Torn ligament on the foot

Ligament tear on the foot: description

A torn ligament on the foot happens quite often, especially during sports. Most affected are ligaments on the ankle, which are very important for the biomechanics of the foot.

One differentiates at the foot a lower and an upper ankle joint:

The construction of the lower ankle involves different tarsal bones. Ligaments stabilize the joint.

Three bones are involved in building the ankle joint: the fibula (forming the outer malleolus of the foot), the tibia (forming the medial malleolus), and the talus (belonging to the tarsal bones). Again, ligaments stabilize the joint and limit its movement to prevent dislocation – the three-part outer band, the four-part inner band and the syndesmosis. In a ligament tear on the foot, the injury usually refers to one or more of these bands.

Outside ligament

Ankle pain indicates a tear in the outer ligament. You can find out more about this in the article External Tear Off.

Interior ligament

If the pain is more localized on the inner ankle, there could be an internal ligament tear. The inner ligament is also called the deltoid ligament. It consists of four different parts, which run from the tibia to the tarsal bones.

Syndesmosebandriss

The syndesmosis ligament is a very tight, connective tissue band that connects the calf and shin around the ankle. Also this tape can tear completely or partially. About six percent of ankle fractures without bone fracture involve the syndesmosis ligament.

Torn ligaments on the foot: symptoms

A ligament tear on the foot is usually accompanied by sudden pain, which can increase with increasing swelling – even hours after the accident. Depending on which band is torn or torn, certain movements are particularly painful. If the ligament tear affects the ankle-like ligaments (outer ligament or inner ligament), the pain at the respective ankle is also localized. In a Syndesmosebandriss (syndesmotic rupture) it comes to pain in strains of the ankle – walking is difficult to impossible, the area around the torn ligament on the foot swells. Especially with a complete ligament tear on the foot, the foot buckles when loaded to the side, and it sets the feeling of (joint) instability.

Torn ligaments on the foot: causes and risk factors

In most cases, a ligament tear in the foot caused by an accident, especially in sports. In particular, by a twist (distortion), it can lead to ligament tear on the foot. Popularly, a distortion is also referred to as a sprain. The affected band is often only touched.

The most common cause of one Interior ligament is a Umknicktrauma. This can come especially when playing sports or when walking or running on bumpy or slippery surfaces.

One Syndesmosebandriss arises mostly in the context of a sports accident in contact or collision with other players. This typically leads to a forced external rotation of the foot, which is dorso-reflected. As Dorsoflexion describes the upward movement of the foot. The most important risk factor for a syndesmotic ligament tear is the exercise of a highly competitive sport, especially American football, lacrosse and football. Men are three times more likely than women to be affected by a syndesmotic ligament tear.

Ligament tear on the foot: examinations and diagnosis

The right contact persons for foot injuries are orthopedists, accident surgeons and sports physicians. In discussions with the patient, the doctor first tries to clarify various questions, such as:

• How did the accident happen?
• Could you still run after the injury?
• Do you have pain? Permanently or only in certain situations?
• Can you localize the pain?
• Have you already experienced similar injuries?
• Do you suffer from chronic diseases like diabetes mellitus?

This is followed by the physical examination. The doctor examines the injured foot, paying attention, inter alia, to restraint, swelling, bruising and other local findings in the injured area. Then he checks blood circulation, motor skills and sensitivity on the affected foot (DMS test). He scans the foot and the lower leg and tries to identify pain points. Through passive (by the doctor) and active (by muscle power of the patient) moving the foot, the range of motion is determined in comparison to the healthy opposite side.

If, when the foot kicks off, it causes pain externally or internally, this indicates a ligament tear (ankle region).

If possible, the doctor also monitors the patient’s gait. The nature of the aisle can provide important information about malpositions and movement patterns and thus provide an indication of a torn ligament on the foot.

Special tests (such as the tilt test, squeeze test, etc.) can provide even more information about the injured ligaments.

imaging

If there is neither swelling nor bruising and pain can not be elicited in the examinations, a ligament tear on the foot usually does not require an imaging examination. Very rarely, a so-called stress X-ray is performed, in which the foot is X-rayed while performing any of the special tests in the exercise posture. Magnetic resonance imaging (MRI) may be useful if a torn ligament on the foot, despite treatment for a long time (six weeks or more) pain.

Ligament tear on the foot: classification

Attached to the examination results, the doctor can distinguish different degrees of severity of a ligament tear:

• Grade I: Mild ligament strain with microscopic cracks only. Slight swelling, minor pain. The joint is stable, walking with little pain is possible.
• Grade II: At least one band is clearly touched. The symptoms are more pronounced than at grade I. The range of motion is limited.
• Grade III: A complete ligament tear on the foot involving multiple ligaments. Strong symptoms, usually impossible. The biomechanics of the foot is clearly disturbed.

Torn ligament on the foot: treatment

If you suspect a ligament tear on the foot, you should take emergency measures in accordance with the PECH rule (break, ice, compression, high camps): Immediately interrupt any sporting activity. Put ice or make a cold envelope (every two to three hours for 20 minutes each). Provide compression of the affected area (pressure bandage) to counteract swelling. Store the injured foot above heart level. You can also use analgesics from the group of nonsteroidal anti-inflammatory drugs (such as ibuprofen) as needed.

These measures should be continued for about three days to stop inflammation and swelling. To protect the injured foot, crutches should be used until a normal gait is possible again. A complete immobilization of the foot is usually considered only with a third grade torn ligament on the foot. From a second-degree injury, however, an orthosis or elastic bandage for stabilization makes sense.

physical therapy

Within the first week you should start with a physiotherapy. When the acute pain has subsided, one can perform simple exercises without weight bearing. Slowly the load is increased. Wearing an orthosis prevents extreme movements during training and thus provides support. In addition to the muscles, the balance should also be trained.

Operative treatment

Only in rare cases is a ligament tear on the foot treated surgically. For example, surgery is often required for seriously injured or professional athletes with specific needs. Also, a (second-) third-degree syndesmotic ligament tear is often operated on.

Torn ligament on the foot: duration, course of disease, prognosis

The initially severe pain in one usually decreases significantly over the course of two weeks. However, around a third of patients still report pain after one year.

One possible consequence of ligament rupture of the foot – especially syndesmotic ligament tears – is (partial) ossification of the affected ligament (heterotopic ossification).

After a torn ligament on the foot you should only do sports again when the pressure pain subsides and the mobility is restored. Sport-typical movements should be possible and there should be no more instabilities in the joint.

Anyone who has had torn ligaments on their feet has an almost five-fold increased risk of re-injury in the same area. To prevent it, you should therefore regularly train and stretch the muscles (also in the legs). Also helpful is a balance training on the wobble board: It trains the coordination of the leg muscles. Also, orthoses or bandages on the ankle can be useful and a renewed Torn ligament on the foot prevent.