The lateral ligament injury of the upper ankle joint is the most common injury to the foot. Simply twisting an ankle in everyday life or strains in any form, for example during sport, can affect the ligament structures and lead to ligament injuries. Around 50% of all foot injuries treated in the rescue centres involve a torn ligament in the foot or a torn ligament in the ankle joint.
Ankle sprains are the most common musculoskeletal injuries. Ligament injuries or better said capsuloligamentary damage in particular have a high incidence and prevalence worldwide. Ruptures of the lateral ligamentous apparatus are by far the most common.
Particularly in popular sports such as football or tennis, the ligaments on the foot can quickly become injured if there are sudden changes of direction.
In this article, we provide you with everything you need to know about capsuloligament injuries after ankle sprains. What are the causes, symptoms and treatment options for torn ligaments? And why is it advisable to consult a qualified foot and ankle surgeon after an ankle sprain?
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Ankle sprains are the most frequent injuries in athletes. They account for 10% to 30% of all sports injuries Inversion-type is the most common mechanism of injury, occurring in 80 to 90% of cases. Sports such as football, handball, basketball, but also skiing or inline skating can easily lead to an injury to the ligaments.
„Ankle sprains, particularly lateral ankle sprains, are the most common athletic injuries 1-3. It is well established that these injuries damage the lateral ankle ligaments and also may damage the osteochondral tissues of the ankle joint. In fact, osteochondral lesions of the ankle are being recognized as an increasingly common injury and may occur in association with as many as 50% of acute ankle sprains and fractures, particularly among patients with sports injuries.“
Source: Victor R. Prisk, MD, Carl W. Imhauser, PhD, Padhraig F. O'Loughlin, MD, and John G. Kennedy, MD, FRCS: Lateral Ligament Repair and Reconstruction Restore Neither ContactMechanics of the Ankle Joint nor Motion Patterns of the Hindfoot, in THE JOURNAL OF BONE & JOINT SURGERY d JBJ S .ORG, VOLUME 92-A d NUMBER 14 d OCTOBER 20, 2010
Have you sprained your ankle and suspect a torn ligament? Orthopedic foot and ankle surgeon Dr Tonio Gottlieb, MD is your foot specialist for all aspects of ligament injuries to the foot and ankle. In his private clinic in Berlin-Zehlendorf, he will examine you with the utmost care, discuss your personal symptoms with you and recommend a personalised approach. Arrange your consultation appointment!
1. How does the anatomy of the ankle ligaments look like?
The ankle joint (articulatio talocruralis) connects the foot to the lower leg. It is stabilised laterally by three relatively thin ligaments and medially by the very strong superficial and deeper layers of the deltoid ligament. They are there to ensure that the joint remains securely in the ankle fork during movement. Especially on uneven ground, the ligaments keep the ankle bones in position so that the joint functions smoothly. The ligaments that stabilise the upper ankle joint are
- outer hinge
The outer ligament consists of three parts. Depending on their position, they are referred to as the anterior, medial and posterior lateral ligaments. They run from the fibula to the talus and the calcaneus.
- inner ligament
The inner ligament is located on the inner ankle and is a much stronger connection between the shin and foot than the outer ligament. The so-called "deltoid ligament" consists of a connecting ligament between the foot and leg. It consists of a deep and a superficial layer that runs between the tibia and the talus calcaneus, scaphoid.
- Syndesmosis
The syndesmosis is another ligamentous connection between the tibia and fibula and holds the malleolar fork together.
2. What types of ligament injuries are there?
In most cases of ankle sprains, only the ankle joint is affected. A great deal of pressure is exerted here, making it much more susceptible to injury than the lower ankle joint. The most vulnerable ligaments of the foot - the lateral ligaments - are located on the outside of the ankle joint. This is why these types of ligament injuries often occur when you "twist your ankle":
- Lateral Ligament sprain, tear of one , two ligaments or complete rupture of the capsuloligament complex
- Injury to the syndesmosis ligament: Tear or rupture of the connective tissue between tibia and fibula
- Inner ligament (Deltoid ligament) strain/tear/rupture
The type and extent of a ligament injury is always individual and also depends on the position the foot was in when the injury occurred.
3. What are the typical symptoms of a ligament injury to the foot and ankle?
Both a strained ligament and a torn ligament show these symptoms in the acute phase:
- Severe, painful swelling of the affected area
- Often haematoma
Other symptoms depend on the severity of the injury:
- The ligament structure can be partially or completely torn.
- Vessels in the capsule can rupture, resulting in the haematomas mentioned above.
- Untreated ligament injuries can become chronic. This means that the ankle joint can become more unstable.
In addition, any ligament injury can be accompanied by damage of the cartilage and can lead to arthritis.
What should I do if I suspect a ligament injury?
If an ankle ligament injury is suspected, the joint should be relieved and cooled immediately. To avoid consequential damage, it is advisable to have the injury examined by an experienced specialist in foot surgery. An untreated syndesmosis injury (ligament that connects the tibia and fibula), for example, harbours a significantly increased risk of osteoarthritis.
Dr Tonio Gottlieb, MD:
„If ligament injuries are not treated, the ankle joint may no longer be as stable as before and the patient may later notice instability compared to the uninjured foot. Osteoarthritis can also be the result.“
4. What are the causes of ankle ligament injuries?
The typical injury mechanism for an ankle ligament injury is the "twisting" of the foot inwards. This causes overloading of the outer ligament. Depending on the severity of the strain, the outer ligament can be overstretched, strained, torn or completely torn (ligament rupture).
Ligament injuries to the foot are particularly common in sports with rapid changes of direction. These include contact sports with high stress on the ankle joint, such as football, hockey, basketball and volleyball, as well as tennis and skiing. Sudden changes of direction can cause the ankle ligaments to overstretch or tear. Rapid changes of speed or position can lead to painful twisting of the ankle. Jerky stopping and starting movements or "getting stuck" on uneven ground also harbour the risk of ligament injury.
In addition to sports injuries, anatomical characteristics can also lead to the ligaments being injured more easily. These include, for example, leg misalignments such as bow legs or knock-knees, where the static load on the ankle joints is higher than normal. Affected patients can then twist their ankle more easily. Even minor sporting exertion can lead to stretched ankle ligaments. In such cases, the static axis of the legs or feet should be aligned using insoles or even surgery. With this cause-orientated treatment, frequent ligament injuries can be avoided.
5. How does the foot surgeon make an accurate diagnosis of ligament injuries to the foot?
If a stretched ankle ligament or a torn foot ligament is suspected, Dr Tonio Gottlieb, MD will first carry out a comprehensive clinical examination:
- The foot is thoroughly palpated and a fracture of the joint is ruled out.
- A special foot platform enables the foot surgeon to diagnose static anomalies and also to clarify possible causes, e.g. for repeated "twisting of the ankle".
- To further confirm the findings, an ultrasound examination can be used as an imaging procedure, for example to differentiate between a torn ligament and a complete ligament tear.
- If necessary, magnetic resonance imaging (MRI) can also be carried out. This examination provides reliable information as to whether ligament injuries or bony injuries are present. On the basis of this precise diagnosis, Dr Tonio Gottlieb, MD will initiate a professional therapy tailored to your needs.
IMPORTANT:
The extent of the injury should be clarified quickly and thoroughly, especially for competitive athletes or passionate amateur athletes who want to return to their sport without restrictions as quickly as possible. Choosing the right treatment options and starting treatment quickly are important in order to avoid long-term damage.
6. What are the treatment options for ligament injuries to the foot and ankle?
The treatment options for ankle ligament injuries depend on the extent and severity of the injury. In principle, a torn collateral ligament can be treated conservatively or surgically. These treatment options are available:
Conservative therapy
In many cases, conservative (non-surgical) treatment of a ligament injury is possible. Depending on the extent of the injury in the case of a stretch, strain, external ligament rupture or internal ligament rupture, immobilisation is carried out using an orthosis or plaster cast. Accompanying physiotherapy is beneficial during the course of treatment.
Surgical therapy
Surgical treatment is always recommended if several ligaments in the foot are torn and the joint is very unstable. Surgery is also recommended for bone or cartilage injuries to the ankle. This applies in particular to patients with high performance and stress demands, such as professional athletes.
Dr Tonio Gottlieb, MD:
„It is often possible to treat a ligament injury without surgery. Even a complete ligament tear can, in the most favourable case, grow back together on its own. It is important to have an accurate diagnosis and the foot surgeon's experience so that the most suitable treatment option is selected from the outset.”
At a glance
| Acute phase | Conservative (non-invasive) | Surgical (minimally invasive) |
| Relief | Walking splint (orthosis) | Ribbons are sewn |
| Immobilisation | ||
| Elevation | Physiotherapy | Ligament reconstruction (ligaments are reconstructed with the body's own tendons) |
| Cooling | Ligamentoplasty (reinforcement of the ligaments in the foot) | |
| Painkillers | Correction of the heel axis | |
7. How long does it take to recover from a ligament injury to the foot?
The recovery time for a torn ankle ligament depends on the severity of the injury:
- If the injury is minor, the foot must be relieved and spared.
- Swelling and haematomas will subside after approx. 1 week in the case of a minor ligament strain.
- More serious injuries such as torn ankle ligaments may require immobilisation in an orthosis or even a plaster cast. Depending on the healing process, physiotherapy exercises can be started relatively quickly - sometimes after just two weeks.
Dr Tonio Gottlieb, MD:
„On the one hand, the injured structure and the soft tissue damage need to be immobilised, but on the other hand, appropriate movement must also be used to stimulate the nerve pathways and receptors in order to train them again. I offer this so-called proprioceptive training in my affiliated physiotherapy practice.”
8. How can future ligament injuries to the foot and ankle be prevented?
If patients notice that they frequently "twist their ankle" or have an unstable feeling in their ankle, they should have this clarified by a foot surgeon. Dr Tonio Gottlieb, MD will examine you in detail with regard to the entire statics. Depending on the diagnosis, he will recommend conservative treatment with insoles or physiotherapy exercises or surgical treatment to successfully prevent ligament injuries to the ankle joint or the outer ligament of the foot.
Athletes can also take targeted preventative measures: careful warming up stretches the calf muscles and reduces the risk of injury.
9. Why is a foot surgeon the right specialist for this type of injury?
If you have torn or ruptured a ligament in your foot, it is always advisable to consult a specialist in the field of foot surgery. Only a timely and reliable diagnosis can prevent further damage such as arthrosis. For all ligament injuries to the foot or ankle, the experienced foot doctor and foot surgeon Dr Tonio Gottlieb, MD is your experienced contact and can recommend conservative or surgical methods for treating a ligament injury. He always treats you in a cause-orientated and holistic manner and has the entire foot and body statics in mind. In his private practice for foot surgery and foot therapy in south-west Berlin, he takes the time to get to the bottom of the causes of your injury and gives you a stringent treatment recommendation - regardless of whether it is an initial diagnosis or a second opinion.
