An anterior talofibular ligament (ATFL) tear is a type of ankle sprain. This common injury occurs when the ATFL (a soft tissue connecting two bones in the outer part of your ankle) stretches too far. Overstretching can cause a partial or complete tear. A complete tear can be a serious injury that might need surgery.
You have a higher risk of an ATFL tear if you play sports. Sudden stops, turns and jumps can stress the tissue. Common symptoms include pain and swelling. You might also have a reduced range of motion. Without treatment, an ATFL tear can lead to chronic ankle instability (when your ankle won’t support you).
At Summit Orthopedics, our foot and ankle experts in the Minneapolis/St. Paul area specialize in treating ATFL tears. Whether you need conservative treatment or surgery, our team will find a therapy to help you get active again without ankle pain.
Grading ATFL Tears
Your doctor will grade your ATFL tear based on how bad it is. The grade will help your doctor decide what type of treatment you need.
- Grade 1. Tiny tears in the ligament fibers cause your ankle to swell and feel tender, but there’s no pain when you put weight on it.
- Grade 2. A partial ligament tear makes your ankle swollen and tender and leads to mild pain when you put weight on it.
- Grade 3. A complete rupture (tear) makes your ankle extremely swollen and tender and causes intense pain when you put weight on it.
An injury to the ATFL can hurt the nearby calcaneofibular ligament, which runs from the bump on the outside of your ankle to the heel. Once the ATFL is damaged, extra stress on the calcaneofibular ligament can injure or tear it.
Causes of ATFL Tears
Anyone can tear their ATFL, and it can happen at any age. ATFL tears are common among athletes, but these injuries don’t just occur during sports. They can also happen as you go about your daily routine.
Your ATFL can tear due to a sudden twist or inward turn of your foot, like when you step on an uneven surface or fall. You may hear or feel the ligament pop if it’s a large tear. Pain, swelling, bruising and weakness in the joint may follow.
Diagnosing an ATFL Tear
Your doctor will ask how the injury happened, what symptoms it caused and what makes them worse.
Next, they will perform a physical examination of your injured ankle, feeling and moving it to check its stability. This exam may include an anterior drawer test. For this test, the doctor will move your ankle to see whether the talus (a small ankle bone to which the ATFL attaches) has shifted out of its normal position. This can be a sign of an ATFL tear.
You may need a diagnostic imaging test, such as an X-ray or MRI, so your doctor can check for other problems that could cause your symptoms.
- X-ray. An X-ray can show whether you have a fracture, which can cause symptoms similar to an ATFL tear.
- MRI. An MRI can let your doctor check the condition of soft tissues.
Nonsurgical Treatment
With proper treatment, a torn ATFL can heal on its own. The process may take a few months for a Grade 1 or 2 tear or up to a year for a Grade 3 tear.
Your doctor will likely suggest nonsurgical treatment to start. Most ATFL tears heal with nonsurgical therapies. Your treatment plan will likely proceed in phases, starting with resting the ankle and gradually working up to exercising it with the help of a physical therapist.
Here’s what your treatment plan may include:
- Rest. At first, you may need to take a break from physical activities and stay off the ankle until your doctor says it’s OK to do more.
- Bracing. Your doctor may recommend wearing an ankle brace or walking boot for a short period to stabilize and protect your ankle.
- Pain medicine. You can take an over-the-counter pain reliever, such as ibuprofen, while your ankle heals.
- Physical therapy. A physical therapist can teach you exercises to improve strength and range of motion and share ways to control symptoms.
Surgical Treatment
Surgery might make sense if nonsurgical treatment doesn’t help. You’re more likely to need surgery if you have a Grade 3 ATFL tear. A surgeon can repair or reconstruct the ATFL, returning stability to the ankle.
- Ligament repair. Your surgeon will remove any injured or unhealthy areas of tissue. They will then stitch the healthy tissue together or reconnect it to the bone.
- Ligament reconstruction. The surgeon will reconstruct your ATFL if it’s too damaged to repair. They will use tissue from elsewhere in the foot or ankle to create a new ATFL.
Care for ATFL Tear at Summit Orthopedics
At Summit Orthopedics, ankle sprains, including ATFL tears, are some of the most common injuries our foot and ankle experts treat. No two ligament injuries are precisely alike. That’s why we create a unique treatment plan for each patient, starting with the most conservative therapies possible. If you need surgery, you can have confidence knowing we’ll use the latest techniques and technologies to treat your injury. Plus, you’ll have an entire team of doctors, physician assistants, rehabilitation therapists and others on your side from start to finish.
Summit Orthopedics surgeons are available at nearly 30 convenient locations across the Minneapolis/St. Paul metro area, serving Minnesota and western Wisconsin. Our state-of-the-art, comprehensive orthopedic centers offer same-day appointments from a team of experts who offer the full scope of orthopedic care.
Find your Summit Orthopedics foot and ankle expert, request an appointment or call us at (651) 968-5201 to schedule a consultation.