The Grumpy Ankle Part 1 – Bifurcate Ligament Injuries

The ankle is an extremely complex joint. It is made up of three main bones, many ligaments and soft tissue structures which all work together to provide a solid platform for movement and balance. Healthy ankles allow us to walk, run, dance and jump and then land safely again.

The most common injury is to the lateral ligaments on the outside of the ankle. Lateral ankle sprains or “rolled” ankles are suffered by up to 70% of the population and occur when the foot is forced in (inverted) and weight is directed down through the outside of the foot. Unfortunately, it has been noted that less that 50% of people who suffer from a lateral ankle sprain seek treatment, which could be a contributing factor to chronic ankle problems in the future![i] (To learn more about these – read here) If these ligaments are not treated well, scar tissue and bony lesions can develop which can cause some of the chronic ankle problems that can result. If this sound like you – read on!

Following ankle inversion injuries, damage to vital structures can be missed if you have not been properly assessed. A commonly missed injury is to the bifurcate ligament. This ligament connects the ankle to the midfoot and is responsible for stability and powering off our toes when we run.[ii] If missed, rehabilitation and healing is prolonged and chronic injury to the ankle can result.

This injury often occurs if the rest of the foot is locked – either by being:

  • In an ankle brace
  • Taped e.g. to play sport
  • wearing strappy high heels

… and the foot rolls in, putting this ligament on stretch while the rest of the ankle is stabilised. Depending on the severity of the injury your physio might recommend immobilisation by putting the foot in a CAM boot or taping for support to let the ligament heal. If a full rupture has occurred, it can pull a fragment of the bone off the attachment and on occasion this may require some further imaging and potentially surgical fixation.

During this time, physiotherapy is vital to ensure appropriate scar tissue is laid down and the ligament can heal. Early physiotherapy allows the patient to complete safe exercises to maintain strength to the rest of your body and prevent the ankle becoming stiff and scar tissue adhesions developing (rest and forget), which prolongs the recovery process.

Once the ligament begins to heal, your physio will work with you progressing appropriate exercises to get you back to full function. These include a focus on ankle and mid-foot strength, landing and jumping techniques and balance re-training.

If you have recently hurt your ankle and not sure what to do, or you don’t seem to be getting better – then let the professionals take a look! Book in to see one of the Sports Physio’s in the Bend + Mend team.



[i] Berman, Z., Tafur, M., Ahmed, S. S., Huang, B. K., & Chang, E. Y. (2017). Ankle impingement syndromes: an imaging review. The British journal of radiology90(1070), 20160735. 

[ii] William R. Walter, Anna Hirschmann, Erin F. Alaia, Monica Tafur, and Zehava S. Rosenberg (2019). Normal Anatomy and Traumatic Injury of the Midtarsal (Chopart) Joint Complex: An Imaging Primer. RSNA Journals, 39:1, 136-152

Lauren Stein

About Lauren Stein

Lauren has a special interest in treating sports injuries stemming from her own experiences and injuries playing soccer and futsal at a high level. Spending hours at the Physio sparked her interest in one day becoming a Physio herself! Lauren has worked on the sidelines with Rugby Union teams and, in addition to helping athletes, she has particular interest in neck and lower back pain as well as knee and ankle injuries. Lauren incorporates both manual therapy techniques and selects specific exercises to best motivate and get speedy improvements for her clients. When she’s out of the clinic you can find Lauren out visiting family in Orange, exploring the restaurants and beaches of Sydney or buried in a good novel.

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