Ligaments are inelastic tissue fibers that connect one bone to another. They prevent joints from moving beyond their normal ranges of motion. They also hold bones in their proper places and absorb shock. The ankle has three main groups of ligaments. The Deltoid ligament is on the medial or inside of the ankle. The lateral ligaments are on the outside of the ankle while the syndesmotic ligaments are at the top of the ankle. The calcaneofibular ligament is part of the lateral ligaments of the ankle. Below are the three ligaments on the outer ankle:

• Calcaneofibular ligament (CFL)
• Anterior talofibular ligament (ATFL)
• Posterior talofibular ligament

A calcaneofibular ligament sprain is the second most common type of ankle sprain but it typically occurs in conjunction with a sprain of other lateral ankle ligaments. These sprains tend to occur when the foot is forcefully pointed downward (a motion called plantarflexion) and rolled inward (a motion called inversion). This can stretch the inelastic fibers of the lateral ligaments beyond their limits causing some or many of the fibers to tear. This is known as a sprain

Pain on the outside of the ankle, just below the lateral malleolus at rest, with weight bearing or movement of the ankle downward or inward are common symptoms of a calcaneofibular ligament sprain. Swelling, bruising and tenderness over the area can appear and instability is common with a high-grade lateral ankle sprain. The talar tilt test is a special test performed by your PT to assess the calcaneofibular ligament.

We can categorize a sprain based on its severity:

Grade I (mild): microscopic damage has occurred to the ligament but only mild local tenderness and minimal bruising/swelling are noted without compromising joint stability. Typically takes 2-3 weeks to heal.

Grade II (moderate): partial tear/rupture of the ligament. Obvious swelling and tenderness noted over the injured ligament but joint instability is either minimal or absent. May require up to 6 weeks to heal.

Grade III (severe): complete rupture of the ligament with severe swelling and tenderness. This injury may be difficult to distinguish from a fracture initially. Instability of the joint is noticeable due to the severity of the rupture. Prolonged time to heal is frequent and may require surgery to repair.

With a more severe ankle sprain, it is important to rule out a possible ankle fracture. Signs and symptoms of a broken bone can overlap with those of a severe sprain.

In the first week or so after a calcaneofibular ligament sprain, it is important to protect the recently injured and newly healing ligament. You want to minimize any movement that causes pain or places any stretch or strain across the injured site. Your PT may recommend bracing or taping to protect the injured area and reduce pain or advise you to use crutches if you cannot walk without limping.

Aside from protecting the area of injury, in this very early phase, your physical therapy treatment will focus on reducing inflammation and pain and maintaining strength in unaffected areas above the injury. To achieve these goals your physical therapy treatment may consist of the application of ice or light soft tissue work to mobilize any edema. Modalities such as electrical stimulation or ultrasound may be applied to increase circulation, decrease inflammation and control pain.

As the healing tissues become stronger, inflammation subsides and pain is reduced, it is time to move on to the next phase of rehab which consists of light muscle activation and endurance work, graded active range of motion, and more weight-bearing activities. Finally, in the later stages of healing your physical therapy treatment will focus on exercises and activities that prepare the injured ligament to withstand the stress and strain of everyday life and the sports and recreational activities we love to do. This may include the use of bands, standing exercises and plyometrics, for example.

CALL TO SCHEDULE AN EVALUATION FOR YOUR SPRAINED ANKLE WITH EVOLVE PT

While no one plans to sprain their ankle, having a great rehabilitation program can lessen the recovery time. Call to schedule an evaluation with our team at Evolve Physical Therapy to get started on your healing journey today.