Ankle Ligament

What are ankle ligaments?

Your ankle ligaments are bands of tissue that connect your foot bones (talus and calcaneus) with your lower leg bones (tibia and fibula).

What do the ankle ligaments do?

Ankle ligaments have several important jobs. They:

• Absorb shock when your foot strikes a surface.
• Connect the bones of your foot with your lower leg.
• Keep the bones in the proper position.
• Prevent your ankle from twisting, folding or collapsing.
• Stabilize your ankle joint (formed by the lower leg bones and the talus).
• Stop your ankle from moving in any unsafe or unnatural directions.

What are ankle ligaments made of?

Ankle ligaments are made of connective tissue that contains:

• Collagen, a protein that binds tissues in animals.
• Slightly stretchy elastic fibers.

Where are the ankle ligaments located?

Ankle ligaments are found throughout your foot, ankle and lower leg. They connect certain bones:

• Calcaneus (heel bone).
• Fibula (calf bone).
• Malleolus (a bump that sticks out from each side of the ankle).
• Navicular bones (a bone on the top of the foot).
• Talus (ankle bone).
• Tibia (shin bone).

How many ligaments are in the ankle?

There are three main sets of ligaments in your ankle:

• Medial ligaments, also known as deltoid ligaments: These ligaments start at the medial malleolus, the end of the tibia, which forms the bump on the inside of your ankle). Then the four ligaments fan out to connect to the talus, calcaneus and navicular bones.
• Lateral ligaments: These start at the lateral malleolus (the end of the fibula, which forms the bump on the outside of the ankle). Then the three ligaments connect to the talus and calcaneus.
• Syndesmotic ligaments: This set of four ligaments connect the tibia and fibula.

Can I injure an ankle ligament?

An ankle ligament can be injured when it moves in the wrong direction, stretches too far or tears. A ligament injury is called a sprain.

A sprained ankle is a very common injury. It happens to people of all ages and levels of health. An ankle sprain usually occurs when someone twists the ankle. For example:

• Falling or almost falling.
• Having someone step on your foot, forcing it into an unnatural position.
• Playing sports that require rolling the foot or cutting back and forth in different directions quickly (for example, basketball, soccer and tennis).
• Walking or running on uneven surfaces (such as a trail).

The three main types of ankle sprains include:

• Inversion ankle sprain: This happens when the ankle rolls inward, injuring the lateral ligaments. This is the most common type of ankle sprain, as the lateral ligaments are weaker than the other ankle ligaments.
• Eversion ankle sprain: This occurs when the ankle rolls outward and injures the medial (deltoid) ligaments. This type of ankle sprain is not common, but it can occur during running or jumping, especially on uneven surfaces.
• High ankle sprain: This type of sprain affects the syndesmotic ligaments. It typically occurs in competitive athletes who experience a forceful blow to the ankle or extreme twisting motion. It’s particularly common in people who participate in American football, basketball, hockey, soccer and snow skiing.

What are the symptoms of an ankle sprain?

If you injure an ankle ligament, symptoms may include:

• Bruising.
• Loose feeling in the ankle.
• Pain on the sides or front of the ankle.
• Popping or snapping sound.
• Swelling around the ankle joint.
• Trouble bearing weight on the ankle or foot.
• Weakness in the ankle joint.

Does an ankle sprain require medical attention?

Most sprains are mild, but they can be severe. If you have a moderate to severe ankle sprain or repeat sprains, you should talk to a healthcare professional. Sprains can weaken your ankle, increasing the chances that you’ll injure it again. They can also cause lasting pain.

How can a healthcare provider tell if I’ve injured an ankle ligament?

If you think you have a sprained ankle, a healthcare provider may:

• Ask you about your symptoms and when they started.
• Conduct a physical exam by looking at the injured ankle, assessing how it moves and comparing it to the other ankle.
• Take X-rays to rule out a broken bone or other problems.
• If your pain isn’t improving, your provider may order other imaging tests, such as MRI, to take pictures of the ankle ligaments.

How are ankle sprains classified?

A healthcare provider will grade your ankle injury by how severe it is and what symptoms you have:

• Grade 1: A grade 1 injury to an ankle ligament is a minor sprain. It means a ligament is overstretched or just slightly torn. With a grade 1 ankle strain, you’ll experience some pain, swelling and maybe bruising. But you’ll still be able to put weight on the affected leg and bend and rotate the ankle.
• Grade 2: A grade 2 ankle sprain is a moderate (partial) tear of the ligament. Symptoms include bruising, swelling and some pain. With a grade 2 injury, you’ll have some difficulty putting weight on the leg. You may also have trouble bending or rotating the ankle.
• Grade 3: A grade 3 injury is a complete tear or rupture of an ankle ligament. With this level of injury, you’ll have severe bruising, swelling and pain. You won’t be able to put weight on the affected leg, and you won’t be able to bend or rotate the ankle.

What are the common treatments for a sprained ankle?

Treatment for an ankle ligament injury can vary greatly, depending on:

• The severity of the ankle injury (grade 1, 2 or 3).
• Whether pain or trouble moving the ankle is interfering with your life.
• Whether you’re at risk for additional ankle injuries in the future.

Your healthcare provider will recommend treatment for your particular injury, ranging from surgical to nonsurgical:

• Rest, ice, compression (using an elastic bandage) and elevation (RICE).
• Nonsteroidal anti-inflammatory drugs (NSAIDs).
• Assistive devices (for example, crutches to help you keep weight off the ankle).
• Immobilization (such as a boot to hold your ankle in place while it heals).
• Physical therapy to strengthen the ankle and improve balance.
• Surgery is rarely required after an acute ankle sprain. Occasionally, people can repeatedly sprain their ankles. They may require surgery to repair the ankle ligaments.

How can I prevent ankle ligament injuries?

Not all ankle injuries can be prevented. But you can take steps to keep your ankle ligaments safer, especially during exercise:

• Avoid uneven surfaces, which can cause you to roll or twist the ankle.
• Improve your flexibility and balance. Doing so helps train your body to react to missteps or stumbles without putting pressure on the ankles.
• Stretch often for better flexibility, and practice standing on one foot for balance.
• Strengthen your ankles with exercises such as standing heel raises, squats, squat jumps and lunges.
• Strengthen your core to help your body react and change direction safely when it needs to.
• Maintain a healthy weight to put less pressure on your ankles.
• Mix up your exercise routine, combining weight training and aerobic activities (cardio).
• Warm up before you exercise, increase intensity gradually and then stretch afterward.
• Wear shoes that fit well.

When should I see a healthcare provider for a sprained ankle?

You should talk to a healthcare provider if you have:

• Inability to use the ankle joint as you could before.
• Looseness or weakness in the ankle.
• Ankle pain.
• Repeat ankle injuries.
• Swelling around the ankle joint.
• Trouble putting weight on the ankle or foot.

A note from Cleveland Clinic

Ankle ligaments are bands of tissue that connect the foot bones with the lower leg bones. Injuries to the ankle ligaments are very common and can range from mild to severe. Talk to a healthcare provider if you have a bad ankle injury or repeat ankle sprains. Proper diagnosis and treatment can help prevent pain and future injuries.