From the Guidelines
For a tear of the anterior fibulotalar ligament (AFTL) with a nondisplaced cuboid fracture, functional support rather than immobilization is preferred, with the use of a brace, and exercise therapy should be started as soon as possible to recover joint functionality. The treatment approach should prioritize reducing pain and swelling, with NSAIDs being an option for pain management 1. Immobilization is not recommended as it can hinder the recovery of joint functionality, and instead, functional support with a brace is advised, allowing for early mobilization and rehabilitation 1.
Key Considerations
- Pain management with NSAIDs, such as ibuprofen or naproxen, can be beneficial for 1-2 weeks 1.
- Exercise therapy, focusing on ankle range of motion, proprioception, strength, and function, should be initiated as soon as possible to enhance recovery and prevent chronic instability 1.
- Supervised exercises with a focus on proprioception, strength, coordination, and function are recommended for sport resumption 1.
- A gradual return to weight-bearing activities and high-impact exercises should be planned, typically avoiding high-impact activities for 3-4 months to ensure proper healing of both the AFTL and the cuboid fracture.
Rehabilitation Approach
- Ankle circles, alphabet tracing with the foot, balance exercises on stable and then unstable surfaces, and resistance band exercises can be included in the rehabilitation program.
- The goal of rehabilitation is to restore ankle stability, improve proprioception, and strengthen the surrounding muscles to prevent recurrent sprains or early-onset arthritis.
- Regular follow-up with a healthcare professional is necessary to monitor the healing process and adjust the rehabilitation program as needed, ensuring the best possible outcome in terms of morbidity, mortality, and quality of life.
From the Research
Tear of ATFL with Nondisplaced Cuboid Fracture
- The treatment of a tear of the anterior talofibular ligament (ATFL) with a nondisplaced cuboid fracture can be complex and depends on various factors, including the severity of the injury and the patient's overall health 2, 3.
- Non-surgical treatment is often the first choice for acute injury of the ATFL, and may involve immobilization, physical therapy, and pain management 2.
- For nondisplaced cuboid fractures, conservative treatment with immobilization and avoidance of weight-bearing on the injured leg may be effective 3, 4.
- However, if the fracture is displaced or there is significant shortening of the lateral column, surgical management may be necessary to avoid negative biomechanical and functional consequences for the foot 3, 4.
- The treatment of ATFL injuries may also involve surgical techniques such as arthroscopic anatomical repair or anatomical reconstruction surgery, which can provide good results and minimize complications 2, 5.
- Biomechanical studies have shown that augmented ATFL repair with CFL repair may be the best option for controlling anterior translation and restoring stability to the ankle joint 6.
Treatment Options
- Non-surgical treatment:
- Immobilization
- Physical therapy
- Pain management
- Surgical treatment:
- Arthroscopic anatomical repair
- Anatomical reconstruction surgery
- Augmented ATFL repair with CFL repair
- Conservative treatment for nondisplaced cuboid fractures:
- Immobilization
- Avoidance of weight-bearing on the injured leg