ATFL Ankle Sprain

Have you ever rolled your ankle? Do you have any ankle pain? One of the most common injuries to the ankle is an Anterior Talofibular ligament (ATFL) sprain which can occur when you roll your ankle. Every patient is different so it’s important to book in, get an individual assessment and seek the right treatment for you.

The ankle joint is a hinge joint formed by three bones; talus, tibia and fibula. The ligaments that support the lateral ankle include the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL) and the posterior talofibular ligament (PTFL).

Acute ankle sprains are a prevalent injury, with over 75% classified as lateral ankle sprains, approximately 73% involving the anterior talofibular ligament (ATFL). Ankle sprains also carry a recurrence rate exceeding 40%, and if inadequately rehabilitated, up to 70% of individuals may develop chronic ankle instability.

Potential risk factors of ATFL sprains include:

• Previous lateral ankle sprain

• High Body Mass Index

• Reduced ankle inversion and plantarflexion strength

• Poor static postural control

• Female

There are three classifications for ATFL sprains dictating the structural integrity of the ligament.

• Grade 1: Microtrauma the ATFL. Recovery 2-4 weeks

• Grade 2: Microscopic tear of a larger region of the ATFL. Recovery 4-6 weeks

• Grade 3: complete rupture of the ligament.

  
  

What an appointment will look like at Our Physio Central Coast

Our Physio can provide the guidance you need to recover from your ankle sprain to have you living healthy and happy.

• Assessment and diagnosis

• Education and advice

• Structured hands-on treatment and exercise therapy to facilitate rehabilitation

• Home exercise prescription

• Return to pre-injury activity

There are three stages to making a full recovery from an ATFL sprain:

Phase 1: Acute/Inflammatory phase (Weeks 1-2)

• Pain and swelling management

• Early mobilisation – gentle ROM within a pain-free range

• Manual therapy – joint mobilisations

• Bracing or taping to provide external support if necessary

• Soft Tissue release of surrounding muscles  

Exercises:

Phase 2: Reparative ( Weeks 3-6)

• Restore full range of motion for ankle dorsiflexion, plantarflexion, inversion and eversion

• Strengthening exercises- Isometric exercises, progressing to dynamic exercises with resistance

• Proprioception training – challenging balance with different surfaces, eyes closed, single-leg balance

Exercises

Phase 3: Return to function/Sport (Weeks 6+)

• Return to pre-injury levels

• Progress to advanced strengthening exercises and challenge proprioception

• Sport-specific training such as jumping, running, hopping, and agility-type exercises

• Return to sport

Note:

Assessment and diagnosis for each individuals injury should always be conducted prior to developing a treatment plan with exercise prescription and appropriate progressions. Should you have any further questions or would like to discuss your ankle pain with a physiotherapist, please contact Our Physio Central Coast (02) 4339 4475 or book an appointment online by clicking below.

Click to Book an appointment

References

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Cottrell, J. A., Turner, J. C., Arinzeh, T. L., & O'Connor, J. P. (2016). The Biology of Bone and Ligament Healing. Foot and ankle clinics, 21(4), 739–761. https://doi.org/10.1016/j.fcl.2016.07.017

Dhillon S, Adhya B, Rajnish RK, et al. Lateral Ankle Sprain: Current Strategies of Management and Rehabilitation Short of Surgery. J Foot Ankle Surg (Asia Pacific) 2022;9(1):46–49.

Dubin, J. C., Comeau, D., McClelland, R. I., Dubin, R. A., & Ferrel, E. (2011). Lateral and syndesmotic ankle sprain injuries: a narrative literature review. Journal of chiropractic medicine, 10(3), 204–219. https://doi.org/10.1016/j.jcm.2011.02.001

Dubois, B., & Esculier, J. F. (2020). Soft-tissue injuries simply need PEACE and LOVE. British journal of sports medicine, 54(2), 72–73. https://doi.org/10.1136/bjsports-2019-101253

Herzog, M. M., Kerr, Z. Y., Marshall, S. W., & Wikstrom, E. A. (2019). Epidemiology of Ankle Sprains and Chronic Ankle Instability. Journal of Athletic Training, 54(6), 603-610. https://doi.org/10.4085/1062-6050-447-17

Kobayashi, T., Tanaka, M., & Shida, M. (2016). Intrinsic Risk Factors of Lateral Ankle Sprain: A Systematic Review and Meta-analysis. Sports health, 8(2), 190–193. https://doi.org/10.1177/1941738115623775

Koh, D., Chandrakumara, D., & Kon Kam King, C. (2023). Incidence of Injuries Associated With Anterior Talofibular Ligament Injury Based on the Reporting of Magnetic Resonance Imaging. Cureus, 15(7), e41738. https://doi.org/10.7759/cureus.41738

Martin, R. L., Davenport, T. E., Fraser, J. J., Sawdon-Bea, J., Carcia, C. R., Carroll, L. A., Kivlan, B. R., & Carreira, D. (2021). Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision. Journal of Orthopaedic & Sports Physical Therapy, 51(4), CPG1-CPG80. https://doi.org/10.2519/jospt.2021.0302

Mattacola, C. G., & Dwyer, M. K. (2002). Rehabilitation of the Ankle After Acute Sprain or Chronic Instability. Journal of athletic training, 37(4), 413–429.

Melanson SW, Shuman VL. Acute Ankle Sprain. [Updated 2023 May 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459212/

Netterström-Wedin, F., Matthews, M., & Bleakley, C. (2022). Diagnostic Accuracy of Clinical Tests Assessing Ligamentous Injury of the Talocrural and Subtalar Joints: A Systematic Review With Meta-Analysis. Sports health, 14(3), 336–347. https://doi.org/10.1177/19417381211029953

Ortega-Avila, A. B., Cervera-Garvi, P., Marchena-Rodriguez, A., Chicharro-Luna, E., Nester, C. J., Starbuck, C., & Gijon-Nogueron, G. (2020). Conservative Treatment for Acute Ankle Sprain: A Systematic Review. Journal of clinical medicine, 9(10), 3128. https://doi.org/10.3390/jcm9103128