Talofibular Ligament Injury Clinical Presentation

  • Author: Marc A Molis, MD, FAAFP; Chief Editor: Sherwin SW Ho, MD   more...
 
Updated: Jul 15, 2011
 

History

The history portion of the examination for a suspected talofibular ligament injury should include the following:

  • Mechanism of injury
  • Time of injury
  • Concurrent injuries
  • Position of the body at the time of injury
  • Rotational component to injury
  • Ability or inability to bear weight immediately after the injury
  • Time of onset of pain and swelling (immediate or delayed)
  • Whether the patient heard or felt a popping sound or sensation at the time of the injury
  • Information regarding any previous ankle injuries
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Physical

The physical examination for a suspected talofibular injury should include the following:

  • Inspect the ankles. Both ankles should be completely uncovered so the injured side can be compared with the uninjured side. Note any swelling, ecchymosis, lacerations, abrasions, or deformities.
  • Palpate the injured ankle, noting any tenderness or crepitus.
  • Test the range of motion. Patients with ligamentous injuries, especially to the ATFL, will have limited and painful inversion of their ankle.
  • Perform a neurovascular examination of the foot distal to the injury. Document the findings.
  • Assess the stability of the ankle joint. The anterior drawer test assesses the stability of the lateral ligaments. To perform this test, the foot is placed in slight inversion and 20° of plantar flexion. The heel is grasped firmly and drawn forward by the examiner, while the tibia is stabilized by the examiner's other hand. A positive sign occurs when the talus moves forward on the tibia. The injured side should also be tested for maximal inversion compared with the uninjured side. If the ATFL is torn, forward motion is detected on performing the anterior drawer test. If the ATFL and the CFL are torn, abnormal inversion is elicited.
  • Talar tilt test: Assess the stability of the calcaneofibular ligament. Grade I sprains are partial tears of the ligaments and are stable to stress testing. Grade II sprains have a mildly increased anterior drawer test and are stable to inversion. Grade III sprains are unstable to both the anterior drawer test and the talar tilt test. Instability with these tests indicates a complete tear of the ATFL and at least a partial tear of the CFL.
  • Perform a neurologic exam. This should include testing the patient's balance. Have them stand on their uninjured foot, initially with their eyes open; then, have them close their eyes. Then have the patient do this with the injured foot and compare. Ankle injuries will often disrupt the nerves, causing the patient to have poor balance.

Related Medscape topics:

Resource Center Trauma

Resource Center Vascular Surgery

Specialty Site Neurology & Neurosurgery

Specialty Site Orthopaedics

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Contributor Information and Disclosures
Author

Marc A Molis, MD, FAAFP  Medical Director of Sports Medicine, Sports Medicine of Iowa

Marc A Molis, MD, FAAFP is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Association, American Medical Society for Sports Medicine, and Iowa Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

David F Martin, MD  Program Director, Associate Professor, Department of Orthopaedic Surgery, Wake Forest University School of Medicine

David F Martin, MD is a member of the following medical societies: American College of Sports Medicine, American College of Surgeons, American Medical Association, American Orthopaedic Association, American Orthopaedic Society for Sports Medicine, International Society on Thrombosis and Haemostasis, Southern Medical Association, and Southern Orthopaedic Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Craig C Young, MD  Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Director of Primary Care Sports Medicine Fellowship, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Russell D White, MD  Professor of Medicine, Director of Sports Medicine Fellowship Program, Medical Director, Sports Medicine Center, Head Team Physician, University of Missouri-Kansas City Intercollegiate Athletic Program, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center Lakewood

Russell D White, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Family Physicians, American Association of Clinical Endocrinologists, American College of Sports Medicine, American Diabetes Association, and American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Jon B Whitehurst, MD  Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital

Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America

Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD  Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, and Herodicus Society

Disclosure: Breg, Inc. Consulting fee Consulting; Biomet, Inc. Consulting fee Consulting; GMV, Inc. Arthroscopy Simulator Evaluation and teaching; Smith and Nephew Grant/research funds Fellowship funding; DJ Ortho Grant/research funds Course funding; Athletico Physical Therapy Grant/research funds Course, research funding

Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Michael Taylor, MD, to the development and writing of this article.

References

  1. Brukner P, Khan KM. Acute ankle injuries. Clinical Sports Medicine. 3rd ed. San Francisco, Calif: McGraw-Hill; 2006.

  2. Jackson MD, Moeller JL, Hough DO. Basketball injuries. In: Sallis RE, Massimino F, eds. American College of Sports Medicine's Essentials of Sports Medicine. New York, NY: Churchill Livingstone; 1996:558-9.

  3. Fong BL, Brunet ME. The leg, ankle, and foot. In: Perrin DH, ed. The Injured Athlete. 3rd ed. Philadelphia, Pa: Lippincott-Raven; 1999:432-9.

  4. Jayanthi N. Lower leg and ankle. In: McKeag DB, Moeller J, eds. ACSM's Primary Care Sports Medicine. 2nd ed. Philadelphia, Pa: Lippincott, Williams and Wilkins; 2007.

  5. Magee D. Lower leg, ankle, and foot. Orthopedic Physical Assessment. 4th ed. Toronto, Canada: Elsevier Sciences; 2006.

  6. Brage ME, Colville MR, Early JS. Ankle and foot: trauma. In: Beaty JH, ed. Orthopaedic Knowledge Update 6. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 1999:597-612.

  7. Breitenseher MJ. [Injury of the ankle joint ligaments] [German]. Radiologe. Mar 2007;47(3):216-23. [Medline].

  8. Rubin A. Ankle ligament sprains. In: Sallis RE, Massimino F, eds. American College of Sports Medicine's Essentials of Sports Medicine. New York, NY: Churchill Livingstone; 1996:450-2.

  9. Schepsis AA. Ligamentous injuries of the ankle. In: Yablon IG, Segal D, Leach RE, eds. Ankle Injuries. New York, NY: Churchill Livingstone; 1983:193-208.

  10. Scranton PE. Ankle and foot: trauma. In: Fitzgerald RH Jr, ed. Orthopaedic Knowledge Update 2. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 1987:447-54.

  11. Haraguchi N, Toga H, Shiba N, Kato F. Avulsion fracture of the lateral ankle ligament complex in severe inversion injury: incidence and clinical outcome. Am J Sports Med. Jul 2007;35(7):1144-52. [Medline].

  12. Garrett WE Jr. Trauma: soft tissue. In: Fitzgerald RH Jr, ed. Orthopaedic Knowledge Update 2. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 1987:89-96.

  13. Harmon KG. Which support is best for first-time ankle sprains?. Clin J Sport Med. Jul 2007;17(4):333-4. [Medline].

  14. Mellion MB, Walsh WM, Shelton GL, eds. The Team Physician's Handbook. 3rd ed. Philadelphia, Pa: Hanley and Belfus; 2002.

  15. Simons S. Rehabilitation of ankle injuries. In: Sallis RE, Massimino F, eds. Simons S. Rehabilitation of ankle injuries. New York, NY: Churchill Livingstone; 1996:458-61.

  16. Kerkhoffs GM, Handoll HH, de Bie R, Rowe BH, Struijs PA. Surgical versus conservative treatment for acute injuries of the lateral ligament complex of the ankle in adults. Cochrane Database Syst Rev. Apr 18 2007;CD000380. [Medline].

  17. Anderson RB. Ankle and foot: reconstruction. In: Kasser JK, ed. Orthopaedic Knowledge Update 5. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 1996:525-48.

  18. Mann RA. Ankle and foot: reconstruction. In: Fitzgerald RH Jr, ed. Orthopaedic Knowledge Update 2. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 1987:455-63.

  19. Kelikian H, Kelikian AS. Disruption of the fibular collateral ligament. In: Kelikian H, Kelikian AS, eds. Disorders of the Ankle. Philadelphia, Pa: WB Saunders; 1985:437-90.

  20. Samoto N, Sugimoto K, Takaoka T, et al. Comparative results of conservative treatments for isolated anterior talofibular ligament (ATFL) injury and injury to both the ATFL and calcaneofibular ligament of the ankle as assessed by subtalar arthrography. J Orthop Sci. Jan 2007;12(1):49-54. [Medline].

  21. Snell R, Smith M. The bony pelvis and lower extremity. In: Clinical Anatomy for Emergency Medicine. St. Louis, Mo: Mosby-Year Book; 1993:708-9.

  22. Tochigi Y, Rudert MJ, McKinley TO, Pedersen DR, Brown TD. Correlation of dynamic cartilage contact stress aberrations with severity of instability in ankle incongruity. J Orthop Res. Sep 2008;26(9):1186-93. [Medline].

 
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