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ATFL Ligament Injury - Ankle


ATFL or Anterior Talo Fibular Ligament is one of the 3 main ligaments on the outer side of the ankle joint. It is a rubbery rope that holds the 2 bones together. ATFL along with its fellow ligaments CFL and PTFL stabilses the ankle on the outer side.  ATFL being in the front part of the ankle on the outer side, protects the joint against inward twisting forces particularly when the ankle is bent downwards. 


Why & how does it happen?

ATFL tear are one of commonest injuries to the ankle joint. It typically happens when the ankle and foot gets twisted inwards and the body load falls on the twisted ankle. When the twisting forces overwhelm what the ATFL can manage, the ACL tear occurs. It often occurs due to missing a step on the stairs, or on the playground. 

Who gets this injury?

Women are more prone to this injury. It is common not only in sporting population but also in general public. Fall from the two wheelers, bikes and cycles are another common reason for this injury. Typical age group is 20 to 50 years.


  • Sudden severe ankle pain

  • In some loud POP sound

  • Painful to walk

  • Feeling that the ankle will give away and not supporting

  • Swelling appears usually few hours later

  • Within a week most patients with ATFL tear will be able to walk with a slight limp

  • Persistence of instability sensation and pain in certain movements and activities

When to seek medical help?

Initial assessment, an x-ray and pain relieving medicines is what is needed as an immediate remedy. Further assessment by an expert Orthopedic Surgeon is useful. Most ATFL injuries do not need an MRI scan during the initial phase of treatment. 

What happens to ATFL if no treatment is undertaken?

ATFL has got the potential to self heal, however proper treatment is necessary. For the ligament to heal, an average of 4 to 6 weeks is required. If the ATFL does not heal or if it heals with a stretch, then it is likely to buckle repeatedly and cause further ankle injuries. In addition, sitting cross legged continues to cause pain if ATFL has not healed well. 

What happens when I visit the Consultant?

You will be asked about the nature of injury, symptoms further to that so far. Consultant will examine you and discuss the treatment modalities. 

What are the treatment Modalities?

The treatment modalities vary from simple ankle binder to PRP Injection to Ankle Ligament Surgery depending upon the grade of tear and the chronicity.

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