Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.
▶ Watch
Medically Reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists, Michigan. Last updated April 2026.
Ankle Ligament Anatomy: Why It Matters
Most people know they’ve “sprained an ankle” — but which specific ligaments were injured determines injury severity, treatment approach, and return-to-activity timeline. At Balance Foot & Ankle in Howell and Bloomfield Township, Michigan, we diagnose ankle sprains precisely rather than treating all ankle sprains identically.
Lateral Ankle Ligaments: Most Commonly Injured
The lateral (outer) ankle has three ligaments that stabilize against inversion (the foot turning inward): the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL), and the posterior talofibular ligament (PTFL). The ATFL is injured in approximately 70% of ankle sprains — it is the weakest lateral ligament and resists inversion-plantarflexion stress. The CFL is the next most commonly injured, torn in more severe sprains — it resists inversion with the ankle in a more neutral position. The PTFL is rarely injured in isolation and only in the most severe sprains. A Grade 1 sprain involves stretching without ligament tear; Grade 2 involves partial tear; Grade 3 involves complete rupture. The specific grade and ligaments involved determines treatment intensity.
Medial Ankle Ligaments: The Deltoid Complex
The medial (inner) ankle is stabilized by the deltoid ligament — a powerful, multi-layered structure that resists eversion (foot turning outward). Isolated medial ankle sprains are uncommon because the deltoid is so strong that eversion injuries more often fracture the medial malleolus before the ligament tears. When the deltoid is injured, it is typically in association with a fibular fracture (an ankle fracture-dislocation pattern). Any medial ankle pain after injury deserves X-ray evaluation to exclude fracture.
Syndesmotic (High Ankle) Sprain
The distal tibiofibular syndesmosis — the fibrous joint that holds the tibia and fibula together above the ankle — is injured by external rotation mechanisms (foot planted and body rotating externally). High ankle sprains are significantly more serious than lateral ankle sprains: they take 2-3 times longer to recover, frequently require surgical stabilization when the mortise is unstable, and return to sport takes 6-12 weeks versus 1-4 weeks for lateral sprains. The distinguishing feature: pain above the ankle joint, reproduction of symptoms with the squeeze test or external rotation stress test.
Accurate Diagnosis Guides Treatment
Treating all ankle sprains identically — without determining which ligaments are involved, whether the mortise is stable, and whether any associated injury (osteochondral lesion, fracture, syndesmotic disruption) is present — leads to undertreated injuries and prolonged recovery. Contact Balance Foot & Ankle at (810) 206-1402 for a thorough ankle injury evaluation that identifies the specific pathology and tailors treatment accordingly.
Foot or Ankle Pain? We Can Help.
Balance Foot & Ankle — Howell & Bloomfield Township, MI
📅 Book Online
📞 (810) 206-1402
Sprained Your Ankle? Get Expert Ligament Assessment
Ankle sprains that dont heal properly can lead to chronic instability. At Balance Foot & Ankle, Dr. Tom Biernacki uses advanced imaging and biomechanical evaluation to identify which ligaments are damaged and create a targeted recovery plan.
Learn About Ankle Sprain Treatment | Book Your Appointment | Call (810) 206-1402
Clinical References
- Doherty C, et al. The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis. Sports Medicine. 2014;44(1):123-140.
- Waterman BR, et al. The epidemiology of ankle sprains in the United States. Journal of Bone and Joint Surgery. 2010;92(13):2279-2284.
- Gribble PA, et al. Evidence review for the 2016 International Ankle Consortium consensus statement on the prevalence and management of lateral ankle sprains. British Journal of Sports Medicine. 2016;50(24):1496-1505.
Insurance Accepted
BCBS · Medicare · Aetna · Cigna · United Healthcare · HAP · Priority Health · Humana · View All →
Howell Office
3980 E Grand River Ave, Suite 140
Howell, MI 48843
Get Directions →
Bloomfield Hills Office
43700 Woodward Ave, Suite 207
Bloomfield Hills, MI 48302
Get Directions →
Your Board-Certified Podiatrists
Ready to Get Back on Your Feet?
Same-week appointments available at both locations.
Book Your AppointmentWatch: Dr. Tom explains
Podiatrist-recommended products
As an Amazon Associate, Dr. Tom earns from qualifying purchases.
Related resources
Ready to solve this? Book today.
Same-week appointments · Howell & Bloomfield Hills · 4.9★ (1,123+ reviews)
☎ (810) 206-1402Book Online →
Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)
- Hallux Valgus (Bunions): Evaluation and Management (PubMed)
- Bunions (Mayo Clinic)