Ankle ligament tears: all you need to know

Ankle ligament tears are injuries where the ligaments, which connect and stabilise bones in the ankle, are partially or completely torn, often due to excessive twisting or rolling of the ankle. Leading consultant orthopaedic foot and ankle surgeon Mr Shelain Patel explains how they occur, common symptoms and treatment options.

How do ankle ligament tears occur, and are there any risk factors involved?

Ankle ligament tears usually follow a severe twisting injury of the ankle. In most cases, the twist stretches the ligaments on the outside of the ankle. The violence of the twist or fall will dictate if the tear is low or high grade.

There are a few known risk factors including a past history of ankle sprain - namely if a previous ligament tear has healed in a stretched position through inadequate care and attention, the ankle will be more prone to collapsing and being unstable.

Unfortunately, wearing high heels contributes greatly to ankle ligament tears since they reduce stability and place the ankle into its most vulnerable position. There is increased recognition of hypermobility in the population. This condition means ligaments are inherently stretchy, which can lead to falls and subsequent ligament tears.

Hypermobility is increasingly recognised in the population. This condition means ligaments are inherently stretchy, which can lead to falls and subsequent ligament tears.

What are the common symptoms of ankle ligament tears?

Instability, pain and swelling are the most common complaints from those suffering from ankle ligament tears. However, the symptoms vary between patients therefore there is no single classic presentation. Instability will be worse on uneven ground such as cobbled streets, whilst pain and swelling will happen at the site of the torn ligaments.

There is no single classic presentation, as the signs and symptoms vary from patient to patient. Instability will be worse on uneven ground such as cobbled streets, whilst pain and swelling will happen at the site of the torn ligaments.

What is the process for diagnosing ankle ligament tears, and can they be treated without surgery?

Diagnosis occurs with a triple assessment of history, examination and investigation. Although it may seem obvious to proceed straight to an MRI, there will be many asymptomatic patients with a positive scan. This is because any previously torn but now healed ligament can still show features of that tear. Therefore, understanding the functional status of the ligament is crucial, and this can be effectively determined through a detailed history and examination by your surgeon.

Diagnosis involves a thorough assessment that includes history, examination, and investigation. While it might seem straightforward to proceed directly to an MRI, many asymptomatic patients will have positive scans. This is because any previously torn but now healed ligament can still show features of that tear. Therefore, understanding the functional status of the ligament is crucial, and this can be effectively determined through a detailed history and examination by your surgeon.

What are the surgical and non-surgical treatment options for ankle ligament tears?

Treatment depends upon whether the tear is acute or chronic. A fresh acute injury needs immobilisation at the start with the ankle in the correct position to allow the tissues to heal. This can be achieved with either a pneumatic walking boot or a specialist ankle brace. It should be noted that Tubigrip-type stockings do not support the ankle sufficiently. Only once healing is taking place should physiotherapy occur.

Early aggressive mobilisation may hinder tissue healing and lead to chronic instability. Long-term (chronic) episodic instability should be managed in a multidisciplinary way. This means starting physiotherapy for muscle patterning to see if the ankle can be ‘trained’ to avoid rolling over, but if this does not work, then an operation to repair the ligament might be offered. 

What is the expected recovery time and rehabilitation process for individuals with ankle ligament tears?

Low-grade acute injuries heal very quickly and within 3 weeks, patients will often feel like they are getting back to normal. In contrast, high-grade acute injuries require immobilisation in a brace or walking boot for 4-6 weeks before starting physiotherapy. Recovery can take months and it is estimated that one in three patients who have sprained their ankles will still have some symptoms after one year.

In patients who fail to improve, surgery may be offered. This will often require the leg to be held in a plaster cast for approximately four weeks to avoid stretching the repaired tissues, and then using an ankle brace or boot for four weeks. During this time, physiotherapy can start to help rebuild the muscles which will have wasted away after immobilisation. Full recovery after surgery is seen at between six and twelve months.

If you are suffering from ankle instability and would like to book a consultation with Mr Patel, do not hesitate to do so by visiting his Top Doctors profile today.