ATFL Surgery and recover

Hi, I ruptured my ATFL in a bouldering fall in June. Also have 90% tears in CFL and Deltoid ligaments. My doctor advised surgery, particularly because I like to crack climb. Apparently, foot jamming is one of the movements that would be most limited by not doing the surgical repair. Has anyone had this surgery? If so, how did it go and how was return to climbing - especially crack climbing and alpine approaches. Thanks ~ Anne Mariah

I had my ATFL and CFL reattached after a climbing accident. The doctor said I would have huge problems with balancing if I didn’t get the surgery! Recovery took me about 4-6 months to feel 100%. I’m fully back at it now! 

I had my ATFL and CFL reattached after a climbing accident. The doctor said I would have huge problems with balancing if I didn’t get the surgery! Recovery took me about 4-6 months to feel 100%. I’m fully back at it now! 

Hi Greg,

Thanks so much for responding! How long did you wait between the accident and the surgery? Could you walk prior to the surgery? And how long until you started climbing again? ~ Anne Mariah

I literally feel your pain. In late October I blew my right ankle out; MRI showed complete ATFL tear, avulsion fracture on fibula, torn CFL and deltoid. My local ortho doesn’t have a podiatry specialist so they’ve referred me to a sports medicine clinic, but they can’t see me until Dec. Local ortho thought that it was 50/50 on whether it would heal on it’s own with no loss of function and would probably negatively affect activities like climbing and trail running for a long time. I’m three+ weeks out and it’s painful as hell and feels completely unstable. Personally I’m thinking if the clinic recommends surgery I’d rather just get it over with sooner rather than later. I had a bad shoulder for years because I didn’t fix it when I should have, just kept re-injuring it over and over until it finally gave out completely and then I didn’t have a choice. I really don’t want to go down that road again. 

How’s your functionality 4 months out? I can walk with a brace or soft cast, but at night I’m still swelling like crazy and now getting some really painful muscle cramps or something across the ankle. 

Hi Michael,

I got surgery to repair my ATFL and CFL this week. I waited four months from the date of my fall with really aggressive PT/strength work. After that time, I felt like my leg was still very unstable and crack climbing really, really hurt. I could hike and run fine after about two and half months, but anything with lateral movement or torquing resulted in swelling and a general feeling of instability. So I got the surgery. Not much of an update at this point as I'm non-weight bearing for the next week. I'd be happy to keep you posted on how things go. 

Hey, when the accident happened I wasn’t able to get the surgery for a full month because of how severe the swelling was in my ankle. Once the surgery was performed I was climbing 3 months later, the doctor wanted me to wait for 4 months but I felt as if I was ready. As of today I feel like my ankle is as strong as it was before I injured it climbing. I’d get the surgery if you want to keep being active and push the boundaries physically outdoors! 

Also I could not walk at all before the surgery, one of the most painful accidents I’ve ever had. 

I fully ruptured my ATFL (grade III confirmed by MRI) and am being discouraged from surgery by my docs/PT. Reading through some threads like this one, it seems that crack climbing in particular might be a reason to go forward with the surgery since it is such a niche type of loading on your ankle. Looking for some opinions specifically on grade III sprains and returning to crack climbing with and without surgery. Anecdotes welcome, what I am hearing is that the road to recovery is much longer without the surgery.

Mixed reviews in this thread: https://www.mountainproject.com/forum/topic/111722230/grade-iii-ankle-sprain

Mixed reviews here as well: https://www.mountainproject.com/forum/topic/119895370/torn-cfl-in-ankle

Within a few days I am walking around no problem and can do balancing/PT, just with limited mobility. It's sore in the morning after long durations of inactivity but otherwise feels 80% normal. I was at the gym the next day hangboarding, so recovery wise I feel like I'm ahead of the curve.

Also if you have any doc recommendations for podiatrists/orthos in the boulder area let me know!

I fully tore both atfls and wasnt aware for 15 years. Fixed one due to hyperextension and other ortho issues on that leg. We thought the instability might be contributing. Since its a recent injury I’d just get it fixed, you may wait it out and then need the surgery anyways, doubling recovery time.

John Sigmon wrote:

I fully tore both atfls and wasnt aware for 15 years. Fixed one due to hyperextension and other ortho issues on that leg. We thought the instability might be contributing. Since its a recent injury I’d just get it fixed, you may wait it out and then need the surgery anyways, doubling recovery time.

Good point. How was your experience climbing without an ATFL, and were you able to crack climb without pain?

I tore my ATFL fully 3 years ago. I didn’t get surgery on it when it happened and opted for rehab. I’ve since been in the hospital 4 more times re rolling the same ankle, each time putting me out for a month or so. I rolled it really terrible last June and was out for about 6 weeks but made what I thought was a full recovery, went to Patagonia, had a huge season in the sierras and didn’t even think about it. Came to Yosemite for a 2 month spring season in April and it folded 5 days in. Completely blown out, and now I’m getting surgery this year. I wish I had done it years ago. It doesn’t effect my crack climbing at all when it’s healthy, but the ankle keeps folding in completely mundane situations, last year it folded in my living room and in Yosemite it happened on the road next to my van after 5 hard days of climbing. Severe instability always, I’m walking fine right now and even climbing but I’m taping it up every day because I’m worried it’ll fold again before I get surgery. The surgery is a lateral ligament reconstruction and the doc said with the new Arthrex internal brace the recovery is only 3 ish months. I don’t believe that at all but we will see! Good luck, the ankle injury blows because it effects literally everything you do. 

P B wrote:

Good point. How was your experience climbing without an ATFL, and were you able to crack climb without pain?

I started climbing probably 11 or 12 years after I tore it, and I had never had any additional pain after the initial several months of recovery from the tear. When I started climbing I didn’t have any issues.

I would absolutely not use that as a reason to not fix it.

Wow thank you both. Every anecdote online seems like people try and try to make PT work without surgery and in the long haul an athletic lifestyle does not work well without the ATFL. I scheduled a consult with a foot/ankle surgeon to get a second opinion. More thoughts are welcome!

I tore my ATFL grade III a few years ago. Wore an airboot for a month to grow scar tissue and worked hard in PT. Since then, I’ve been progressively rolling my ankle more and more. Similar to Tanner's experience, my ankle would just fold in during approaches or fetching the mail. No amount of PT helped at this point because the scar tissue had degraded. 

I finally got a modified brostrom with internal brace repair last fall. To be honest I wish I'd gotten surgery sooner. My ankle joint space had narrowed significantly since the original injury (read: early arthritis) because every subsequent sprain (so many I lost count) had damaged the cartilage. They even found bone spurring and loose bodies floating around in the ankle. They removed the pieces during surgery but this has since made my recovery a PITA because it takes forever for open bone surfaces to heal.

NGL, I've found the ankle surgery recovery to be way worse than my two ACL surgeries. My ankle continues to ache in activity-limiting ways even 6 months post-op. I finally got back into crack climbing last month, but I can't do long approaches w/o noticeable pain.  

Still, I don't regret getting the surgery whatsoever. Finally having a stable ankle 100% beats unpredictable ankle sprains and worsening arthritis.

P B wrote:

Wow thank you both. Every anecdote online seems like people try and try to make PT work without surgery and in the long haul an athletic lifestyle does not work well without the ATFL. I scheduled a consult with a foot/ankle surgeon to get a second opinion. More thoughts are welcome!

Just to add, I’ve been to 4 (!) different orthopedists in the past 6 weeks basically searching high and low for anyone to tell me I might be ok without surgery and every single one has said get it done. Basically the consensus is I’ll just keep rolling the ankle over and over again no matter how much PT I do and eventually it will be a complete blowout where I tear the other ligaments or break the bones or something much worse 

Saw a sports medicine doctor, foot/ankle surgeon, and PT for my ruptured ATFL and they all pushed back against surgery, so I am coming back as the dissenting opinion. I will see what the future holds and report back.

P B wrote:

Saw a sports medicine doctor, foot/ankle surgeon, and PT for my ruptured ATFL and they all pushed back against surgery, so I am coming back as the dissenting opinion. I will see what the future holds and report back.

Find new doctors tbh

P B wrote:

Saw a sports medicine doctor, foot/ankle surgeon, and PT for my ruptured ATFL and they all pushed back against surgery, so I am coming back as the dissenting opinion. I will see what the future holds and report back.

Ok done let’s not get surgery together this is all I needed to hear 

Tanner James wrote:

Ok done let’s not get surgery together this is all I needed to hear 

Sounds like mine is fresh whereas you have had some reinjury so def listen to your doctors! Thanks everyone for sharing your experience, it’s been really helpful and pushed me to get that second opinion. I’ll be on the lookout for instability and indicators as you all mentioned!

John Sigmon wrote:

Find new doctors tbh

I second this. I also heard this from several people on here, decided to take a wait and see approach and basically wasted a year.

My sports medicine doc at a major college hospital told me the same thing (no surgery needed) and they only recommend surgery after “chronic instability” is proven. Do the PR and strength training and I’ll be 100%. Yeah, no.

Could I climb? Yes. However even after fully being healed from the break/tear, all it took was wrong twist or move to ruin a trip. I broke it in Oct ‘21, was considered fully healed in April ‘22, passed all the strength/stability tests and in May climbed at Smith. First time I really torqued on it it popped and swelled to where I was limping for about a week. May - Aug ‘22 it was basically 50/50 on whether it pop/swell doing any type of activity, but I found it was ok most of the time if I climbed in a fig 8 brace. I couldn’t run on pavement for more than 1/2 a mile, couldn’t trail run for more than 2-3, and basically my ankle became a persistent liability. It even popped one time walking in bare feet on grass on slightly uneven ground.

In Aug ‘22 I saw a different doc and had a new MRI- basically everything became so loose the ankle could move around and partially dislocate. New doc told me no amount of strength training would fix that and their practice was to always repaired surgically for any active adult.

Had the surgery in early Sept ‘22. Recovery sucked, couldn’t do much for months but was able to ski in Dec-Feb, but it seemed like my ankle permanently swollen- whole foot was a full shoe size larger.

Stopped skiing in early March and did nothing for 2 months. As far as decisions go that’s about the only smart one I made through all this. In May I  slowly started adding in activities and it feels almost like new now. I can’t run on pavement for any real distance yet without it swelling, but everything else is great. Zero instability while climbing/hiking/light trail running, and while it still swells occasionally seemingly for no reason, it’s back to a more normal size at rest.

Best of luck, I’ve had 2 shoulder and 1 hip surgery from injuries and the ankle has by far been the most frustrating/limiting.