Anterior Talofibular Ligament Sprains

The ankle joint is made up of the tibia, fibula and talus bones. These bones are connected together by ligaments which help to provide stability to the ankle joint. The most common ligament that is damaged when someone sprains their ankle is the anterior talofibular ligament (ATFL). The ATFL connects the talus to the fibula and is located on the outside of the ankle, it is the most easily damaged ligament when the foot is plantar flexed and inverted forcefully, also referred to as “rolling your ankle”. AFTL sprains are a common injury, they are associated with sporting movements such as jumping, landing and changing direction in basketball, netball and football but can also occur as a result of walking on uneven ground or tripping.

Although ATFL sprains are one of the most common acute musculoskeletal injuries, it is an injury that people don’t receive adequate care for which can have long term complications. How many people do you know have a “bad” ankle or one that they constantly roll? This is a classic case of chronic joint instability. The catalyst for writing this blog is that I am currently seeing three clients with ankle injuries, all had experienced previous ankle sprains and had done minimal rehabilitation. You can argue that if they had under taken a comprehensive rehabilitation programme after the initial sprain they could have avoided or at least minimised the risk of further injury.

Often the acute symptoms associated with an ATFL sprain such as pain and swelling resolve in a short period of time, so people don’t pursue further treatment. After the resolution of acute symptoms many people develop long term symptoms including persistent ‘giving way’ of the ankle joint, a feeling of ankle joint instability, pain and injury recurrence; ultimately resulting in functional limitations.  I saw this time and again with basketball team mates who sustained ankle sprains, they would manage their acute symptoms then adopt the band aid approach of strapping their ankle only to re-injury the ankle down the track and develop chronic long-term symptoms.

The importance of proper rehabilitation after an ATFL sprain cannot be overemphasized. The keys to optimal recovery include;

  • Acute phase management adopting the P.R.I.C.E.E.R acronym; protection, rest, ice, compression, elevation and early rehabilitation.
  • Getting an accurate diagnosis of the grade of the ankle sprain sustained and the structures involved.
  • Beginning rehabilitation early under the guidance of an exercise professional rather than immobilizing the joint (depending on the grade of the sprain) to regain ankle range of motion, assist with ligament regeneration and improve ankle proprioception.
  • Include progressive strengthening exercises, proprioceptive training and activity specific training.

If you have sustained an ATFL sprain an Accredited Exercise Physiologist at Absolute Balance can guide you through the rehabilitation process and reduce the risk of developing long-term symptoms, contact us today for an assessment.

Lisa Wallbutton (BSR, MClinicalExPhysiol(Rehab))

Accredited Exercise Physiologist (AEP) (ESSAM)



Karslioglu, B., Dandinoglu, T., Erdem, Y., & Dandin, O. (2017). Current treatment approaches for ankle ligament injuries: what has changed? Medicine Science International Medical Journal , 91-95.