How does the ankle work?

The ankle is the joint that connects the bones in the lower leg to the foot bones. It can be divided into two parts: the upper and lower ankle.

The upper ankle allows us to move our feet upwards, downwards, and a little to the side. It is made up of three bones:

  • the tibia (shinbone): the main bone in the lower leg,
  • the fibula (calf bone): a second, thinner bone on the outer side of the lower leg, and
  • the talus (anklebone): the foot bone that connects to the shinbone and calf bone.

The lower ankle connects the anklebone to the bones in the tarsus (the midfoot and hindfoot) and the heel bone. It doesn't move as much as the upper ankle does. The lower ankle allows the foot to tilt to the side a bit and also turn inwards and outwards. Turning your foot outwards is known as pronation, and turning it inwards is called supination.

Illustration: Healthy ankle, seen from above and from the side – as described in the article

Cartilage, tendons and ligaments  

In healthy joints, the ends of bones are covered with a layer of cartilage. If this cartilage is healthy, it is very smooth and hard, but also elastic. It acts as a shock absorber and reduces friction. Tendons, ligaments and the joint capsules hold the joint together and help it to move. Tendons connect muscles to bones. Ligaments connect bones to bones and help keep the joint stable.

Ankle ligaments are tough, elastic bands of connective tissue that connect bones in the joint, keeping them tightly together. Because the ankle joint is made up of many bones, there are also a lot of ligaments to stabilize and strengthen it. Three ligaments run along the outside of the ankle, and one ligament (consisting of four bands of tissue) runs along the inside of the ankle.

Stability and vulnerability  

The ankle joint has to withstand a lot of weight and force. When you run and jump, for instance, your ankles have to carry forces equivalent to several times your body weight. If the strain is too big, the ligaments might overstretch or tear (rupture).

If a foot lands in an awkward position and bends outwards, the outer ankle ligaments may be injured. Injuries to the ligament on the inner side of the ankle are less common.

Stretched and torn ankle ligaments are among the most common injuries. Because the lower ankle is more stable than the upper ankle, strains, sprains and fractures nearly always only affect the upper ankle.

Illustration: Ankle injuries: Grade I, II and III sprains – as described in article
Illustration: Ankle injuries: Fracture of inner and outer ankle – as described in the article

Lippert H. Lehrbuch Anatomie. München: Urban und Fischer; 2017.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

Comment on this page

What would you like to share with us?

We welcome any feedback and ideas - either via our form or by We will review, but not publish, your ratings and comments. Your information will of course be treated confidentially. Fields marked with an asterisk (*) are required fields.

Please note that we do not provide individual advice on matters of health. You can read about where to find help and support in Germany in our information “How can I find self-help groups and information centers?

Über diese Seite

Updated on June 24, 2022

Next planned update: 2025


Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

How we keep you informed

Follow us on Twitter or subscribe to our newsletter or newsfeed. You can find all of our films online on YouTube.