Torn ligament at the ankle
Synonyms
(fibular) Ligament rupture, supination dreams,
English: sprained ankle
definition
The Ankle joint consists of a upper ankle and one lower ankle. Injury to the outer ligaments in the upper ankle is the most common and is therefore also simplified as Torn ligament in the ankle shown. In the event of an injury, one or more of the Outer bands severely overstretched and tear as a result. The three outer ligaments that can tear in such an injury are called Ligamentum fibulotalara anterius (ATFL), Ligamentum fibulotalare posterius (PTFL) and that Fibulocalcaneare ligament (CFL).
Figure torn ligament
- Front fibula -
Ankle ligament -
Lig. Fibulotalare anterius - Fibula-calcaneus
Tape -
Calcaneofibular ligament - Posterior fibula
Ankle ligament -
Posterior fibulotalar ligament - Heel bone - Calcaneus
- Ankle bone - Talus
- Outer ankle -
(= Fibula bone)
Lateral malleolus - Fibula - Fibula
- Shin - Tibia
- Cuboid bone -
Os cuboideum - Scaphoid (of the foot) -
Navicular bone - Inner ankle -
(= Shin bone) -
Medial malleolus
I - I - Upper ankle
(Hinge line blue) -
Articulatio talocruralis
II - II - Lower ankle
(Hinge line purple) -
Articulatiotalocalcaneonavicularis
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My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
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Athletes (joggers, soccer players, etc.) are particularly often affected by diseases of the foot. In some cases, the cause of the foot discomfort cannot be identified at first.
Therefore, the treatment of the foot (e.g. Achilles tendonitis, heel spurs, etc.) requires a lot of experience.
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causes
To a Torn ligament does it come from a "Twist“ (Supination trauma) of the foot in the upper ankle. On the one hand, this can happen during sport, particularly often during Soccer and tennis, but also by wearing the wrong footwear or walking on uneven surfaces (Cobblestones) happen. Usually the upper ankle is responsible for moving the foot forward and backward. With the so-called "twisting ankle" it happens that the foot is turned inwards in the upper ankle joint (the big toe comes up towards the top). The lower ankle is actually responsible for this movement. As a result, the outer ligaments are stretched more and more and overstretching (Ligament stretch), a partial tear or a complete torn ligament.
Pain that occurs
The ankle ligament tear is one of the most common injuries to the musculoskeletal system. It usually comes about as part of sporting activity. The torn ligament of the outer ligament is a typical injury site, which is caused by an outward buckling. Pain can then arise directly when twisting an ankle and can be felt as shooting and stabbing. After this, the pain can first subside and then reappear later in the process or it can persist immediately. This depends above all on the severity of the ligament tear and accompanying injuries and also on whether the ligament may have already been damaged.
Ankle pain is one of the first and most typical symptoms of a torn ligament. While the pain is rather sharp and punctiform at the beginning, it can later express itself as dull and radiating into the surrounding structures. They can occur as a result of stress while walking or stress on the ankle joint and can be caused by applying selective pressure at the site of the torn ligament. In addition, the pain can also occur at rest, depending on the position of the ankle.
Which ligament is affected can be found out, among other things, by the punctual pressure pain over the structure. Despite the ongoing healing process, the pain from the torn ligament may persist. Even after the ligament has fully recovered, it can still be so irritated by the torn ligament that it continues to cause pain for a certain period of time under stress and movement.
However, the course of ankle pain differs from person to person and can vary widely. If the pain from the torn ankle ligament persists despite the therapy measures being followed and initial rest, a clarification with a foot specialist is recommended.
Physiotherapy and the independent increase in the load are important for restoring the function of the ankle joint after the torn ligament has healed. This can again lead to pain and the associated relieving posture, which should, however, be avoided. The muscle building around the ligament structures is important so that the ligaments are relieved in the future. So that recovery measures can still be carried out, it is important to deal with the pain properly. Measures that bring relief from the pain help, for example cooling with special gels or cooling pads and elevating the foot. Appropriate painkillers can also be taken, but are only recommended to a limited extent due to their side effects on the stomach.
It is important to pay attention to the swelling
The swelling is one of the main symptoms of a torn ankle ligament, along with the bruise and ankle pain when walking. The main reason for this is the bleeding caused by the torn ligament. In addition, the swelling after a torn ligament also develops because water accumulates in the tissue due to the injury at the ankle. The swelling is particularly pronounced in the evening when the affected foot is down all day. This is because the hydrostatic pressure acts on the vessels and the tissue through gravity and the water is shifted into the interstitial space.
On the one hand, the swelling is uncomfortable because it makes it difficult to wear shoes or a splint and may leave pressure marks after wearing them. On the other hand, the swelling is uncomfortable because it causes pain and a feeling of tension.
The swelling is improved by elevating the leg and cooling the area affected by the torn ligament. Immobilizing the ankle can also have a positive effect on the swelling, as the healing process can proceed unhindered. The duration of the swelling can vary and is directly influenced by the treatment. The swelling may last for a few weeks. With appropriate measures, it can go away earlier.
More on this: Ankle swollen on one side
anamnese
A bruise occurs on the anatomical course of the respective ligaments (Hematoma) and pressure pain (Tenderness). Often times, patients also state that they heard a crack or crack at the time of the injury.
The injury also results in joint instability and stiffness. By a X-ray examination can a broken bone (fracture) can be excluded. To classify the torn ligament precisely and to see how many ligaments are damaged, a MRI from the foot (Magnetic resonance imaging) prepared.
classification
Ligament injuries in the upper ankle are divided into three degrees of severity. In the event of injuries from Grade 1 the ankle is still resilient and there are only minor bruises. A ligament rupture did not occur in Grade 1 injuries.
In the event of injuries from Grade 2 the ankle can only be subjected to limited loads and there are significant bruises. Patients can often only stand or walk briefly because the pain is too severe.
An injury from Grade 3 leads to the ankle joint immediately after the injury (post-traumatic) is not resilient and you can also see a clear swelling with a bruise. In children, the torn ligament predominates, which means that the ligament is at the point of attachment to the bone run away.
Therapy & Rehabilitation
The therapy of the torn ligament depends on the number of torn ligaments. If the anterior fibular alar ligament (ATFL) ruptures alone, surgical intervention is not necessary. The RICE principle, which is an acronym for rest (rest), ice (ice), compression (compression) and elevation, is important for all types of ligament ruptures. The patient wears a pneumatic stabilization splint for about 12 weeks, or after one week they get a stable shoe that they have to wear for 4 -8 weeks.
If the fibular calcaneus ligament (CFL) travels in addition to the AFTL, a night splint is prescribed for the first 6 weeks in addition to the pneumatic stabilization splint. The pneumatic splint or a stable shoe must then be worn for 3 to 6 months. All outer ligaments are rarely ruptured. If this injury does occur, surgical therapy is the first choice. The ligaments are surgically sutured and, if necessary, reattached to the bone. Then the lower leg is cast in plaster. However, surgical therapy is controversial in the literature because rehabilitation takes longer and the result is longer sports leave.
However, if at least two ligaments are torn or there are minor bone fragments as a result of the rupture, the structures can rarely be restored so well without surgery, so that the patient can then go back to exercise without restrictions. Depending on the activity and age of the patient, the time it takes to fully exercise again can vary. The return to sport occurs gradually as soon as physiotherapy and / or everyday life can be completed again without pain. If the symptoms subsequently relapse, the injury must be re-examined and a different therapeutic strategy selected.
An ankle orthosis can also be used as one of the several therapy options. Read more about this under: Ankle brace
Stability through the use of a rail
An important measure in treating a torn ankle ligament is this Stabilization and fixationso that the ligament can grow back together and despite the ligament rupture one to ensure physiological sequence of movements at the joint. Here is one rail which orthopedists like to recommend. They are available in different sizes and designs and can be adjusted using adjustable Velcro straps or something similar individually adapted become. Compared to taping, it offers significantly more stability and fixation in the desired position of the ankle, as it contains a rigid component.
Another advantage the rail is that they quickly attached and removed again can be removed in between for a short time.
A disadvantage The splint when the ligament ruptures is that it is due to its rigid shape Bruises can come and the splint can be found uncomfortable, especially if the injury causes swelling.
The splint should only serve as a fixation at the beginning of therapy. Later, when the ankle can gradually be loaded again, it is primarily intended to stabilize and prevent twisting. You usually should about six weeks be worn continuously.
Stability through the use of a tape bandage
Taping plays in treating one Torn ligament at the Ankle joint a major role. The tape bandage offers one in the ankle high stabilitybecause it is not so elastic and is attached with a relatively high tension. After the torn ligament, the ankle should be attempted to be fixed in a position that allows the torn ligament to grow back together. Through the high stability in the ankle taping prevents movements that would worsen the condition of the torn ligament. At the same time, the tape has the property that Mechanoreceptors of the skin to stimulate when this is stretched or jammed by the tape. As a result, the Deep sensitivity and the Blood circulation and thus regeneration can thereby be optimized so that the torn ligament at the ankle is supported in its healing.
Above all, taping has that great advantagethat despite immobilization of the joint there is a certain residual function guaranteedwhich enables those affected to be relatively mobile. How the tape is applied is determined by the structures affected by the ligament tear. It is important that the position and condition of the tape bandage regularly checked and if necessary renewed is used to avoid any injuries to the skin or poor posture in the ankle.
Healing time after an ankle ligament tear
The healing time of a torn ankle ligament includes the point in time from which the ligament is torn to the moment when the ankle can be loaded again without problems. The extent of the Healing times vary widely. she can Weeks to months However, it is on average around one to three months.
The healing time depends on various factors, which can have both a positive and a negative influence. negative It would be assessed if the affected ligament after a ligament tear at the ankle joint continued to be stressed by stress on the foot when walking or exercising becomes. Since the ligaments at the ankle are exposed to high forces when stressed, this means that if a ligament ruptures, the ligaments do not have sufficient opportunity to grow together again in peace. In addition, newly created tissue bridges between the ligament ends due to the healing process can tear off again when the body weight is shifted to the affected side. Thus the Healing duration drawn into the longer become. Fixing or stabilizing the ankle joint, for example, using a splint in the wrong position and position, can mean that the torn ligament takes longer to heal.
positive one affects the healing time Consistently carried out protection of the ankle. This means that the foot may not be loaded at all at the beginning, and then gradually increased after a while. This usually allows the ligament to heal again without any problems. A splint or tape should also be worn to keep the ankle in the Gentle phase stabilized and fixed and thus protected from external influences and one Bad posture is. What is also beneficial for the healing time of the torn ligament is physiotherapy, which is supposed to activate and strengthen the muscles around the ankle joint so that the ligament has to deal with less force on its own in the future and it is spared. In addition, the affected ligament should be stretched and strengthened together with the other ligaments on the ankle joint after healing in a physiotherapy treatment. On the one hand, if possible Restore the initial situation, on the other hand to one To prevent ligament rupture in the future.
This shows that the healing period is not a fixed period of time that applies to everyone, but is a summary of many events and the result of various measures.In order to achieve the shortest possible healing time, it is advisable to work with a doctor to draw up a treatment plan that takes into account all the factors involved in the healing of the torn ligament at the ankle.
Torn ankle ligament in children
Also children are not spared an ankle injury. What is special about children, however, is that the Band structures are much more stable than are in an adult. If, for example, sporting activity or the like causes the ankle to twist or another pathological movement at this joint, this leads to it usually not torn ligamentsbut that Tape tears a piece at its attachment point Bones or cartilage out and is therefore no longer functional.
Thus is a more classic Torn ligaments rarely occur in children. Still, here is the Outside of the ankle more often affectedthan the inside. It should not be forgotten in children that in some cases, genetically determined, they have weaker connective tissue and thus also ligament structures. In these children, a torn ankle ligament is not uncommon, as the instability in the ankle joint puts a lot of strain on the ligaments when they move and can be more easily injured. Since such injuries with a imaging measure, such as X-rays, can be displayed poorly, is one in case of doubt Jointoscopy necessary for further diagnosis.
It is important in children then appropriate treatment to be initiated so that later deformation and instability of the ankle due to a torn or torn ligament do not occur. This would in fact encourage further injuries from movement and strain and restrict mobility, which of course should be avoided.
forecast
With a complete healing of the Torn ligaments the ankle can then be loaded again without restriction. However, repeated tears of ligaments in the ankle joint can lead to fundamental instability, which makes renewed ligament tears more likely.
prophylaxis
To the upper Ankle joint To additionally stabilize and thus prevent ligament injuries, external stabilizers can be worn or particularly sturdy footwear, which over the ankle goes. In the sporting area, however, performance can be limited.
Further injuries in the upper ankle
In addition to the outer bands, the Syndesmotic ligaments (Connection between the tibia and fibula) or the medial collateral ligament (Delta ligament, inner ankle ligament) to travel. These injuries are much rarer, but often have a protracted course and require more rigorous immobilization than a single injury to the outer ligaments.
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