Torn Ligament in Ankle: Recovery Time & Physical Therapy Tips!

Do you want to know the recovery and healing time after a torn ligament in ankle?

In this blog post, I will provide you with the most accurate information on this topic. I rely on my experience as a physical therapist, as well as the review of international scientific publications addressing the subject.

Ankle ligament ruptures are indeed very common and extensively studied, which should already provide some reassurance 🙂.

What is meant by torn ligament in ankle?

At the ankle level, there are several ligaments that attach to the bones of the foot. These ligaments help stabilize the ankle and prevent it from twisting in various directions with each step.

When the ankle is twisted, these ligaments can:

1. Stretch or become strained.
2. Partially tear, with a portion of their width affected.
3. Completely tear, resulting in a complete separation.

All three situations are referred to as an ankle sprain (or torn ligament in ankle in everyday language).

The three types of ankle ligament injuries

The severity of the ankle sprain is determined by the condition of the ligaments (stretched, partially torn, or completely torn):

1. Mild ankle sprain = grade 1 = ligaments are simply stretched or strained.
2. Moderate ankle sprain = grade 2 = ligament is partially torn.
3. Severe ankle sprain = grade 3 = ligament is completely torn across its width. The ligament’s attachment to the bone may also be compromised, resulting in a “bone avulsion” sprain.

Having a partial or complete ligament tear in the ankle corresponds to a grade 2 or 3 sprain.

💡 Take comfort in knowing that even with a “severe” sprain, the pain associated with an ankle sprain does not necessarily last longer!

This also applies to the sensation of instability or the feeling of complete recovery.

The recovery timelines are not necessarily longer for individuals with a total torn ligament (van Rijn 2008).

The only factor that seems to affect the duration of symptoms is engaging in highly intense sports (such as ball sports or combat sports) compared to not participating in sports or engaging in low-intensity sports.

Ligaments that can be affected

This can affect one or two ligaments:

• The lateral or outer ligament of the ankle, located near the outer malleolus, is the one that is more commonly stretched or torn.
• The medial or inner ligament of the ankle, located near the inner malleolus.

These ligaments can also be further divided into bundles, which are like “sub-ligaments.” That’s why you might sometimes see terms like injury, involvement, or rupture of:

• The anterior talofibular ligament.
• The calcaneofibular ligament.
• And so on.

But these are actually parts of the same main ligament: the medial or lateral ligament of the ankle.

In fact, you often won’t know precisely which ligaments and bundles are affected or if they are partially torn. This can only be seen through ultrasound or MRI.

The relevance of imaging tests for diagnosis

X-rays do not allow us to see the ligaments and whether they are torn or not. However, they can show a bone avulsion (grade 3 sprain with total ankle rupture).

Often, you will not be prescribed an ultrasound or MRI because it will not change the management plan to know if you have 1 or 2 affected bundles, and whether they are stretched or torn.

Even an X-ray is not always necessary in case of suspected sprain. It depends on several factors, including the presence of Ottawa criteria:

• Tenderness at 6 cm or less from either of the two malleoli.
• Inability to take 4 steps, either immediately after the injury or during the examination.

If you answer yes to either of these criteria, especially within the first 48 hours after the injury, then an X-ray is necessary.

The purpose of an X-ray is solely to rule out an ankle fracture or bone avulsion. It is not useful for determining the grade or severity of the sprain or the appropriate management approach.

How long does swelling last after a torn ligament in ankle?

Shortly after an ankle injury, it typically starts to swell.

What causes this?

It is an accumulation of fluid in the joint. This is a normal and healthy phenomenon that occurs to facilitate the early repair of damaged structures such as ligaments, muscles, fascia, etc.

The fluid contains nutrients and other substances that promote the healing of the injured tissues.

Swelling can persist for a long time after an ankle sprain, even for several months or years in some individuals!

However, your ligament can be fully healed and functional even if you still have edema and swelling. It may cause some discomfort in certain movements, particularly flexion.

But isolated swelling is not a cause for concern or an indication of non-healing!

In fact, research teams have found that people who still experience swelling after a torn ligament in ankle do not necessarily have worse functional scores. They can recover just as well as those who no longer have swelling (Pugia 2001, Ivy 2005)!

How long does it take for a torn ligament in the ankle to heal?

A study published as early as 2008 aimed to answer this specific question: what is the healing time for the lateral ankle ligament when it is stretched or torn due to a sprain?

Here’s what it concluded:

In the studies we reviewed, it took at least 6 weeks to 3 months for the ligament to heal. However, from 6 weeks to 1 year after the injury, a large percentage of participants still exhibited objective mechanical laxity and subjective ankle instability.

Hubbard 2008

You may sometimes come across varying times for ligament healing, such as 10 days, 3 weeks, or 6 months. Why do these timeline differ? It’s because different criteria are often used to define ligament healing:

• Some refer to the tissue properties returning to normal.
• Some consider the decrease or disappearance of inflammation.
• Others focus on the sensation of instability, etc.

Counterintuitively, it is possible to gradually resume activities even if the ligament is not fully healed! In any case, you will rarely undergo examinations to monitor the progress of healing.

It is your symptoms that should guide you in the resumption of activities, not a hypothetical theoretical healing time!

How long does pain last after an ankle ligament rupture?

The available studies on the timeline of pain in ankle sprains indicate that (Van Rijn 2008):

• Pain decreases rapidly within the first 2 weeks following the injury.
• Up to 2 out of 3 people will no longer experience pain after one year.
• Up to 9 out of 10 people will no longer experience pain after three years.

These studies often focus on people with longer-lasting or more troublesome forms of ankle sprains. This is because some people do not seek medical attention for an ankle injury and are therefore not included in these studies.

Therefore, you can absolutely be among those people whose pain completely disappears within a maximum of 2 weeks!

You can read the full blog post on persistent pain after an ankle sprain.

What is the total recovery time for a torn ligament in ankle?

Again, it depends on what we mean by “total recovery.”

Here is a table providing indicative timeframes. Of course, there is a great deal of variability among people!

Activity	Timeline
You have significantly less pain	2 weeks
You can resume driving your car	Few days to a few weeks
You can start cycling again	Few days to a few weeks
You can resume walking on uneven terrain	Few weeks
You can gradually start running	Few days to a few weeks
You can resume other sports activities	Few weeks to several months depending on the activity and its intensity
You are completely healed	Few weeks to a few months. 36% of people consider themselves completely healed within a maximum of 2 weeks. And when interviewing people who had an ankle sprain 3 years after the injury, 85% consider themselves completely healed. Source: Van Rijn 2008

It is worth noting that within 2 weeks to 8 years following an ankle ligament rupture, 3% to 34% of people experience a recurrence (Van Rijn 2008), meaning a new ankle sprain.

Lastly, some individuals never experience a sensation of instability despite being diagnosed with an ankle sprain or a torn ligament (Van Rijn 2008).

The recovery time after a torn ligament in ankle ligament is less than 2 weeks for 1 out of 3 people! Same answer for anterior talofibular ligament tear!

Can an ankle ligament repair itself?

Yes, it’s great news: our body is fully capable of repairing a torn ligament on its own.

All medical and non-medical treatments have only one objective:

• To relieve symptoms (pain, swelling, sensation of instability).
• To prevent worsening of the condition (through gradual weight-bearing and possible immobilization).
• To create favorable conditions for the body to recover naturally.

However, these treatments do not accelerate the healing or recovery time of the ligament in the ankle!

Even though we sometimes come across advertisements for products claiming to accelerate tissue healing time (such as Revitive Medic therapy or shockwave therapy), these are purely marketing claims and lack strong scientific support.

So, yes, an ankle ligament can heal itself as long as we don’t hinder this natural healing process!

That’s where the role of physiotherapists and other healthcare professionals comes in – to support you in the gradual resumption of activities if you need assistance during this stage.