Ankle Ligament Tears: Causes, Symptoms, Treatment, and Prevention

The ligaments in the ankle help to keep the bones in the right position and stabilise the joint, helping you to walk, jump and run. An ankle ligament tear occurs when you suffer a sprain and these strong ligaments supporting the ankle stretch beyond their limits. It can happen to anyone of any age and at any activity level.

Sprains can range from tiny tears in the fibres to complete tears. The latter can cause the ankle to become unstable, damaging the bones and cartilage over time.

Hence, if you have suffered an ankle sprain, it is important to seek prompt medical advice and the appropriate treatment as soon as possible.

Most ankle ligament tears are a result of a twisting injury to the foot or ankle and you may notice hearing a pop sound. This usually occurs while playing sports or exercising.

An ankle sprain that causes an ankle ligament tear can also occur when you fall or trip, walk or exercise on an uneven surface and play sports that require jumping actions.

The symptoms you experience can differ according to the severity of your ankle ligament tear. You may feel and see:

• Pain when bearing weight on your ankle or at rest
• Swelling
• Bruising
• Tenderness
• Instability of the ankle

The symptoms of a severe sprain and complete ankle ligament tear can feel similar to a broken bone so it is advisable to seek prompt medical attention to prevent long-term complications.

Your orthopaedic doctor will first perform a physical examination to discuss the symptoms you are experiencing and to carefully check your foot and ankle. The doctor will observe any swelling or bruising, gently press around the ankle to determine which ligaments are injured, move your ankle in different directions to test its range of motion and assess its stability. 

Following the physical examination, your orthopaedic doctor may order further imaging tests like x-rays to rule out any fractures and MRI scans for clear images of the ligaments, cartilage and tendons. 

Your orthopaedic doctor will then categorise your ankle ligament tear into different grades: 

• Grade 1 – Slight stretching and microscopic tears are present
• Grade 2 – Partial tearing of the ligament
• Grade 3 – Complete tear of the ligament

The physical examination and imaging tests aid your doctor in determining the grade of your ankle ligament tear so that the right treatment can be administered.

Your doctor may recommend at-home treatments for milder sprains, such as using the RICE method and taking nonsteroidal anti-inflammatory medications.

For more severe sprains, other non-surgical treatment methods can help too. Immobilisation by wearing a cast or brace, going through physical therapy and doing strengthening exercises may work.

Although surgical treatments for an ankle ligament tear is rare, your doctor may recommend that you undergo arthroscopy or a reconstruction procedure if conservative treatments have been ineffective. Surgery is also usually suggested when the patient suffers ankle sprain with additional injuries such as a tendon rupture.

Arthroscopy involves inserting miniature camera and instruments through small incisions to remove any loose fragments of bone or cartilage, or parts of the ligament.

A reconstruction surgery involves repairing the torn ligament with stitches or sutures. Sometimes, using tissue graft obtained from other ligaments and/or tendons may be needed to reconstruct the damaged ligament.

Ankle ligament tears can be prevented with the right precautions. Take note to warm up and down thoroughly before and after exercising, pay attention to the surfaces you exercise on (avoid uneven surfaces), choose footwear that has good support, and do strengthening exercises. Most importantly, work towards maintaining good muscle strength, balance and flexibility to reduce the chances of suffering an ankle ligament tear.