introduction

One of the most common injuries and about 20 percent of all sports injuries are ligament injuries of the upper ankle. The foot is connected by several ligaments with the lower leg, which also stabilize the joints. The band at the outer ankle consists of three parts. These run from the fibula to the talus and heel bone. There is also a band at the inner ankle and another important band is the so-called syndesmosis, which connects the tibia with the fibula. In most cases, torn ligaments on the foot affect the ligament of the lateral malleolus, injuries to the other ligaments are relatively rare. Typically there is a ligament tear on the foot by a folding of the foot inwards. In such a "Verstauchen" of the foot, it comes to an overload of the outer band, which can even break in extreme cases. It is usually not so easy to distinguish between a ligament tear and a ligament strain.

Ligament tear outside on the foot

The foot tends to fold inwards due to its anatomy.

Due to the course of the Achilles tendon, the direction of the kinking is predetermined and can be reproduced on the toes of tense calf muscles.

The reason for this is an imbalance in the muscles, the calf muscles outweigh and pull the foot inwards, the weaker shin muscles pull the foot outwards and upwards.

This imbalance is favored, for example, when wearing shoes with high heels, which is why it kinks faster.
Even out of the jump, for example, in a sporting activity such as playing football, it usually comes to a kinking of the foot inwards, the outer band is overstretched at the ankle or even ruptures. Most often the front part of the outer ankle ligament is affected, the posterior part is almost never affected.

Torn ligament on the foot at the child

Children often suffer torn ligaments on the foot, especially when they are very active or engage in sports such as football.
Even in children, the most common injury is a stretch or tear of the outer band.

In contrast to children, in extreme cases a break in the outer ankle occurs in older people; in children, serious injuries lead to a violation of the growth plate.
As a result, there is a (albeit very small) risk of growth disturbance.

The injury to the growth plate can lead to increased or decreased growth of the bone, a deviation of the leg length to the other leg up to one centimeter can be caused.

However, the child's skeleton has a high reparation tendency, whereby consequential damage can be largely avoided by a violation of the growth plate by means of the appropriate treatment.

In most cases, even children have "only" ligament rupture of the foot, which heals without any consequences as a result of conservative treatment using a splint.

Figure torn ligament

Figure torn ligament right foot from the back (A) and outside (B)
  1. Front fibula -
    Anklebone Band -
    Lig. Fibulotalar anterius
  2. Fibula-calcaneal
    Tape -
    Ligament calcaneofibulare
  3. Rear fibula
    Anklebone Band -
    Lig. Fibulotalar posterior
  4. Heel bone - calcaneus
  5. Anklebone - Talus
  6. Outer ankle -
    (= Fibula ankle)
    Malleolus lateralis
  7. Fibula - fibula
  8. Shin - Tibia
  9. Dice leg -
    Os cuboid
  10. Scaphoid (of the foot) -
    Os navicular
  11. Inner Knuckle -
    (= Shinbone) -
    Malleolus medialis
    I - I - Upper ankle
    (Joint line blue) -
    Articulatio talocruralis
    II - II - Lower ankle
    (Joint line purple) -
    Articulatiotalocalcaneonavicularis

symptoms

A ligament tear on the foot is initially expressed by severe pain, which are caused directly by an injury. Mostly the foot or the ankle swells very fast and strong. Due to this pressure or the accident, blood vessels can rupture and lead to a bruise, the foot turns red-bluish. It is usually very painful to strain the foot, but it is possible. The symptoms of torn ligament and straightening hardly differ at first. The extent of the pain can not necessarily give an indication of the severity of the injury, as a pulled ligament often causes more pain than a torn ligament. Very typical for a ligament tear on the foot is that in the ankle a changed mobility is noticeable, that is, it is unstable and the appearance on the foot is uncertain.

swelling

A swelling of the ankle or the entire foot and associated severe pain are typical of a ligament injury to the foot.

In a ligament strain usually only slight swelling occur, as in a torn ligament, which may be accompanied by a strong swelling and a throbbing sensation.

Typically, ligament rupture results in bruising ( hematoma ) as the tissue is severely damaged and blood leaks into the surrounding tissue.

In order to minimize the swelling and to minimize the associated pain, the injury should be cooled immediately. A slightly compressive bandage may additionally prevent excessive swelling of the joint, and under no circumstances should too much pressure be exerted to prevent the blood supply from being restricted.
Also, the high positioning of the foot leads to a reduction of the swelling.

The swelling of the foot takes about two to five days in a torn ligament, during this time, the swelling is usually accompanied by severe pain, which also decrease with decrease in swelling.

causes

A ligament tear on the foot is usually caused by extreme movement in the ankle joint. It comes to a heavy load on the bands and to exceed the normal range of motion - the tape breaks. The most common mechanism on the foot is the kinking. But even external acts of violence such as a foot or leg kick can lead to a ligament injury.

It is not necessarily a sporting activity to be performed to rip a band on the foot. Even a wrong putting on of the foot or a slipping on wet ground in the everyday life can lead to a torn ligament on the foot. Sports that most often lead to ligament injuries on foot are mainly football, jogging, skiing, tennis and squash. The rapid change of direction and stop-and-go movements in these sports as well as any uneven surfaces cause heavy stress on the ligaments on the foot, which can lead to a crack. But also genetic causes, such as foot deformities or soft ligaments, can increase the risk of torn ligaments on the foot.

diagnostics

The beginning of the diagnosis of a ligament tear is the anamnesis interview. Above all, the doctor wants to get to know the accident in order to rule out the first structural lesions.

This is followed by a clinical examination in which the stability test is in the foreground. After that, whether it is a stable or unstable ligament injury, the load capacity is tested. Here it is relevant to know if a passive or active mobility is possible.

If there is a hematoma formation, this point can be punctured to determine on the basis of the blood, whether it is an old or fresh ligament injury. The realization that it is a fresh ligament tear can have a positive effect on the prognosis. On the one hand, the treatment spectrum is greater and, on the other hand, the chances of recovery are better. The further procedure provides for an X-ray. It is preferred that held recording application. Since you can only detect your ligament rupture at the point of attachment of the bone in a normal x-ray, the "held recording" helps to detect torn ligaments other localization. For this, the joint, whose band structure is torn, must be brought into an extreme position, so that malpositions are recognizable due to the ligament tear. In principle, the MRI of the foot (= magnetic resonance tomography) is the more advantageous diagnostic tool, as it displays tissue and organs and makes ligament rupture easier to recognize. Experienced doctors can also diagnose torn ligaments using sonography.

therapy

In the event of a ligament injury to the foot, it is first necessary to observe a number of first-aid measures immediately after the accident or injury. The foot should be cooled, carefully bandaged and stored high. In this way, a further swelling can be reduced and thereby unpleasant pain can be avoided by the high pressure of the swollen tissue. Easy to remember is the so-called PECH scheme: pause (immediate relief), ice (cooling), compression (light pressure bandage), high camps.

It is essential to relieve the foot immediately and not continue, for example, the football match started. In addition, a doctor should usually be visited relatively quickly, in order to avoid consequential damage. The doctor usually diagnoses a ligament tear on the foot by examining an increased mobility in the joint, since ligament stabilization is limited. Frequently, an X-ray is made on which a torn ligament is not visible, but can be excluded by the injuries of the bone.

Conservative therapy

As a rule, a ligament tear is treated conservatively and no surgery is performed. Special walkers, so-called orthoses, allow a safe movement in the foot without endangering the injured area. This gentle treatment allows the foot to roll normally without having to fold over again. This will prevent muscle breakdown and, as a rule, such a splint is worn day and night for about six weeks. Physiotherapeutic therapies can provide support, as well as simple sports activities should be performed to build the muscles further. However, these should be discussed with the attending physician to avoid overloading the injured foot.

OP with a torn ligament on the foot

Especially in case of injuries of several ligaments on the foot or in competitive athletes, in which the foot and the hocks are heavily loaded, is advised often to an operation.

In the case of a complicated course of a torn ligament on the foot, in the event of accompanying injuries or for the planning of operations, magnetic resonance imaging (MRI) is usually performed. With this examination, the bands can be displayed very accurately.
The operation of a torn ligament on the foot carries the same risks as any surgery, such as infections or wound healing disorders, about which the affected person must be informed in advance.

In the case of a very unstable joint or injury to bone or cartilage at the ankle, surgical treatment may be useful.
Especially in case of high load demands as in a professional athlete an OP is recommended. Very seldom does the ligament rupture heal by a conservative treatment and it can be necessary in the consequence still another operation.

The operation consists of a suture of the torn ligament and possibly a fixation of injured bone or cartilage parts. If the band is severely damaged, a tendon of the body can be transplanted to the site and the torn ligament reconstructed in this way. After the operation, the foot is immobilized for approximately six weeks, similar to the conservative treatment.

Overall, the long-term results in ligament tears on the foot after conservative treatment are similar to those after surgery.

Healing and prognosis

Often it comes after appropriate first aid measures after a Umknickverletzung to soon reduce the pain.
However, in most cases it still makes sense to see a doctor.

If it is not just a muscle strain, but a torn ligament, inappropriate treatment can lead to permanent joint problems.

The ligaments on the foot are extremely important for the stability of the ankle. If a torn band heals badly, the joint can remain permanently unstable.
In this case, it leads to repeatedly Umknickverletzungen with the risk for renewed ligament injuries.
This can be a significant impairment in everyday life, work and sport. In addition, an incorrect loading of the unstable joint can lead to painful joint wear (arthrosis) with wear of the protective articular cartilage.

Basically, a torn ligament on the foot with the appropriate treatment, however, heals very well and without consequences.
The leg may be gently loaded again as soon as the symptoms have subsided.

A simple rule is that everything is allowed that does not hurt. For this reason, the pain should not be anesthetized with medication, because by an early overload, the healing process can be prolonged.

Sports activities that burden the injured ankle should be operated after a torn ligament on the foot only after the recovery and recovery phase (after six weeks), otherwise there is a renewed risk for a ligament injury.

prophylaxis

A well-trained tibia musculature is the most important stabilization for the hocks and the foot. In order to effectively protect against torn ligaments on the foot, it is therefore very important to strengthen the calf muscles. Anyone who has had torn ligaments can wear special sports shoes with more support or a supportive bandage to support sporting activities. Also special sensorimotor exercises have been proven in the prevention of ligament tears on the foot. For example, balancing on a balance board can be very useful, and in conjunction with simultaneous movements such as catching a ball, important movement patterns are automated and the ankle becomes more stable. In addition, wearing high-heel shoes should be avoided as it shortens the calf muscles and increases the risk of ligament injuries.


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