Talofibular Ligament Injury Workup

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

Laboratory Studies

  • Laboratory studies are not indicated in the workup of ligamentous injuries of the ankle.

Related Medscape topic:

Resource Center Pathology & Lab Medicine

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Imaging Studies

Indications for imaging studies in cases of suspected talofibular ligament injuries include the following:

  • Bony tenderness or deformity
  • Suspicion of a fracture or syndesmotic injury
  • Severe pain or swelling that makes the physical examination unreliable
  • Inability to walk

Initial radiologic studies of the ankle should include the following:

  • An anteroposterior (AP) view with the ankle in slight adduction
  • A true lateral view
  • A mortise view (45° oblique view with the ankle in dorsiflexion)
  • Consider stress views of the ankle.
  • If a syndesmotic injury is suspected, then AP and lateral views of the tibia and fibula should also be obtained to rule out associated fibular fractures.

Magnetic resonance imaging (MRI) may be useful in evaluating the soft-tissue anatomy of the ankle, such as ligaments and tendons.[12] This imaging modality is not typically an initial test performed, but MRI may be useful in the patient who is not healing, in whom a stress fracture is suspected, or in chronic ankle pain and instability.

Related Medscape topics:

Resource Center Joint Disorders

Resource Center Pain Management: Advanced Approaches to Chronic Pain Management

Resource Center Pain Management: Pharmacologic Approaches

Specialty Site Radiology

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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

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  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.

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  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.

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  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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