Torn Ligament In Ankle
The ankle facilitates up and down movement between the leg and the foot. It is a hinge joint with the bones of the leg forming a slot and the talus bone of the foot fitting between them. The bones of the leg, mainly fibula and tibia, connect with the talus and stay in place due to strong bands of tissue called ligaments. Each ligament consists of several strands or a fibrous material called collagen, which is very strong. The deltoid ligament, which is on the inside of the ankle, has a couple of layers. Although the ligament is quite strong, fractures of the anklebones can tear them apart. Sporting injuries involving ankle ligament are rare, but torn ligament in ankle is always a possibility.
What Are The Ligaments Of The Ankle
The ankle is a hinge joint between the leg and the foot, and allows up and down movement. The bones of the leg form a slot, and the talus bone of the foot fits between them. The talus is held to the tibia and fibula by strong bands of tissue called ligaments. Each ligament is made of many strands or fibres of a material called collagen, which is extremely strong.
The ligament on the inside of the ankle has two layers the deepest one is most important. This ligament is mainly torn in association with severe fractures of the ankle bones. Sporting injuries of this ligament are rare.
The ligament on the outside of the ankle is made up of three separate bands: one at the front , one in the middle and one at the back . The front and middle bands are the ligaments injured in a sprain.
The tibia and fibula form a joint between themselves just above the ankle. This also has strong ligaments, one at the front and one at the back . The ligament at the front is involved in 10-20% of ankle sprains this injury is important, as it takes a long time to heal, although it usually heals without the need for surgical treatment.
The Healing Process For A Torn Ligament
Ligaments heal at the cellular level, in three main phases. The first is the acute inflammatory phase, followed by the regenerative or proliferative phase, followed by the tissue remodeling phase.
Sometimes, the healing is slower than would be hoped for, and it can sometimes be incomplete. In other words, you wont necessarily get your ligament back to 100% without medical intervention.
Your joint may feel lax due to the ligament injury, and that improves slowly over a period of weeks and months. Still, even after a year of healing from the injury, there are people who have laxity and instability in their joints because of the lack of treatment while it was healing.
Even if your doctor doesnt think you need a lot of intervention, there are at-home options that can also help.
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What Is Lateral Ankle Ligament Reconstruction
Lateral ankle ligament reconstruction is a surgery to tighten and firm up one or more ankle ligaments on the outside of your ankle. Its also known as the Brostrom procedure. Its most often done as an outpatient surgery, so you can go home the same day.
Your ankle is a hinge joint that allows motion up and down, and from side to side. Your foot and ankle have several ligaments. These are strong band-like structures that keep the bones in your ankle and feet tightly connected. On the outer side of your foot, you have several ligaments. These include the anterior talofibular ligament and the calcaneofibular ligament . These help keep your ankle and foot steady when you walk.
If you have had repeated ankle sprains or if you have certain foot deformities, your ligaments can start to get weak and loose. If this happens, your ankle may become unstable.
During lateral ankle ligament reconstruction, the surgeon makes a small cut on the outside of your ankle. This is done while you are under general anesthesia. Then your surgeon tightens one or more of the ligaments on the outside of your foot.
Treatment Of Tendon Injuries
Options for treating tendon injuries are similar to options for treating sprains. They include:
- Immobilization using a cast or splint
- Oral or injected anti-inflammatory drugs to reduce pain
- Physical therapy for range of motion, strength, and balance
- A brace to provide support during activities
- Surgery to repair the tendon or tendons and sometimes to repair the supporting structures of the foot
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Investigations To Diagnose Ankle Joint Ligament Injury
Investigation is aimed to find the tissue injury and also to rule out fracture and dislocation of ankle joint.
- X-Ray: X-ray examination is useful to diagnose if there is any fracture and dislocation of ankle joint in addition to the ankle joint ligament injury.
- MRI: MRI is useful to evaluate fracture, dislocation and hematoma.
- Ultrasound: Ultrasound is a specific investigation to evaluate hematoma.
- Arthroscopy: An orthopedic surgeon performs arthroscopy. Arthroscopy examination is a specific test to diagnose and treat ankle joint ligament injury and tear.
- Blood Examination: White Blood Cell Count is increased in infection and septic arthritis. WBC is normal in ankle joint sprain without any infection.
What Does Ankle Ligament Reconstruction Surgery Involve
It will usually be done as a day case procedure under a general anaesthetic. Your consultant may conduct an initial arthroscopic examination of the ligament, prior to making a bigger incision close to the ligament. It may be that the existing ligament can be repaired using stitches. Alternatively, the repair may require strengthening using support from other tissues, or a tendon may be used to take the place of torn ligaments.
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What Are The Risks Of A Lateral Ankle Ligament Reconstruction
Every surgery has risks. Risks for this surgery include:
- Excess bleeding
- Complications from anesthesia
- No improvement in your ankle stability
Your own risk for complications depends on your age, the anatomy of your foot, and your general health. Talk with your healthcare provider about any concerns you might have. You can discuss the risks that most apply to you.
What Are The Ankle Ligaments
The most common ankle injuries involve lateral ligament damage and are one of the most prevalent seen by physiotherapists. Approximately 7-10% of emergency department hospital admissions are due to ankle strains1. The lateral ankle ligament is a complex of three different ligaments including the calcaneofibular ligament , anterior talofibular ligament , and the posterior talofibular ligament .
SUMMARY
In this article you will learn what the ankle ligaments are, the signs, symptoms and how to diagnose torn ankle ligaments. You will learn how surgery is performed and how you can both prevent and recover from an ankle ligament surgery.
This animated video describes conditions and treatment methods associated with pain of the ankle.
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Clinical Findings Of A Lateral Ligament Ankle Sprain
In general, a sprained lateral ligament of the ankle causes pain outside the ankle. Other symptoms include:
- a pop or crack sound at the time of the injury
- swelling, which forms immediately or overnight
- stiffness due to inflammation, which is worse in the morning and improves with activity
- instability of the ankle joint this may occur with complete tearing of the ligaments
- tenderness at the ligaments
Usually, your doctor will diagnose a lateral ligament ankle sprain by carefully examining the ankle and foot. As a rule, you must ensure you dont have a break or cartilage injury. An X-ray, ultrasound, or MRI is often needed to confirm a lateral ligament tear and rule out other injuries.
Where Ligament Tears Are Most Common
- Ankle:Ligament tears are most common toward the outer side of your ankle at what’s called the lateral ligament complex. It includes the anterior talofibular , the calcaneofibular , and posterior talofibular ligaments. The medial deltoid ligament, toward the inside, is injured less often. A high ankle sprain is more often seen in competitive athletes.
- Knee:The four major knee ligaments are the anterior cruciate ligament , posterior cruciate ligament , medial collateral ligament , and lateral collateral ligament . The ACL tear is the most common of these injuries.
- Wrist:There are 20 ligaments in the wrist. Tears will most often occur when you fall on an outstretched hand. The scapholunate and the triangular fibrocartilage complex are the most common ones injured.
Other common sites of ligament tears and the possible causes behind them include:
- Thumb:The ulnar collateral ligament can be torn when skiing or in a fall when the thumb is bent in an extreme position.
- Neck:The neck’s ligaments can be torn during whiplash injuries, as in a car accident. The hard speed-and-stop is an extreme motion that injures the cervical spine, the part of the spine in the neck. The ligament tear is just one part of a whiplash injury. It may also damage muscles, nerves, and bones.
- Back:The ligaments in your back can be torn by lifting something that is too heavy.
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Nutrients Supporting Ligament Recovery
During the recovery phase of any ligament injury its important to try take measures to promote healing and lessen inflammation. In addition to following the RICE guidelines, recovery can be aided by paying close attention to diet.
Good nutrition can help to accelerate healing by reducing tissue inflammation and stress. Eating plenty of fresh fruit and vegetables will help to increase antioxidant activity and lower inflammation.
Research by Barker and colleagues at the Sports Science Department of the Orthopedic Specialty Hospital in Utah found that people who took antioxidant supplements had a much higher rate of recovery after ligament damage compared with the control group9. This study confirmed that a higher intake of antioxidants assisted with the decrease in inflammatory agents, allowing the tissues to repair faster.
Vitamin C, protein, zinc and copper are all important nutrients that support ligament recovery. As vitamin C is involved in collagen production it is an essential precursor for the structural base of ligaments. Vitamin C has also been shown to successfully stop inflammation following surgery to repair torn ligaments10.
High-quality protein is also needed to facilitate rejuvenation of ligaments and other tissues following injury. Furthermore, zinc lowers oxidative stress and copper improves blood supply to the muscles, further supporting recovery11.
Ankle Joint Ligament Injury Caused Due To Domestic Falls
Domestic injury causing ankle joint ligament injury or tear is observed mostly in elderly patients. Elderly patients are also often suffering with osteoporosis and ligament injury is associated with fracture of ankle bone, tibia or fibula. Causes of domestic fall such as fall on slippery surface, tripping on carpet, or fall over staircase can cause ankle joint ligament injury.
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Are There Different Signs For Different Ankle Injuries
The symptoms of a sprain and of a fracture are very similar. In fact, fractures can sometimes be mistaken for sprains. That’s why it’s important to have an ankle injury evaluated by a doctor as soon as possible. The signs include:
With a sprain, the ankle may also be stiff. With a fracture the area will be tender to the touch, and the ankle may also look deformed or out of place.
If the sprain is mild, the swelling and pain may be slight. But with a severe sprain, there is much swelling and the pain is typically intense.
Tendinitis and acute tears of the peroneal tendon result in both pain and swelling. In addition, the ankle area will feel warm to the touch with tendinitis. With an acute tear, there will be a weakness or instability of the foot and ankle.
Tendinosis may take years to develop. Symptoms include:
- Sporadic pain on the outside of the ankle
- Weakness or instability in the ankle
- An increase in the height of the foot’s arch
With the subluxation you will notice ankle instability or weakness. You also may notice sporadic pain behind the outside ankle bone and a “snapping” feeling around the ankle bone.
What Can I Expect If I Have A Sprained Ankle
After giving your ankle time to heal and treating the sprain according to your healthcare providers recommendations, you’ll be able to get back to regular activities. Your prognosis depends on your commitment to building strength back in your ankle through exercises and rehabilitation. If your ankle hasn’t healed completely or you stopped the strengthening exercises, your injured ligament could weaken and put you at risk for future ankle sprains.
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Complete Nonretracted Tendon And Ligament Tears
When patients find out their radiology report has revealed a complete tendon or ligament tear, this certainly seems quite alarming, as if the structure has completely snapped in half, like a rubber band might. And while this can be true , the majority of the time, a complete tear is actually nonretracted.
While a complete nonretracted tear does mean that the tendon or ligament has been torn through, some of the injured fibers actually remain intact . In other words, the tendon or ligament is still holding together even though it has been torn through. A complete nonretracted tear of a tendon or ligament can usually be helped with a precise injection of high-dose stem cells. The blue area in the GIF image below represents a tendon or ligament, and you can watch as a complete nonretracted tear forms in the structure but doesnt pull completely back.
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When Should I Seek Treatment For An Ankle Ligament Tear
If any of these symptoms occur, you should seek treatment from a specialist. Also, if you have suffered a sprained ankle in the past, and persistently go over on your ankle, its likely that you have chronic ligament damage.
It is really important to get treated sooner rather than later, as chronic instability and weakened ankles can lead to other more serious conditions, such as ankle arthritis.
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How To Treat A Sprained Ankle
The first goal is to decrease pain and swelling and protect the ligaments from further injury. This usually means adopting the classic RICE regimen rest, ice, compression, and elevation. If you have severe pain and swelling, rest your ankle as much as possible for the first 2448 hours. During that time, immerse your foot and ankle in cold water, or apply an ice pack for 1520 minutes three times a day, or until the swelling starts to subside.
To reduce swelling, compress the ankle with an elasticized wrap, such as an ACE bandage or elastic ankle sleeve. When seated, elevate your ankle as high as you comfortably can to the height of your hip, if possible. In the first 24 hours, avoid anything that might increase swelling, such as hot showers, hot packs, or heat rubs.
Recovery Process From A Ligament Tear
Ligament tears are common when performing in sports or just when stepping awkwardly. These injuries occur when an individuals joint is stretched out beyond the normal range, causing the ligament to partially or fully tear.
If the ligament is only partially torn, you will likely be told by your doctor to follow the RICE method: rest, ice, compression, and elevation of your joint that was affected. However, if it is fully torn, you may need to have surgery to repair the ligament tear.
Although surgery to fix a torn ligament is usually performed as an outpatient procedure, the recovery process will take a while. You will likely undergo rehabilitation for about six months, but the length of time will depend on the severity of your injury.
Below is the general timeline and what you can expect during ligament tear recovery.
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Recommended Reading: The Orthopedic Institute Of Nj
Visit The Irise Spine And Joint Institute For Sprained Ankle Treatment
Do you suspect you might have torn a ligament in your ankle? Do you need to talk to a doctor about diagnosis and treatment? Our orthopedic specialists at the Florida Spine and Joint Institute have got you covered. Contact our team today for more information about sprained ankle treatment or to schedule an initial appointment.
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What Are The Types Of Ankle Sprains
There are three types of ankle sprains based on how much ligament damage occurred:
- Grade 1 . The ligament fibers stretched slightly or there is a very small tear. Your ankle will have minor swelling and tenderness to the touch.
- Grade 2 . The ligament is torn, but it isnt a complete tear. Your ankle has swelling over the injury and it hurts to move.
- Grade 3 . The ligament is torn completely. Your ankle has significant swelling, the injury is painful and walking is difficult.
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How Does The Doctor Diagnose An Ankle Injury
The first thing a doctor will do is ask questions about how the injury occurred. Then the doctor will examine the ankle, noting the amount of swelling and bruising. The physical examination of the ankle may be painful because the doctor needs to move the ankle to evaluate the pain and swelling in order to make a proper diagnosis.
The doctor may order an ankle X-ray to determine whether there are any broken bones. In addition to an ankle X-ray, your doctor may ask for X-rays of the leg and foot to determine whether there may be other related injuries. If the doctor suspects a stress fracture, the doctor will ask for other imaging scans such as an MRI, which will show more detail about the injury. If there is a fracture, the doctor may also ask for a stress test, which is a special X-ray taken with pressure applied to the joint. This will help the doctor determine whether surgery is needed.
For most ankle injuries, pain is controlled by using an over-the-counter medication such as acetaminophen or other nonsteroidal anti-inflammatory drug such as ibuprofen. The specific treatment of the injury depends on the type of injury.