Lower limb
Anterior talofibular ligament (ATFL)
Ligamentum talofibulare anterius (ATFL)
- Origin
- Anterior border of the lateral malleolus, about a centimetre above the tip
- Insertion
- Neck of the talus, just in front of the lateral articular facet
- Function
- Checks anterior translation of the talus in the mortise and inversion in plantar flexion. The weakest and shortest of the three lateral ligaments, and therefore the first to tear.
- Innervation
- Superficial fibular nerve; rich in mechanoreceptors contributing to ankle proprioception
- Movement & chain
- Taut in plantar flexion and slack in dorsiflexion. That explains why an ankle almost always sprains in plantar flexion with inversion: in that position this ligament carries the load almost alone.
- Palpation
- Find the tip of the lateral malleolus and move obliquely forward and slightly upward, towards the neck of the talus. The ligament runs just under the skin there; in slight plantar flexion it can be felt as a cord.
- Clinical
- In roughly two thirds of all inversion injuries this is the only damaged ligament. The ankle anterior drawer test targets it specifically. The Ottawa ankle rules decide whether imaging is needed: tenderness on the posterior edge of a malleolus, or inability to bear weight for four steps.
- Segmental innervation
- Segmentally L5-S1 via the superficial fibular nerve
- In clinical practice
- For an acute sprain, functional treatment with a brace and early weight bearing beats a cast. Proprioceptive training substantially lowers the chance of recurrence, which matters: without it up to a third sprain again.
- Region in the model
- Lower limb