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How Clinic Based Ultrasound Technology Aids in diagnosing ankle ligament injuries


Ankle injuries are common and can be challenging to diagnose accurately. Early and precise detection of these injuries is crucial for proper treatment and recovery. Clinic based ultrasound technology has emerged as a valuable diagnostic tool for various medical conditions, including anterior talofibular ligament (ATFL) injuries which is the most common ligament affected. In this article, we will discuss how ultrasound devices aid in diagnosing different types of ligaments on the outer ie lateral side and inner ie medial side of the ankle.


What is ATFL and Why is Accurate Diagnosis Important?

The ATFL, or anterior talofibular ligament, is a critical component of the lateral ankle ligament complex. Located on the outer side of the ankle, this ligament connects the talus bone (a key bone in the foot) to the fibula (the smaller, outer bone of the lower leg). The ATFL is responsible for stabilising the ankle joint, particularly during movements that involve inversion, or turning the foot inward. This stability is crucial for maintaining proper joint alignment and preventing injuries.


Ankle sprains, one of the most common sports-related injuries, often involve damage to the ATFL. When the foot experiences excessive inversion, the ATFL can become overstretched or even torn. This can happen during sudden movements, such as changing direction quickly, jumping, or landing awkwardly after a jump. Additionally, everyday activities, like stepping off a curb or losing balance on an uneven surface, can also result in an ATFL injury if the ankle twists excessively.


ATFL injuries can range from mild to severe, depending on the extent of the ligament damage:

  • Grade 1 (mild): The ATFL is overstretched but not torn, causing minor swelling, tenderness, and stiffness.
  • Grade 2 (moderate): The ATFL is partially torn, leading to moderate pain, swelling, and difficulty bearing weight on the affected ankle.
  • Grade 3 (severe): The ATFL is completely torn, causing significant pain, swelling, and instability, making it difficult or impossible to bear weight on the injured ankle.

Preventing ATFL injuries involves maintaining good ankle strength, flexibility, and balance. Regular exercise, proper footwear, and using caution on uneven surfaces can help reduce the risk of these injuries. However, despite taking precautions, accidents can still happen. In such cases, timely and accurate diagnosis is crucial for determining the appropriate treatment and preventing long-term complications, such as chronic instability or arthritis. In some cases, misdiagnosis or delayed treatment can lead to prolonged pain, reduced mobility, and an increased risk of re-injury.


Ultrasound Technology: A Valuable Diagnostic Tool

Ultrasound devices are portable, user-friendly, and provide real-time imaging of the affected area. They offer several advantages over other forms of imaging such as an MRI such as ease of use, lower cost, and increased accessibility.


Ultrasound technology uses high-frequency sound waves to create detailed images of the internal structures of the ankle. The device emits sound waves that penetrate the skin and soft tissues, reflecting off the underlying anatomy. The returning echoes are then processed and converted into a digital image displayed on the device's screen. There is no radiation involved so it is very safe.

ultrasound machine

Using ultrasound for diagnosing ATFL injuries provides several benefits, including:

  • Accessibility: Ultrasound machines are portable and can be used in various settings, including clinics, hospitals, and sports fields.
  • Real-time imaging: Live imaging allows healthcare professionals to evaluate the ankle's structures dynamically, aiding in an accurate diagnosis. This can be especially helpful in young children who are unable to stay still inside the MRI machine.
  • Cost-effectiveness: a cost-effective diagnostic tool compared with MRI scans.


Potential Diagnoses from Ultrasound

Ultrasound technology can help diagnose several common ankle injuries, including:

  1. ATFL (Anterior  talofibular ligament) sprains and tears: Partial or complete tears of the ATFL can be identified using ultrasound, allowing for an accurate assessment of the injury's severity.
  2. ATiFL (anterior inferior tibiofibular ligament) sprains and tears. This ligament attaches the tibia bone to the fibula bone just above the ankle.
  3. CFL (calcaneofibular ligament ) sprains and tears.  This ligament attaches the calcaneus bone to the fibula bone on the outside of the ankle joint.
  4. Medial ligament sprains and tears - these ligaments are located on the inner side of the ankle joint.
  5. Peroneal tendon injuries: Ultrasound can detect issues such as peroneal muscle tendon tears, dislocation, or inflammation.
  6. Achilles tendon injuries: Ultrasound can help identify Achilles tendon tears or tendinopathy.

Ultrasound technology are most useful in detecting superficial injuries such as the above. For deeper structures, such as the talus or calcaneus bones, where fractures are suspected, either an X ray or MRI would be better.


Treatments for Ankle Injuries and the Role of Ankle Boots and Braces

General treatment options for ankle injuries include rest, ice, compression, and elevation (RICE). Depending on the severity and type of injury, additional interventions may be necessary. Ankle boots and braces offer valuable support and stability for injured ankles, particularly in cases of ATFL injuries.

man wearing ankle boots

Ankle boots and braces provide several benefits, such as:

  • Immobilisation: Restricting movement can help prevent further damage and promote healing.
  • Support: Ankle boots and braces offer external support, reducing stress on the injured ligament or tendon.
  • Pain relief: By immobilising and stabilising the ankle, these devices can help alleviate pain and discomfort.

Other treatment options for ankle injuries may include physiotherapy to improve strength, flexibility, and balance or surgical intervention in severe cases.


Ultrasound technology is a powerful diagnostic tool for accurately identifying ATFL injuries and other ankle issues. It offers numerous advantages, such as accessibility, real-time imaging, and cost-effectiveness. Proper diagnosis is essential for determining the appropriate treatment plan, including the use of ankle boots and braces, which provide stability, support, and pain relief. Always consult a healthcare professional for any concerns related to ankle injuries.

The clinician assessing your ankle will determine whether you are suitable to undergo the best type of imaging depending on your medical situation.  Please note an ultrasound scan may not always be possible on the same day as the initial assessment, due to time constraints. 

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Topics: Body Check, Health & Wellness, Fitness & Active Health, General Practice / Family Medicine

Dr Ray SH Ng

Dr Ray SH Ng

Family Medicine, General Practice, Sports Medicine