Anterior Talofibular Ligament Injection

Indications and Clinical Considerations

The talofibular ligament is susceptible to strain from acute injury from sudden inversion of the ankle or from repetitive microtrauma to the ligament from overuse or misuse, such as from long-distance running on soft or uneven surfaces. Patients with strain of the talofibular ligament experience pain just below the lateral malleolus. Inversion of the ankle joint exacerbates the pain. On physical examination, there is point tenderness just below the lateral malleolus. With acute trauma, ecchymosis over the ligament may be noted. Passive inversion of the ankle joint exacerbates the pain. Coexistent bursitis and arthritis of the ankle and subtalar joint also may be present and may confuse the clinical picture.

Plain radiographs are indicated for all patients with ankle pain. On the basis of the patient’s clinical presentation, additional testing may be indicated, including complete blood cell count, sedimentation rate, and antinuclear antibody testing. Magnetic resonance imaging and/or ultrasound imaging of the ankle is indicated if disruption of the talofibular ligament, joint instability, occult mass, or tumor is suggested ( Fig. 180.1 ).

FIG. 180.1, A and B, Consecutive axial T1-weighted magnetic resonance arthrogram images demonstrating complete rupture of the talofibular ligament with only a small proximal remnant (broken arrows). High signal-intensity fluid has extravasated outside the normal joint recesses (asterisks).

Clinically Relevant Anatomy

The ankle is a hinge-type articulation among the distal tibia, the 2 malleoli, and the talus. The articular surface is covered with hyaline cartilage, which is susceptible to arthritis. The joint is surrounded by a dense capsule that helps strengthen the ankle. The joint capsule is lined with a synovial membrane that attaches to the articular cartilage. The ankle joint is innervated by the deep peroneal and tibial nerves.

The major ligaments of the ankle joint include the talofibular, anterior talofibular, calcaneofibular, and posterior talofibular ligaments, which provide the majority of strength to the ankle joint ( Fig. 180.2 ). The talofibular ligament is not as strong as the deltoid ligament and is susceptible to strain. It runs from the anterior border of the lateral malleolus to the lateral surface of the talus ( Figs. 180.3 and 180.4 ; also see Fig. 180.2 ).