Damage to the ligaments of the ankle joint is a fairly common injury. Most often, the injury occurs in winter when slipping the foot on ice, icy steps and platforms. It is possible to damage the ankle while playing sports, but not only – often an injury can happen to you at home – for example, by stumbling or twisting your leg, going down the stairs you can also injure the ligamentous apparatus of the foot and ankle.
The ligamentous apparatus provides not only stability of the ankle joint and other joints of the foot, but it protects the ankle joint from external influences and non-physiological movements, especially twisting and rotational in nature.
There are three groups of ligaments involved in fixating the ankle joint.
On the outer surface of the joint are the calcaneofibular, anterior and posterior talofibular ligaments, which extend along the outer ankle and keep talus from lateral displacement.
On the inner surface of the joint passes the deltoid (internal collateral) ligament, consisting of deep and superficial layers. The superficial layer is attached to talus and scaphoid bones, the deep layer is attached to the inner part of the talus.
The third group of ligaments, represented by the tibiofibular syndesmosis, the posterior transverse, posterior and anterior tibial ligaments, connects the tibia to the fibula. Most often, damage to the outer group of ligaments occurs (usually the anterior talofibular ligament suffers).
The mechanism of damage to the ligaments is as follows: when the foot is subjected to a force directed against the natural physiological movement, its twisting or excessive rotation occurs, which may result in rupture of the ligaments. Patient at the time of injury usually loses balance, may fall and, of course, loses the ability to load the injured limb. Occasionally, the moment of rupture is accompanied by a characteristic sound – a loud and sharp click or crunch, after which pain and swelling occur.
The main mechanisms of damage of the ankle joint ligaments
There are three types of injuries of the ligamentous apparatus of the ankle joint:
-Tearing of individual fibres. In everyday life, such damage is usually called an ankle sprain, however, this name does not correspond to the actual state of things, since the ligaments are completely inelastic and cannot be stretched.
– Ankle ligament tear. A significant part of the fibres is torn, but the ligaments continue to fulfil their supporting function.
– Complete rupture of the ligaments of the ankle joint or their separation from the place of attachment.
Symptoms of ankle ligament damage
All three types of damage to the ligaments of the ankle joint are accompanied by the same clinical signs, however, the severity of these signs directly depends on the severity of damage.
A patient with damaged ankle ligaments complains of pain while walking. Swelling and bruising in the area of damage are visually detected. Palpation of injured ligaments is painful. Hemarthrosis is possible (the presence of blood in the joint cavity).
With an ankle sprain, oedema is local, the victim experiences pain but retains the ability to walk. With tearing of the ankle joint ligaments, oedema extends to the outer and anterior surface of the foot. Walking is difficult due to pain.
The appearance of the a with damage to the ligaments of the ankle joint
A complete rupture of the ankle joint ligaments is accompanied by hemarthrosis, pronounced oedema, bruising, extending to the back and plantar surface of the foot. Walking is very difficult, sometimes impossible due to pain.
If ankle ligament is suspected, in most cases an X-ray examination is necessary to rule out a possible fracture, which may be accompanied by similar symptoms – swelling and pain. If there is no fracture, focusing on these external signs, it is possible to determine the severity of damage to the ligaments.
Inspection of the site of damage can be painful since to determine the location and extent of damage, it is necessary to move the foot in different directions during functional tests. In case of a complete rupture of ligaments, instability of the joint is detected. Also, damage to the articular surfaces is possible, which can also be suspected during the examination.
If serious damage to the ligaments, destruction of the articular surfaces, damage to the bones are suspected, MRI (magnetic resonance imaging) may be required. Using this imaging, you can visualize the presence or absence of fractures, damage to ligaments, etc.
Treatment of the damaged ankle ligaments
Treatment of the first and second degree of damage to the ligaments of the ankle joint is carried out on an outpatient basis.
Conservative treatment may vary depending on the degree of damage to the ligaments. So, with the 1st degree of severity, sparing of the injured limb, cooling (ordinary ice should be used as quickly as possible from the moment of injury – within 20-30 minutes) and sufficient immobilisation (using tight dressing, for example) are recommended. Also, while resting or sleeping, it is recommended to keep the foot above body level. Combination of these methods can significantly reduce swelling, pain, and also correct dysfunction of the lower extremities.
For injuries of the 2nd degree of severity, the same methods of treatment are used, however, for a longer period of time. Additionally, special splints can also be used for better and longer-term immobilisation of the foot and ankle joint.
Orthosis for fixing the ankle joint in case of ligament damage
In severe injuries (3d degree), plaster cast is applied to the injured limb for 2 to 3 weeks. Surgery even in this case is rarely required.
During the rehabilitation period, common physiotherapy methods – ultrasound and electrical stimulation – are used to reduce oedema, pain and prevent chronic disease. Physiotherapy exercises – active and passive exercises aimed at developing movement in the joint – are also an important element of recovery from injury. If the exercises are too painful, you can try to reduce the load by performing them in water.
The complexity of the exercises gradually increases depending on the degree of recovery – as soon as the previous ones can be easily completed, more complex movements are added. All this helps to restore muscle strength and range of motion in the joint on time.
Both at the healing stage (to speed up the repair) and in case of contracture, shock wave therapy is an effective treatment method.
Physiotherapy of the ankle joint
Surgery for injuries of the ankle ligaments is rarely used, only in cases when it is not possible to achieve positive effects using conservative therapy when joint instability persists after several months of rehabilitation treatment.
There are several options for surgical intervention for damage to the ligaments of the foot and ankle:
Endoscopic surgery(arthroscopy). Surgeon with the help of a fiber-optic device – an arthroscope inserted into the joint cavity, examines it under visual control and corrects detected defects.
Reconstructive surgery on the ligaments. The integrity of the ligaments is restored surgically – by suturing or moving other ligaments and strengthening them with the help of ankle joint.