Anterior Talofibular Ligament (ATFL) Tear

An anterior talofibular ligament (ATFL) tear is a common injury among athletes and active people. This ligament, located in the ankle, is often damaged during activities that involve sudden changes in direction, jumping, or twisting movements.

Experiencing ankle pain or instability? Consult our ankle injury specialist today for an accurate diagnosis & personalised treatment plan.

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Dr Dennis Ng Zhaowen

Causes of ATFL Tear

ATFL tears occur due to various factors, most commonly involving acute trauma or repetitive stress:

  • Sports Injuries
    Sports that involve sudden stops, jumps, or changes in direction, such as basketball, football, and tennis, frequently lead to ATFL tears.
  • Improper Footwear
    Wearing shoes that do not provide adequate support or are not appropriate for the activity can increase the risk of an ATFL tear.
  • Previous Ankle Injuries
    People with a history of ankle sprains or injuries are at a higher risk of ATFL tears due to weakened ligaments.
  • Falls and Missteps
    Unexpected falls, especially on uneven surfaces, can cause the foot to twist awkwardly, resulting in a tear.
  • Poor Surface Conditions
    Running or playing sports on uneven or slippery surfaces can lead to ankle injuries, including ATFL tears.

Symptoms of ATFL Tear

Identifying the symptoms of an ATFL tear is essential for early diagnosis and treatment. Common symptoms include:

  • Pain - Intense pain localised at the outer part of the ankle, often exacerbated by movement. This pain is usually sharp and can be severe, especially during activities that involve ankle motion.
  • Swelling - Rapid swelling around the ankle joint, sometimes accompanied by bruising or discolouration. The swelling typically appears quickly after the injury and can be significant, making the ankle look puffy and enlarged.
  • Instability - A feeling of the ankle giving way or being unstable, particularly during weight-bearing activities. This instability can make it difficult to walk or stand and may increase the risk of further injuries if not addressed promptly.
  • Tenderness - Sensitivity to touch along the ligament path and around the ankle joint. This tenderness can be felt when pressing on the affected area and is often a clear indication of ligament injury.
  • Popping or Tearing Sensation - Some individuals may experience a popping or tearing sensation at the time of injury. This sensation is often accompanied by immediate pain and can indicate a significant ligament tear.
  • Difficulty Bearing Weight - Severe tears may make it challenging or impossible to bear weight on the affected ankle. Attempting to walk or stand on the injured ankle can lead to increased pain and further damage.
  • Bruising - Along with swelling, bruising may appear around the ankle and foot. The bruising results from blood vessels being damaged during the ligament tear, leading to discolouration.

Diagnosis of ATFL Tear

Accurate diagnosis of an ATFL (Anterior Talofibular Ligament) tear involves a combination of clinical examination and imaging studies to ensure a comprehensive evaluation and appropriate treatment plan.

Clinical Examination

During a clinical examination, the doctor will:

  • Medical History: Take a detailed medical history, including the mechanism of injury and any previous ankle injuries. Understanding the circumstances leading to the injury can provide clues about the type and severity of the ligament damage.
  • Physical Examination: Perform a physical assessment of the ankle, checking for pain, swelling, tenderness, and instability. This examination may include palpating the affected area to identify points of maximum tenderness and observing any visible deformities or swelling.
Imaging Studies

Imaging studies are important to confirm the diagnosis and determine the severity of the tear:

  • X-rays: Used to rule out fractures or other bone injuries that may accompany the ligament tear. Although X-rays do not show soft tissue damage, they are essential for excluding bone-related issues.
  • MRI (Magnetic Resonance Imaging): Provides a detailed view of the soft tissues, including ligaments and tendons, allowing for accurate assessment of the tear’s extent.


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Treatment Options for ATFL Tear

Treatment for an ATFL tear depends on the severity of the injury and the patient’s activity level.

Non-Surgical Treatments

Non-surgical treatments are the first line of defence for managing ATFL tears, particularly for partial tears.

  • Rest, Ice, Compression, Elevation (RICE): These help reduce pain and swelling in the initial stages of injury. Resting the ankle prevents further damage, applying ice reduces swelling and pain, compression helps minimise swelling, and elevation decreases fluid accumulation in the affected area.
  • Bracing or Taping: Provides additional support and stability to the ankle during the healing process. Ankle braces or taping techniques can protect the ligament from further stress and aid in maintaining proper alignment during movement.
  • Medications: Anti-inflammatory medications, such as ibuprofen, help manage pain and reduce inflammation. These medications can be used as needed to alleviate discomfort and improve mobility.
  • Corticosteroid Injections: These injections can reduce inflammation and pain in more severe cases. Corticosteroids are powerful anti-inflammatory agents that can provide significant relief when other treatments are insufficient.
  • Platelet-Rich Plasma (PRP) Injections: PRP injections may promote healing by using the body’s natural growth factors. PRP therapy involves injecting a concentration of the patient’s platelets into the injured area to stimulate tissue repair and regeneration.
Surgical Treatments

Surgery is considered when non-surgical treatments fail to provide relief or in cases of severe tears.

  • Ligament Repair: The torn ligament is surgically repaired and reattached to the bone. This procedure involves suturing the damaged ligament back to its original position, allowing it to heal properly.
  • Reconstruction: In cases of extensive damage, a tendon graft may be used to reconstruct the ligament, restoring stability to the ankle. This involves using a tendon from another part of the body or a donor to replace the damaged ligament, providing a new, strong structure to support the ankle.
  • Arthroscopy: Minimally invasive surgery using a small camera and instruments inserted through tiny incisions. Arthroscopy can be used to assess and repair ligament damage, remove debris, or address other associated injuries within the ankle joint.

Prevention of ATFL Tear

Preventing an ATFL tear involves taking proactive steps to protect the ankle from injury.

  • Proper Footwear - Wear appropriate shoes that provide adequate support and are designed for the specific activity.
  • Strengthening Exercises - Regularly performing exercises to strengthen the muscles around the ankle, enhancing stability.
  • Warm-Up and Stretching - Ensuring a thorough warm-up and stretching routine before engaging in physical activities to prepare the muscles and ligaments.
  • Balance Training - Incorporating balance and proprioception exercises to improve joint stability and coordination.
  • Avoiding High-Risk Activities - Be cautious during activities that involve sudden changes in direction or jumping, and avoid uneven or slippery surfaces when possible.

Effective & Evidence-Based Orthopaedic Care

Dr. Dennis Ng is dedicated to understanding your unique needs, focusing on restoring
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Jeremy Teo
Jeremy Teo
I tore my left pec muscle after a bench press accident and had the fortune of getting help from Dr Dennis. He is a very caring and helpful individual that you can tell wants the best healing progress for you and actively follows up with you sincerely. I initially had a two month delay and misdiagnosis at Ktph and it caused my tendon to retract. Should have went to Dr Dennis from the start.. 5/5
Emily Loo
Emily Loo
I felt that doctor Dennis is very experienced and he skilfully aligned my fractured toe after my accident so that I didn’t need to do a minor surgery. He was friendly and professional and I felt his fees were reasonable without additional overselling of tests, supplements etc. that I have experienced elsewhere. Overall it was a smooth and effective experience and I would highly recommend doctor Dennis.
Ming W
Ming W
Wonderful experience with Dr. Dennis and his team. The staff were attentive and efficient. Dr. Dennis is professional, caring and knowledgeable. I had a shoulder injury and knee injury that required surgery. The whole journey, including pre and post surgery, Dr. Dennis and his team made sure I received the best treatment possible. Really thankful for the team and I definitely will recommend this place to others.
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Jermy Tan
Saw Dr Dennis for my lumbar slipped disc. Great doctor and he explained clearly the different options available. Went with surgery and have been recovering well since then.
Amanda Seah
Amanda Seah
I came in with a shoulder injury that meds from a GP did not relieve one month ago. Dr Dennis and his team were great in diagnosing the exact injury with an mri, and he prescribed physio. My shoulder condition has greatly improved and I can now move my arm almost completely! Thank you Dr Dennis!
Jaslyn HENG (Kenrick)
Jaslyn HENG (Kenrick)
A very friendly and nice doctor who manage to cure my elbow issue whjch has been bothering me for more than 6 months! Thank you Doctor Dennis!
Xianmin Jiang
Xianmin Jiang
I had severe left shoulder pain due to exercise. After MRI checking , it was shown high-grade tendon tearing. Dr Dennis did the surgery for my left should calf repair. After surgery, I strictly follow what he suggested. The recovery was really amazing and fast. I was curious about what happened to my shoulder, he explained in details and with great patience. Now, I am fully recovered in a very fast speed and come back to my loved sports and exercises. I definitely recommend Dr Dennis for his profession, patience and delicate skills. Last not the least, thank for his medical team. The nurses are always prompt to reply when I need help and message them.
Omar Lechuga
Omar Lechuga
Dr. Dennis helped me with an elbow pinch coming from a trauma. His attention to detail confidence and great empathy really helped me to fully recover. Thank you Dr. Dennis.
Benjamin Mah
Benjamin Mah
Dr Dennis has been helpful in the diagnosis and explanation of my injury

Dr Dennis Ng Zhaowen
Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road #08-41,Singapore 329563

Dr Dennis Ng Zhaowen

  • Senior Consultant Orthopaedic Specialist
MBBS (Singapore)
FRCSEdOrth (Gold Medal Award)

Before private practice, Dr Dennis Ng was the former Deputy Head of the Shoulder & Elbow Division and Sports Knee Division in National University Hospital.

He completed his fellowship at the prestigious Fowler Kennedy Sports Medicine Centre in London, Ontario, Canada, and has rich experience treating professional athletes and returning them to sports. 

His special areas of interests include management of sports injuries such as ankle sprains, ligament and ATFL tears, achilles tendinitis etc.



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    Mount Elizabeth Novena Specialist Centre

    38 Irrawaddy Road #08-41
    Singapore 329563

    Monday – Friday: 9am – 1pm; 2pm – 5pm
    Saturday: 9am – 1pm
    Sunday & PH: CLOSED

    Other Clinic Location

    Gleneagles Medical Center

    6 Napier Road #07-15
    Singapore 258499

    Monday – Friday: 9am – 1pm; 2pm – 5pm
    Saturday: 9am – 1pm
    Sunday & PH: CLOSED

    Frequently Asked Questions (FAQs)

    How long does it take to recover from an ATFL tear?

    The recovery time for an ATFL tear varies based on the severity of the injury and the treatment approach. Mild to moderate tears managed with non-surgical treatments typically take several weeks to a few months to heal. Recovery from surgical treatment may take longer, often several months, and includes a structured rehabilitation program to restore strength, flexibility, and stability to the ankle. Regular follow-up with a doctor is recommended to monitor progress and ensure a successful recovery.

    Why should I see a doctor if I suspect an ATFL tear?

    Seeing a doctor is important if you suspect an ATFL tear because they can provide an accurate diagnosis and appropriate treatment plan. Delaying medical evaluation can lead to improper healing, chronic instability, and an increased risk of re-injury. A doctor can assess the severity of the tear, recommend the best treatment options, and guide you through the rehabilitation process to ensure a full recovery.

    What are the risks of not treating an ATFL tear?

    If left untreated, an ATFL tear can lead to chronic ankle instability, persistent pain, and an increased likelihood of re-injury. Over time, this can result in long-term complications such as arthritis or difficulty participating in physical activities. Prompt treatment helps ensure proper healing and reduces the risk of future problems.

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