torn ligaments in the foot

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Achilles tendon rupture – first steps after the injury

Rehabilitation after an Achilles tendon rupture is long and painful; many patients eventually despair and worry that they may never be able to walk again. However, if the injured person is persistent and determined, they may even have an opportunity to return to the sport. The prerequisite for this is that all recommendations of the doctor are followed, that one is careful and consistent. Of course, a lot depends on the age, motivation and physical condition of the patient.

After a long immobilization, the patient wants to get back on his feet as soon as possible, but this is very difficult because it feels as if the foot has forgotten its function and one has to learn to walk again. First, however, the foot must be carefully prepared for the effort. Physiotherapy, water aerobics and orthopedic aids can help. The qualification and experience of the treating specialist plays a major role. Only the orthopedist can calculate the appropriate load for each phase of recovery. This is very important: if too much weight is put on the foot, the tendon can tear again, and if too much weight is put on it, a contracture can occur.

Proper positioning of the injured leg when walking

Proper positioning of the leg when walking is part of functional therapy. A special orthosis or shoes with heels or a supportive cushion can be used for this. At the beginning, the heel should not be deeper than 5 cm; gradually, on the advice of the doctor, it is reduced to 2-3 cm. The angle of the orthosis should be adjusted by the treating orthopedist. Once the heel is 'removed', high-elasticity glute trainers can be used. Initially, the injured person walks on crutches, but does not lean on the injured limb. Over time, two crutches should be replaced with one crutch, preferably an elbow crutch ('canoe') on the opposite side of the patient's leg.

• Keep feet strictly parallel;
• Increase stride length by gradually 'rolling' the foot from heel to first toe;
• Toes should not point to the side, but straight ahead;
• Slight pulling on the Achilles tendon.

CAUSES

The causes of the pathology can be very different and depend on gender, age, physical activity and the location of the affected joint.

At home, the most common cause of injury is a routine twisting of the leg while walking, a trip, or an accidental fall. Girls who wear uncomfortable shoes, active teenagers, elderly people who walk on slippery surfaces, and many other causes can develop ankle sprains and anomalies. These injuries are common in professional athletes.

A fall or an injury to the hand can result in a dislocation of the ligaments in the shoulder or wrist. In athletes, injuries are caused by a sudden throw or swing; in bodybuilders, they are caused by carrying heavy weights.

Factors that contribute to ligament injuries include

• excessive body weight;
• uncomfortable shoes or clothing;
• older age;
• Peculiarities of foot structure – flat feet or standing tall;
• arthritis, joint inflammation, diabetes;
• Sedentary lifestyle or very active lifestyle.

SYMPTOMS OF LUXATION

The first symptom is acute pain due to the dislocation injury. After some time, the injury site becomes swollen and hyperemic. Sometimes after an ankle sprain or ligament injury, you move on without paying attention to the symptoms, putting even more stress on the injured area. The pain then increases significantly and the joint can no longer be used, e.g. B. when raising the arm or standing on the leg. Increased mobility of the injured joint is caused by ligament strain.

Strain injuries can be divided into 3 degrees:

1. Mild – the ligament injury is minor, only a few fibers are damaged, the pain is bearable, it can subside after some time without medical intervention, and the joint functions normally. How long does it take for a minor sprain to heal - 10 to 14 days.

2. Moderate sprain - up to half of the fibers are damaged, the pain is severe, the joint's ability to function is limited and medical attention is required. A moderate sprain of the ankle or knee ligaments takes about three weeks to heal, but complete immobilization of the limb is required during this time for the treatment to be effective.

3. Severe - ruptured ligament, excruciating pain, inability to use the joint and urgent medical attention is required. A severe ankle sprain can take three to six months to heal.

A bruise can develop very quickly: hematoma at the site of injury or extensive bleeding, swelling, tingling or numbness, temperature increase (almost always local).

The symptoms and pain associated with severe sprains are similar to fractures. Therefore, do not try to self-medicate, but go to the clinic for a referral for an X-ray so that the problem can be accurately diagnosed and treated.

symptoms of an injury

The main symptoms of a sprained foot are pain, reduced mobility, swelling and bruising. These do not appear immediately, but gradually. At first there is a stabbing pain, which increases when trying to position the foot. The swelling gradually goes down, but after a few hours an inflammatory swelling develops. This puts pressure on the sensitive nerve endings and causes persistent pain in the foot. After the swelling subsides, a large, dark purple bruise forms that lasts for a week. The blood cells that have leaked from the injured vessels slowly decompose. This also changes the color of the bruise: it takes on a greenish-yellow color.

Slight degree of sprain

A minor sprain is characterized by the severing of a small number of fibers. The pain occurs only at the time of injury and then quickly subsides. After a few hours, the ligaments begin to swell slightly, and the bruising is minimal, if any. The injured person feels pain when the foot strikes, but can move freely.

Moderately severe sprain

This diagnosis is made when about 50 % of the fibers are torn. The clinical manifestation of the foot injury is acute pain, which worsens when attempting to take a step. The affected person can limp and walk a short distance unaided. After about 5 hours, the foot swells and further restricts mobility. A few days later, a large bruise appears at the site of the swelling.

Severe sprains

In a severe sprain, most of the fibers are either torn or completely detached. There is not only a stabbing pain, but also a clear crackling noise. It resembles the sound of a dry, thick stick breaking. The pain subsides easily and intensifies as swelling develops over the entire foot and sometimes the lower ankle as well. Also, the resulting hematoma is not limited to the area of the torn ligaments, but extends to the heel and lateral surfaces of the foot. The sufferer can no longer stand on the foot due to the pain and loss of stability of the foot.

diagnosis

Moderate to severe symptoms of ligament injury can mask periarticular and intra-articular fractures. An X-ray is therefore taken to rule out damage to the bony structures. This examination is also meaningful when ligaments are completely detached from their bony base. A freestanding single fragment is clearly visible in the area of her approach. This thin plate is the part of the bone that has detached along with the fibers of the connective tissue bundle.

MRI and CT scans are done to determine the extent of the injury, rule out cartilage damage, and assess the condition of the blood vessels. Arthroscopy is usually done when it is difficult to make a definitive diagnosis.

X-ray of the foot.

collateral ligaments

Inside the knee there are two collateral ligaments: the outer ligament and the inner ligament. If only one of these ligaments is torn, conservative treatment is possible. In the acute phase of the injury, the patient may be hospitalized.

The joint puncture is performed as soon as possible after the patient is admitted to the hospital. The goal of the doctor is to eliminate the hemarthrosis (blood accumulation in the knee) and also to relieve the pain. After the joint is irrigated, a local anesthetic (such as 0.5 % procaine) is administered to relieve pain.

A plaster cast is placed on the knee. The patient wears it for about 1 week. Once the swelling of the joint has subsided, the cast is removed. It is then replaced with a circular bandage. This extends from the groin to the toes. The limb is immobilized with excessive deflection of the lower limb toward the damaged ligament.

The limb is immobilized for up to 2 months. Once the acute inflammation has subsided, the doctor will prescribe physical therapy. This improves the blood supply to the joint and normalizes the regeneration processes. Therapeutic exercises are carried out. These aim to strengthen the muscles of the hips. Physical activity also stimulates blood circulation, which improves the trophism of the knee joint.

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When 'crosses' are torn, in the vast majority of cases they cannot be healed without surgery. The ligaments do not heal by themselves. Walking with a torn ligament is forbidden: it leads to dystrophy of the joint, muscle wasting and can lead to chronic pain.

There are only two situations in which surgery is not possible:

• partial cruciate ligament tear (ie only part of the fibers are damaged; this type of injury is also known as a sprain);
• Medical contraindications to surgery.

In the initial period after the injury, the joint is swollen and the pain is severe. Because of this, it is clinically impossible to determine if the ligaments are completely torn. Proper examination is not possible until the hematoma is removed and the knee is anesthetized. For this purpose, a puncture is performed. The joint cavity is flushed. After the blood and clots have been removed, you will be anesthetized with a local anesthetic solution. A procaine solution of 0.5 % or 1 % injected in 25-30 ml can be used.

An instrumental examination is always required. It's likely that more than just the tapes were damaged. The doctor will at least take an x-ray. This eliminates burst fractures (where a piece of bone breaks off where the band attaches) and damage to the femoral and tibia condyles.

After the necessary therapeutic and diagnostic procedures, the extremity is immobilized. A plaster cast is applied for 2 months. Large swelling usually occurs in the first week. This leads to an increase in the volume of the limb. The limb is always swollen when the cast is applied. When the swelling goes down, the bandage is loosened. It should be changed after 5-7 days.

Then the recovery process begins. Painkillers, exercise therapy and physiotherapy are used. The patient is recommended static exercises for the thigh muscles. Intra-articular injections of hyaluronic acid and platelet-rich plasma can be used to accelerate regeneration processes and prevent dystrophic changes in the cartilage in the knee joint.

First aid

If pain or swelling is the cause of the injury, there are some simple measures that can help with recovery.

• Immobilization of the injured limb with a splint;
• taking medication for the pain;
• Apply a cold compress to prevent swelling;
• Keep the injured limb elevated.

Then see a specialist in secondary care who will take a comprehensive approach. Therapy is prescribed for each patient individually.

How is the therapy carried out?

As a rule, with such diseases, conservative methods (bandages, painkillers and anti-inflammatory drugs) are used, but how exactly the sprain is treated depends on the severity of the injury. Treatment can last from one to six months. If this is unsuccessful and the ligament is badly torn, an operation is indicated.

Surgical treatment includes arthroscopy to repair the ligaments. Rehabilitation is carried out through physiotherapy, massage therapy and a series of specific exercises.

If examination reveals comorbidities, treatment of the spine and joints may be necessary.

Treatment and rehabilitation after a knee ligament strain

Therapy begins as soon as the patient is in the inpatient department of Dr. Glazkova was included. Depending on the severity of the disease, doctors select the optimal treatment regimen. To date, dislocated ligaments of the knee joint have been rehabilitated using the following techniques:

• surgical intervention. This is used when the patient has suffered a complete ligament tear and the situation is made worse by instability of the knee joint. This is probably the only case where conservative treatment methods are ineffective.
• pain management. The patient is given intramuscular injections of antibiotics to eliminate pain.
• Rest and cold therapy. To minimize pressure on the injured limb, the traumatologist may recommend using a splint. Cold compresses are also widely used in traumatology.
• puncture. It is performed when blood enters the joint cavity in the event of a joint fracture. This is to avoid suppuration, which can cause septicemia.

Regenerative treatment of torn ligaments

In most cases, however, it is not necessary to open the joint with an arthroscope. The innovative cellular technology of the Doctor OST medical center makes it possible to treat patients with the consequences of injuries, including torn ligaments and tendons, without surgery and postoperative rehabilitation.

Cell technology stimulates natural regeneration processes and uses stromal cell and growth factor concentrates made from the patient's own biomaterial instead of drugs. Our patients have already been convinced of the potential of this innovative technique.

Advanced joint treatment with stromal cells. Allows stimulation and regeneration of damaged joint tissue without chemotherapy or surgery. Read more

For the first time and only at Doctor OST! The latest technology to treat acute pain caused by damage to the musculoskeletal system, joints and ligaments. Effective tomorrow! Read more

The newest way to treat joints now at Doctor OST! Completely without chemicals, synthetic foreign materials, surgery and prostheses. Read more

PRP therapy is the latest treatment for rebuilding damaged tissue with platelet-rich plasma. Read more

expert opinion

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COMMENTS SELJUNIN AV
SPECIALIST IN MOTOR REHABILITATION.

Patients are concerned about how long it will take for torn ligaments to heal after arthroscopy. In fact, the healing time to 90 % depends on the patient and the strict postoperative regime. If there were no complications, the healing time after arthroscopy is 1.5-2 months. Complete healing of the damaged ligament is achieved after 4-6 months. But even at this point, the healing of the joint has just begun, so to speak! The rehabilitation is still pending. Gradually, the joint has to be loaded and the patient has to learn to walk independently without a cane. Training with a physical therapist is very important at this stage. Medical center Doctor OST in Chelyabinsk is ready to offer individual exercises on kinesiotrainers with biofeedback. During rehabilitation, it is important to track and prevent attempts to compensate for weakened muscle groups with other muscle groups. Disrupted movement patterns slowly but effectively destroy the musculoskeletal system and initiate the development of new diseases: arthrosis, herniated discs and intervertebral fractures.

Complications of dislocations

If the symptoms are ignored or if the dislocated foot is treated alone, complications arise:

• The mobility of the joint is impaired because the ligaments have not grown together properly;
• Cartilage, bones and soft tissues of the joint become inflamed;
• The ankle becomes unstable and weak;
• There is a high probability of recurrence;
• pain in the joint;
• The brachial and posterior tibial nerves are damaged.

Even the slightest rotation of the foot prevents normal movement and is uncomfortable. The treatment lasts at least two weeks.

With timely first aid and proper treatment, the affected person recovers quickly. There is also no risk of complications. As a precaution, wear comfortable shoes and exercise only after warming up the muscles.

We also encourage you to watch a series of videos to deepen your knowledge and answer your further questions.

What are the warning signs of an injury?

The human foot is one of the areas where there is a lot of nerve tissue. Therefore, the symptoms of a sprained ligament are so immediate and obvious that the injured person may suspect an injury himself. Symptoms of a sprain:

• sharp, stabbing pain: lessens with inactivity, worsens when weight is put on injured area of foot;
• in the case of the big toe ligament: discomfort when trying to stand on tiptoe;
• 5-60 minutes after dislocation – swelling, throbbing, subcutaneous bruising.

As with any sprain, the degree of damage to the ankle ligament is important. It can be light, medium, heavy, or extra heavy. In the first two cases, consultation with a trauma surgeon is indicated, but special treatment is not required. In the other cases, the ligament problem must be treated as an inpatient.

How can a dislocation be diagnosed?

The diagnostic procedures for a foot injury can be summarized as follows:

• history of the circumstances under which the dislocation took place;
• Physical examination with palpation and probing;
• X-ray examination of the foot;
• Ultrasound examination of the ligaments.

All diagnostic manipulations of the connective tissue must not be accompanied by pain signals. Therefore, a local anesthetic is usually administered before the manipulation.

At the first signs of a sprain, this can also be done alone. Cooling gels, ointments, and NSAIDs can be used to relieve ligament pain. Applying cold to the foot also has an analgesic effect.

What should I do if I have a ligament injury?

If you see a trauma surgeon with severe pain from a sprain from a ligament injury, injection anesthesia is an option. But this happens only after an examination of the foot (the doctor needs to know at what movements the ligaments give way).

In addition to anesthesia, dislocations of the movable structures of the foot can also be treated:

• Kinesio taping is an application method that allows partial mobility of the foot;
• bed rest with simultaneous anti-inflammatory tactics;
• LOF (after the swelling has subsided);
• Physical therapy.

If necessary, the injured toe is treated with a splint. In this case it is easy to 'earn' a sprain (ligaments of the foot) and a strict 2-3 week program must be followed to achieve full healing.

• How are torn ligaments in the ankle treated?.
• Treatment of torn ligaments in the ankle.
• Ankle ligament strain, ICD.
• How do you treat a sprained ankle?.
• Sprained ligaments in the metatarsal area.
• How to distinguish a fracture from an ankle sprain.
• Injury to the ligaments of the ankle.
• Diagram of a joint with and without a dislocation.