From a functional perspective, the ligaments of the ankle are indispensable for maintaining proper alignment and balance during weight-bearing activities like walking, running, and jumping.

They contribute to the overall mobility of the ankle by supporting the joint's range of motion while also providing stability during dynamic movements.

However, like any structure in the body, these ligaments of the ankle are not immune to problems.

Such injuries to the ligament can lead to pain, swelling, and even chronic instability if left untreated, significantly impacting one’s ability to move comfortably and maintain an active lifestyle.

The Deltoid Ligament is the largest and most important ligament on the medial side of the ankle.

It is composed of two layers, the first being the superficial layer, which connects the medial malleolus to bones like the calcaneus and navicular to provide overall ankle stability (Moonot, et. al. 2023).

The other one is the deep layer, which is thinner but stronger, playing a crucial role in stabilizing the talus and preventing excessive inward motion (over-eversion).

Together, these layers ensure the integrity of the ankle during weight-bearing and dynamic activities.

The Spring Ligament, also known as the plantar calcaneonavicular ligament, is located beneath the deltoid ligament and plays a key role in maintaining the foot arch.

By supporting the medial longitudinal arch, it contributes to overall foot and ankle stability, ensuring proper load distribution and preventing overpronation during movement.

The Tibialis Posterior Tendon runs close to the medial collateral ligaments and works synergistically with them to stabilize the ankle.

It helps maintain proper alignment of the foot, especially during activities that involve walking or running and prevents excessive strain on the medial structures of the ankle.

These elements together form a strong support system that protects the medial ankle and enables efficient movement. medial malleolus

Injuries to the ligaments can vary in type and severity, ranging from acute trauma to chronic overuse conditions.

Below, each type of injury, its symptoms, and common causes are explained in detail.

Ankle sprain occurs when the ligaments of the ankle are overstretched or partially torn due to a sudden twisting motion or impact. The severity of a sprain is categorized into three grades:

• Grade I (Mild): The ligament is stretched but intact, leading to mild pain, slight swelling, and minimal impact on function.
• Grade II (Moderate): Partial tearing of the ligament, resulting in noticeable swelling, pain, and reduced ankle stability. Walking may be difficult.
• Grade III (Severe): A complete tear of the ligament, causing significant pain, swelling, bruising, and a loss of ankle stability. Weight-bearing is often impossible without assistance.

A tear is a more severe injury where the ligament fibers are partially or completely ruptured. Similar to sprains, there are different types of tears; here are the following:

• Partial tears: When these happen it means some of the fibers are damaged, leading to localized pain, instability, and moderate swelling.
• Complete tears: When these occur, it means that the ligament is fully ruptured, causing severe pain, inability to stabilize the joint, and significant impairment that requires surgery.

Repeated stress or overuse of the ligaments of the ankle can lead to tendinitis, an inflammation of the nearby tendons, or chronic weakening of the ligaments.

Overuse injuries are common in athletes or individuals with flat feet.

If untreated, they can lead to further complications, such as ligament degeneration or chronic instability.

• Pain on The Inside of The Ankle: It’s often the first and most prominent symptom of medial ligament injuries. It can range from mild discomfort to sharp, severe pain, depending on the injury's severity.
• Swelling: Inflammation typically occurs around the injured area, sometimes accompanied by bruising. Swelling can limit the range of motion in the ankle.
• Instability: A feeling of the ankle "giving way" or being unable to support weight properly is common with moderate to severe ligament damage.
• Difficulty Bearing Weight: Walking or standing can become painful or impossible, particularly with Grade II or III sprains or complete tears.

Traumatic injuries often occur during sports or activities involving rapid direction changes, jumping, or uneven surfaces.

Examples include landing awkwardly from a jump, twisting the ankle while running, or direct impacts, such as during a fall or collision.

These incidents can stretch or tear the anterior or posterior talofibular ligament suddenly, resulting in acute injury.

Overuse injuries develop gradually due to repetitive stress placed on the ankle and its corresponding ligaments.

Activities like running, jumping, or standing for prolonged periods can create small, cumulative strains that weaken the ligaments over time.

Athletes in sports such as basketball, soccer, or long-distance running are particularly vulnerable to overuse injuries.

Factors like flat feet or improper footwear can increase the strain on the lateral ligaments, worsening the wear and tear.

Unlike traumatic injuries, overuse injuries tend to present as chronic discomfort or stiffness, which may progress if not addressed promptly.