privately? Yes

You’re in safe hands at Sulis Hospital.

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