Ankle Ligament Injury: What You Need to Know

The ankle joint is a movable articulation of the lower ends of the tibia and fibula with the talus bone of the foot. The ankle experiences intense loads, so the joint is strengthened by ligaments.

Types of ankle ligament injuries:

• stretching;
• partial tears;
• ankle ligament rupture;
• tearing of the ligament at its insertion, often along with a small piece of bone.

At CELT you can get a consultation with a traumatologist-orthopedic specialist.

• Initial consultation – 3,000
• Repeated consultation – 2,000

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Diagnostics

When you have an ankle injury, the first thing you need to do is make sure that the bone is not damaged. To exclude a fracture, an x-ray of the foot and an ultrasound examination (ultrasound) are performed.

For mild to moderate injuries, other additional diagnostics are usually not required. During the examination, the doctor will assess the condition of the joint and prescribe appropriate treatment.

If a serious injury is suspected, the doctor will order a magnetic resonance imaging scan. This study allows you to obtain clear layer-by-layer sections of the ankle, and, if necessary, to recreate a three-dimensional model.

Diagnosis and treatment of ankle ligaments

To clarify the source of damage, palpation and x-rays are performed in two projections.
If the symptoms do not coincide with the imaging findings, MRI and arthrography are prescribed with the injection of contrast fluid into the joint capsule to color the affected area. Tomography allows you to assess the scale of the problem and the extent of tendon damage. Integrated informative methods make it possible to correctly prescribe conservative treatment for an ankle injury. For small tears, the ankle is locally anesthetized with novocaine, Voltaren or Dolgit ointment, and bandaged with a figure eight. The swelling is relieved with physical therapy, and a course of exercise therapy program is prescribed. Therapy lasts a week, then a 2-week rehabilitation is carried out to consolidate the result.

Ankle taping for sprained ligaments gives excellent results. Ribbon:

• immobilizes joints without restricting mobility;
• prevents inversions;
• creates ideal conditions for recovery.

Orthopedic doctor Andrey Sergeevich Litvinenko comments:
The foot is bent back, starting from the center of the sole, the tape is taken out through the ankle, the Achilles tendon to the popliteal fossa and fixed. After taping the ankle ligaments, the bandage is not removed for a week.

In case of partial damage, the leg is immobilized by splinting. To relieve acute sensations, analgesics are prescribed and physiotherapy is prescribed. In case of a complete rupture, therapy begins with the application of a plaster cast for 30 days, which is removed during massage and other procedures. Further tactics are built with an emphasis on physiotherapy and physical education. Movements of the fingers and ankles accelerate the transport of nutrition and oxygen and restore metabolism. For the next 3 months, the ankle is fixed with a support bandage, tape or orthopedic splint.

Treatment

Treatment for a sprained ankle is simple and is considered a minor injury. It is important to provide first aid to the victim in a timely and correct manner. Cold is applied to the joint area, and then it is fixed with an elastic bandage. After this, you need to contact a traumatologist to clarify the diagnosis.

Moderate injuries include partial ligament tears. The victim must be taken to the emergency room as quickly as possible. The doctor performs anesthesia with an anesthetic solution and applies a fixing bandage. After some time, physiotherapy, massage, and then therapeutic exercises are prescribed.

Ligament tears and avulsions are classified as more severe injuries. Most often, after pain relief, the traumatologist applies a plaster splint, which must be worn for 6 to 8 weeks. After removing the plaster, physiotherapy, massage, and therapeutic exercises are prescribed. Restoration of performance after injuries to the ligamentous apparatus of the ankle joint can take 1.5 months.

Experienced specialists at the multidisciplinary CELT clinic provide high-quality medical services to patients with ankle injuries and other types of injuries.

Physiotherapy methods

Treatment of ankle ligament injuries, depending on the stage, involves cooling - cryotherapy or thermal procedures. To relieve swelling, phonophoresis with a decongestant drug is used. Then they apply warm paraffin applications and use hardware technologies. All methods quickly remove inflammation, pain, and accelerate blood and lymph circulation in the legs. Procedures, except cryotherapy, are carried out 2 days after the lesion or surgery.

1. Exposure to dry cold air relieves swelling and inflammation.
2. A laser with a red beam improves capillary blood flow and lymph movement.
3. Diadynamic therapy stimulates metabolic processes in bones and tissues.
4. Amplipulse therapy improves fiber elasticity and muscle tone.
5. Electrical nerve stimulation relieves pain and restores mobility.

Orthopedics and traumatology services at CELT

The administration of CELT JSC regularly updates the price list posted on the clinic’s website. However, in order to avoid possible misunderstandings, we ask you to clarify the cost of services by phone: +7

All services

Make an appointment through the application or by calling +7 +7 We work every day:

• Monday—Friday: 8.00—20.00
• Saturday: 8.00–18.00
• Sunday is a day off

The nearest metro and MCC stations to the clinic:

• Highway of Enthusiasts or Perovo
• Partisan
• Enthusiast Highway

Driving directions

Surgery and recovery

If immobilization and medications do not help, surgery is performed if the ligaments of the left or right ankle are seriously damaged. The surgeon makes an incision and stitches the torn ends of the fibers. If the bundle is torn off, the doctor fixes it to the bone and removes the hematoma. A plaster cast is applied to the seam for a week and hardware techniques are prescribed. After surgery, long-term rehabilitation is necessary. The patient does physical exercise, relaxes his muscles on the simulator and masters new movements using a special technique. Myorelaxation eliminates spasms and ineffective movement patterns that led to injury, myocorrection forms and consolidates new ones. If you follow medical recommendations and complete a rehabilitation course, the prognosis is favorable.

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Symptoms Diagnostics. Treatment

In the first and second degrees of damage to the ankle ligaments, no abnormalities are found on x-rays.

First degree

Complaints of mild pain when walking, but the walking function itself is not impaired. Edema and swelling are observed in the area where the ligament attaches. Wearing a pressure bandage for up to two weeks is recommended. It is recommended to undergo physiotherapeutic treatment: alternating magnetic field, baths, paraffin and ozokerite applications. Full recovery occurs within two weeks.

Second degree

Complaints of severe pain when palpating the ankle ligament, especially at the site of the ligament tear. Due to severe pain, walking may be difficult, and the pain intensifies when moving. In case of partial rupture, a plaster splint is applied for a period of at least 10 days. A course of physical therapy with a gradual increase in loads and physiotherapeutic procedures are prescribed. Recovery usually occurs within three weeks.

Third degree

Complaints of severe pain when trying to step on the injured leg.
Severe swelling is observed, swelling and hemorrhage are significant and spread over the entire surface of the foot, even involving the plantar part. Walking is difficult. The patient must be hospitalized in a hospital. A closed plaster cast is applied to the joint for two weeks. The bandage is modified in order to begin physiotherapeutic procedures in a timely manner. Treatment lasts more than a month, after which it is still necessary to wear a special fixing bandage that supports the ankle joint to avoid re-rupture.

Sincerely, doctors Matveev A.A. Shchetinin S.A.

Sports injuries of the foot and ankle

Pre-warming and stretching have long been recognized as activities that help prevent injury.

Insufficient joint flexibility is the main factor responsible for the appearance of certain sports-related problems.

Lack of flexibility of the foot and ankle joint or restriction of movement in certain joints occurs in a wide variety of diseases or conditions, but in sports you can more often encounter a situation where changes are limited to one joint, as happens, for example, with tarsal coalition.

Until the coalition begins to manifest itself, the athlete can already achieve certain results, but then an obstacle appears in his way, and he is forced to seek medical help. Typically, athletes with tarsal coalitions indicate frequent injuries to the ankle and foot in the past, but they do not attach much importance to this until an accurate diagnosis is established.

Restriction of movement in the ankle joint is a factor associated with the development of pain in the anterior part of the joint and is observed in skiers. Often, osteophytes of the anterior edge of the tibia and neck of the talus can be detected.

The formation of bone osteophytes at the edges of the ankle joint may result in the development of impingement syndrome.

Restriction of movement in the ankle joint is also associated with other problems of the foot and ankle joint - hallux valgus, arthrosis of the first metatarsophalangeal joint, plantar fasciitis, ankle sprains, Achilles tendinitis. All of these conditions are associated with excessive tension in the Achilles tendon.

Restricted movement in the toes can contribute to a sports injury. Insufficient range of motion and limited dorsiflexion of the first metatarsophalangeal joint is called hallux rigidus.

In dancers with acquired hallux rigidus, the limitation of dorsiflexion of the big toe is most pronounced.

Restriction of movement in other metatarsophalangeal joints is observed in patients with Freiberg's disease.

Limitation of movement associated with damage to the interphalangeal joints of the toes, in the absence of concomitant deformation of these toes, rarely becomes a source of problems. In turn, hammertoes and hammertoes in athletes usually require surgical treatment.

Another type of joint mobility change, hypermobility, can also be a source of foot and ankle problems in athletes.

Pathological hypermobility is a manifestation of a number of connective tissue diseases, for example, Ehlers-Danlos syndrome, Marfan syndrome, Larsen syndrome, Down syndrome, hyperlysinemia, homocysteinuria and osteogenesis imperfecta.

Hypermobility syndrome, not associated with known connective tissue disorders, has also been described as a potential source of musculoskeletal problems, including ankle synovitis.

In some sports, as well as in ballet and gymnastics, more flexible athletes are always preferred. Dancers are specially selected based on the flexibility of their feet and ankles. The same applies to gymnasts and ski jumpers, for whom maximum plantar flexion of the foot at the ankle, when it forms a beautiful straight line with the shin, is no less important.

Good joint flexibility certainly has objective advantages, but it also has a downside. Scientists and doctors have noticed that the incidence of injury is higher in those ballet dancers who have greater joint mobility. In an effort to achieve adequate plantar flexion at the ankle, a ballet dancer may experience posterior ankle impingement, hypertrophied posterior process of the talus, calcaneal osteophyte, or os trigonum.

Pathological increase in joint mobility is called instability. For example, in patients with chronic instability of the ankle joint, compared with healthy people, along with a violation of the integrity of the ligamentous apparatus, there was a decrease in proprioceptive sensitivity, as well as a decrease in the strength of certain muscle groups of the lower leg. Because of this, instability increases the likelihood of re-injury. This does not happen with physiological hypermobility.

Distinguishing between these two conditions can sometimes be quite difficult.

Muscle strength

It has long been known that weak muscles are a predisposing factor in the development of injuries. For example, weak peroneal muscles usually contribute to ankle sprains, and therefore one of the goals of rehabilitation is to strengthen them.

Muscle imbalance is also considered a predisposing factor for injury. For example, the normal ratio of strength between knee extensors and flexors is approximately 5:4, that is, the former are slightly stronger than the latter. If this balance is disturbed for any reason, the risk of injury increases.

A difference in muscle strength between the right and left leg greater than 10% also increases the likelihood of injury.

With this in mind, exercises aimed at restoring muscle strength and balance have become an integral part of any rehabilitation program, be it rehabilitation after injury or rehabilitation after surgery. Moreover, strength training is a mandatory component of any training program for both amateurs and professionals.

Ankle pain

The ankle joint is the articulation of the tibia and fibula with the talus. However, the ligamentous stabilizers of the ankle are also involved in stabilizing the subtalar and talonavicular joints. The tibia and fibula are held together by tibiofibular ligaments (anterior and posterior) and an interosseous membrane, which together are called syndesmotic ligaments. The two shin bones form a “fork” (in the shape of an inverted “U”), in which the talus bone is located (Fig. 2).

Rice. Ankle fork: The talus (T) sits in a fork that resembles an inverted “U.” The articulation between the tibia (Tib) and fibula (Fib) bones is called the distal tibiofibular syndesmosis. This joint plays an important role in the normal functioning of the ankle joint. It is stabilized by the anterior and posterior tibiofibular ligaments, also called syndesmotic ligaments (shown in red).

The talus, in turn, acts as a “universal joint,” articulating with the calcaneus to form the subtalar joint.

In addition to the syndesmotic ligaments, the ankle joint is stabilized externally by the anterior and posterior talofibular and calcaneofibular ligaments, which are collectively called the lateral collateral ligaments.

Rice. Lateral ligaments of the ankle joint.

The deltoid ligament, consisting of three portions, is the medial stabilizer of the ankle joint. The length and tension of this ligament are vital to ensure normal cooperative motion between the tibia, talus, calcaneus and navicular bones. The deep portion of the ligament is attached to the talus, and its more superficial and wider portion is attached to the calcaneus and navicular bones. Like the anterior talofibular ligament, the deltoid ligament rarely undergoes complete rupture; more often it is overstretched (deformed).

Rice. The deltoid ligament (circled in yellow) is shaped like the letter delta. This ligament contains portions connecting the tibia with the navicular (blue), talus (red) and calcaneus (green).

The anterior talofibular ligament (ATFL) is the most commonly injured ligament. The PTMS connects the lateral malleolus to the neck of the talus and prevents anterior displacement of the talus. This ligament resists inversion of the ankle joint together with the calcaneofibular ligament. The PTMS itself is not a separate ligament, but rather a thickening of the capsule. As a result of the injury, the ligament is damaged along its length, which will lead to elongation of the ligament. This hyperextension of the ligament can cause clinically significant ankle instability.

The calcaneofibular ligament (CFL) starts at the tip of the lateral malleolus, runs down and back, and attaches to the heel bone. Unlike the PTMS, the PMS is a separate ligamentous structure.

The posterior talofibular ligament (PTFL) originates from the posterior edge of the lateral malleolus and attaches to the posterior surface of the talus. PTMS stabilizes the ankle and subtalar joints. Damage to the TMJ is rare, usually only with dislocations or gross subluxations in the ankle joint.

The anterior inferior tibiofibular ligament is damaged by the so-called. “high ligament damage” of the ankle joint. This ligament is located on the anterior outer surface of the ankle joint and is involved in stabilizing the fork formed by the tibia. Damage to this ligament occurs when the foot is fixed on the ground and rotated externally. After this ligament heals, a rough scar may form on the anterior outer surface of the ankle joint, which can cause impingement.

Rice. Anterior inferior tibiofibular ligament

The interosseous membrane is formed by strong fibrous tissue that connects the shin bones to each other. With certain types of injuries, the interosseous membrane can be damaged along with the anterior and posterior tibiofibular ligaments, as a result of which the tibia bones diverge, the so-called. diastasis and the ankle joint becomes unstable.

The tibiofibular ligaments and interosseous membrane are collectively called the tibiofibular syndesmosis.