Ankle ligament injury
An ankle ligament injury, commonly referred to as a sprain, occurs when the ligaments, which are strong bands of tissue that connect bones to each other and stabilize the joint, are stretched or torn. This type of injury typically happens when the ankle is twisted or turned in an awkward manner, often during physical activities but can also occur during everyday movements
In addition to ligament injury, these types of traumas can also cause ankle tendon injury – different variants of tendon impairment. These conditions can also be treated surgically, for example foot and ankle tendon surgery can be performed in 45 clinics across Germany for an approximate price of $8.6 K (https://doctor.global/results/europe/germany/all-cities/all-specializations/procedures/foot-and-ankle-tendon-surgery).
Anatomy of the ankle ligaments
The anatomy of the ankle ligaments consists of three key groups:
Lateral Ligaments
These are on the outer side of the ankle and include:
- Anterior Talofibular Ligament (ATFL): Connects the talus to the fibula and is most commonly injured.
- Calcaneofibular Ligament (CFL): Runs from the fibula to the calcaneus.
- Posterior Talofibular Ligament (PTFL): Connects the talus and fibula at the back of the ankle.
Medial Ligaments (Deltoid Ligament)
A robust and broad ligament on the inner side of the ankle, supporting medial stability. It has several smaller ligaments connecting the tibia to various foot bones.
Syndesmotic Ligaments
These ligaments connect the tibia and fibula (lower leg bones) and are essential for the stability of the ankle joint. They include the interosseous membrane and several other ligaments at the ankle’s distal syndesmosis.
These ligaments are crucial for providing stability to the ankle joint, preventing excessive movement, and maintaining proper leg and foot alignment.
Classification of ankle ligament injuries
Ankle sprains are categorized into four distinct levels based on the severity of the injury:
- Grade I: This represents a mild condition where the ligament is stretched or has a minor tear, with minimal to no instability in the ankle joint.
- Grade II: This level indicates a more significant injury involving an incomplete ligament tear, leading to some looseness in the joint.
- Grade III: At this stage, the ligament is fully torn or ruptured, creating a sensation similar to a fractured bone due to the inability to bear weight on or utilize the joint owing to its instability.
- Grade IV: This most severe category involves rupturing two or more ligaments, significantly compromising the joint’s stability.
Symptoms of an ankle ligament injury
Symptoms of an ankle sprain can vary depending on the severity of the ligament injury and may encompass:
- Bruising is visible around the ankle area.
- A sensation of instability or looseness in the ankle.
- Discomfort or pain located at the sides or front of the ankle.
- A distinct popping or snapping noise at the time of injury.
- Swelling surrounding the ankle joint.
- Difficulty or inability to place weight on the affected ankle or foot.
- A feeling of weakness within the ankle joint.
The severity of these symptoms directly correlates with the extent of damage to the ligament. For instance, a stretched ligament might result in mild pain, allowing for continued ambulation. A partial tear can lead to significant limping and restricted movement. In cases where the ligaments are completely torn, walking might become exceedingly difficult or impossible due to the loss of the joint’s stabilizing functions.
Causes of Ankle ligament injury
An ankle injury arises when the joint is excessively twisted, deviating from its normal alignment. These injuries are commonly seen during athletic activities or from walking on surfaces that are not even, leading to forced and unnatural foot and ankle positioning. The risk of injuring the ankle is heightened by using inappropriate footwear, such as high heels or unstable, ill-fitting shoes like clogs or sandals. Ankle injuries can also occur from various incidents, including:
- Tripping or falling
- Walking or running across uneven ground
- An awkward landing from jumping
- Direct trauma, such as from an automobile accident
- Ankle twisting, rotating, or rolling
A significant majority of ankle injuries, approximately 80%, are attributed to external-supination injuries. This condition occurs when the foot is inverted, leading to damage primarily to the ligaments on the outside of the ankle, with the anterior talofibular ligament (ATFL) being the most frequently affected. The potential for injuring the ankle ligaments notably increases during winter due to slipping or the foot tipping over on icy surfaces.
Ankle ligament injury diagnosis
Diagnosing ankle ligament injuries is comprehensive, involving an in-depth assessment of the patient’s medical history, physical examination, and diagnostic imaging. Initially, healthcare providers inquire about the patient’s symptoms, their onset, and any previous ankle injuries to aid in accurate diagnosis. This history-taking is critical for understanding the context and severity of the current injury.
Physical examination plays a pivotal role in diagnosing ankle ligament injuries. Observing the patient’s gait and posture provides initial insights into the injury’s impact. Clinicians look for signs of deformity, malalignment, muscle atrophy, edema (swelling), and ecchymosis (bruising) that could indicate the extent of the injury. Palpation of the ankle is then performed to identify tenderness over bony prominences, muscles, and ligaments, which helps pinpoint the injured structures. Assessing the patient’s passive and active range of motion further elucidates the injury’s severity and the affected ligaments.
- X-ray- primarily aimed at excluding bone injuries. The method is not very informative for detecting acute ligament tears. Localized calcium deposits can be detected in the case of aged damage to ligamentous structures. With a complete rupture, the location of the articular surfaces of the ankle is disturbed. If ligament damage is combined with periosteum tear, the radiograph reveals a zone of its detachment, rising above the bone body.
- Ultrasound is the main method of screening diagnostics of the joint and periarticular zone soft tissue structures. In ligament injuries, fiber breaks, swelling, and areas of hemorrhage may be detected. A hematoma is visualized between the damaged ligaments in case of a complete rupture.
- MRI allows an objective assessment of the condition of the ligament-tendon compartment.
Ankle ligament injury treatment
Treatment of ankle ligament injuries is carried out mainly by conservative methods. Surgical intervention is indicated in case of complete rupture, as well as in case of old injuries.
Conservative treatment
With acute injuries to the ligaments of the ankle joint area, rigid immobilization with a plaster cast or orthosis is performed. Nonsteroidal anti-inflammatory drugs, which reduce tissue swelling and pain, are also successfully used,
Surgical treatment
Surgical ligament stitching is performed in the case of complete tears in athletes and people leading an active lifestyle. This is followed by immobilization for up to 2-4 weeks.
In the case of old ankle ligament injuries, various techniques such as anatomical reconstruction of the ligament, peroneal tendon grafting, static stabilization with tendon grafts, and others are used.
Ankle ligament reconstruction surgery is available in more than 768 clinics worldwide (https://doctor.global/results/procedures/ankle-ligament-reconstruction-surgery). For example, ankle ligament reconstruction can be performed in 8 clinics across the Czech Republic for an approximate price of $3.5 K (https://doctor.global/results/europe/czech-republic/all-cities/all-specializations/procedures/ankle-ligament-reconstruction-surgery).
Ankle ligament injury prevention
Prevention of ankle ligament injuries is aimed at preventing injuries, especially during icy conditions. Athletes and ballet dancers are advised to strictly observe the technique of performing exercises, which will reduce the likelihood of an accident.
Rehabilitation after an ankle ligament injury
The duration of rehabilitation can vary significantly, often extending beyond one month, mainly depending on the individual’s occupational demands. A key focus of rehabilitation, especially in sensorimotor training, is enhancing joint stabilization and movement control. This is typically achieved through targeted physical therapy exercises, carefully designed to gradually increase the patient’s physical activity level without overstressing the injured site.
Within the rehabilitation program, physiotherapeutic interventions play a crucial role. At the beginning of the rehabilitation journey, methods like electrophoresis are used to apply pain relievers, glucocorticosteroids, or nonsteroidal anti-inflammatory medications directly to the targeted area. This method effectively creates a localized drug depot in the skin. It ensures a high concentration of the medication is delivered to the site of injury, aiding in reducing inflammation and pain.
Ultrasound therapy is another beneficial treatment to enhance microcirculation and lymphatic drainage in and around the injured joint, thereby supporting the healing process. Similarly, UHF (Ultra High Frequency) therapy stimulates reparative processes and mitigates inflammation within the affected tissues. Magnetotherapy is incorporated into the treatment regimen to promote further blood and lymphatic flow, which helps reduce inflammation and facilitate recovery.
Massage therapy is significant in the rehabilitative approach, improving blood circulation and tissue nourishment. This not only aids in strengthening and toning muscles but also in alleviating muscle tension and restoring muscular balance, essential components for a successful recovery.
In summary, rehabilitation for ankle ligament injuries or similar conditions is multifaceted, encompassing a range of physiotherapeutic treatments alongside carefully planned physical therapy exercises. Each modality is selected for its specific benefits, such as pain relief, improved circulation, and accelerated healing, all aimed at achieving optimal recovery and return to function for the injured individual.
