Ankle injuries are among the most common musculoskeletal conditions seen in physiotherapy clinics, especially in active individuals and athletes. Two of the key ligaments frequently involved in ankle sprains are the ATFL (anterior talofibular ligament) and the CFL (calcaneofibular ligament). Understanding these injuries, their management, and the rehabilitation process is essential for effective recovery and return to activity.
What Are the ATFL and CFL Ligaments?
- ATFL (Anterior Talofibular Ligament):
The ATFL is the most commonly injured ligament in an ankle sprain. It connects the fibula (outer lower leg bone) to the talus (ankle bone) and stabilises the ankle during plantarflexion and inversion movements. - CFL (Calcaneofibular Ligament):
The CFL runs from the fibula to the calcaneus (heel bone) and provides stability when the ankle is in a neutral or dorsiflexed position. It often gets injured in more severe ankle sprains.
ATFL and CFL Sprain or Rupture – Causes and Symptoms
These ligaments are typically injured due to:
- Sudden twisting or rolling of the ankle (inversion injury)
- Landing awkwardly after jumping
- High-impact sports or uneven surfaces
Symptoms may include:
- Sharp pain on the outside of the ankle
- Swelling and bruising
- Difficulty bearing weight
- A feeling of instability or “giving way”
- In complete ruptures, there may be a noticeable loss of function or structural integrity
Early Stage Management of ATFL and CFL Injuries
The acute phase of injury management (first 48–72 hours) aims to reduce pain, swelling, and prevent further damage.
RICER Protocol:
- Rest – Limit weight-bearing activities. Crutches may be required for more severe injuries.
- Ice – Apply for 15–20 minutes every 2–3 hours to reduce inflammation.
- Compression – Use an elastic bandage or ankle brace to support and control swelling.
- Elevation – Keep the ankle elevated above heart level as much as possible.
- Referral – Seek assessment by a physiotherapist or medical professional to determine the severity of the sprain or rupture.
Avoid HARM Factors:
- Heat
- Alcohol
- Running
- Massage (in the first 48 hours)
Physiotherapy Rehabilitation for ATFL and CFL Injuries
Once the acute inflammation settles, the focus shifts to restoring function, strength, and proprioception. A tailored rehab plan is essential to prevent chronic instability or recurrent sprains.
Phase 1: Early Mobilisation & Pain Control
- Gentle range-of-motion exercises
- Isometric strengthening
- Continued use of ankle brace if required
Phase 2: Strength & Balance Training
- Resistance exercises for peroneal muscles
- Single-leg balance training
- Proprioceptive drills using wobble boards or foam pads
Phase 3: Sport-Specific & Return-to-Activity
- Functional exercises: hopping, agility drills, cutting movements
- Plyometrics and dynamic balance
- Gradual return to running and sport with physiotherapist guidance
Long-Term Management and Injury Prevention
To reduce the risk of future ankle injuries:
- Continue regular ankle strengthening and balance work
- Use ankle taping or braces during high-risk activities
- Ensure proper footwear for your sport or activity
- Consider a custom exercise program from your physiotherapist
When to See a Physiotherapist
If you’re experiencing persistent ankle pain, swelling, or instability after a suspected ATFL or CFL sprain, early assessment is crucial. A physiotherapist can:
- Diagnose the grade of ligament damage (Grade I–III)
- Provide hands-on treatment
- Create a structured rehab plan tailored to your lifestyle and goals
Book a Physiotherapy Appointment
At After Hours Physio, we offer urgent home-visiting physiotherapy in Melbourne, specialising in acute injury management for patients who can’t get to a clinic. Whether it’s a mild ankle sprain or a suspected ligament rupture, we’ll get you back on your feet faster.
📍 Serving Blackburn, Box Hill, Mitcham, Doncaster and surrounding suburbs.
🕐 After-hours appointments available.
📞 Contact us today for immediate ankle injury support.