Ankle Ligament Injuries
Ankle ligament injuries may be acute traumatic sprains or chronic recurrent instability. Both involve damage to the lateral ankle ligaments but differ in severity, symptoms and management.
Acute Traumatic Ligament Injury (Ankle Sprain)
Usually occurs following a sudden inversion (twisting) injury.
Symptoms
- Immediate pain on the outer side of the ankle
- Swelling and difficulty weight-bearing
- Occasionally pain on the inner side of the ankle
Investigations
- Plain X-rays to exclude associated fractures
Treatment
Most injuries heal without surgery.
- Walking boot or brace for approximately 4 weeks
- Followed by physiotherapy to restore strength and balance
Surgery is considered only if persistent or recurrent instability develops after rehabilitation.
Chronic Recurrent Ankle Instability
Develops when ligaments fail to heal adequately after repeated sprains.
Symptoms
- Recurrent “giving way” of the ankle, especially on uneven ground
- Repeated sprains
- Pain along the outer ankle, often involving the peroneal tendons
Causes / Associated Factors
- Heel varus alignment
- Cavovarus foot shape
- Mechanical ligament insufficiency
Investigations
- Weight-bearing X-rays to assess alignment
- MRI scan to confirm ligament damage and assess associated tendon injury
Treatment
Non-Operative Management
- Physiotherapy and bracing may help symptoms
- However, recurrence rates are relatively high
Definitive Surgical Management
Typically Includes:
- Ligament reconstruction with internal brace augmentation
- Correction of heel alignment (calcaneal osteotomy) when deformity is present
Recovery After Surgery
- Immobilisation in plaster cast
- Non-weight-bearing for approximately 4 weeks
- Followed by structured physiotherapy rehabilitation
The goal is to restore stability, prevent further sprains and reduce the risk of developing ankle arthritis.
