Treatment of torn ligaments in the ankle

Conservative treatment is recommended for minor sprains and bruises. This is a bundle of measures: medications (pain-relieving, anti-inflammatory, cartilage-protecting agents, ointments, vitamins), physiotherapy (electrophoresis, laser therapy, magnetic therapy, wave therapy and other methods recommended by the doctor), massage therapy, bandages to limit the mobility of the injured hand etc.

Causes of strains

Mechanical stress on the ankle joint can cause a ligament tear. The pressure exerted on the fibers exceeds their strength and elasticity. Football players, track and field athletes, ice skaters and skiers are particularly at risk. During training, the foot abruptly turns inward while the rest of the lower limbs continue to run straight.

In 60 percent of cases, foot subluxation is a domestic injury. Ligament injuries can occur when walking, descending or climbing stairs. A careless movement causes the foot to bend inwards. The ligaments can no longer absorb the pressure caused by the weight of the entire body.

Most ankle injuries occur in athletes

People with the highest risk of ankle ligament rupture include:

• metabolic disorders
• overweight;
• older age;
• congenital or acquired foot deformities (flat feet, club feet, heel feet, etc.).
• previous trauma to the ankle joint;
• uncomfortable footwear or the habit of constantly wearing high-heeled shoes.

symptoms of an injury

The immobilization of the ankle joint is ensured by three groups of ligaments. If the fibers are partially torn, the supporting function of the ankle joint is retained. The main clinical signs of a rupture are:

If a ligament is torn, external symptoms can occur in the form of bruises and hematomas.

The 'drawer mark' is used to identify damage to a group of tapes. The traumatologist fixes the lower third of the tibia and checks the displacement of the foot. The side where more mobility is noted indicates a damaged ligament group.

ICD-10

Torn ligaments are the most common injury to the musculoskeletal system. It can be caused by a sporting, occupational or domestic injury. It can affect people of all ages, but most commonly young, physically active patients. In the vast majority of cases, incomplete ligament tears (tears and sprains) can be treated conservatively. Complete ligament tears, especially those with torn ligament ends, usually require surgery.

causes

A torn ligament can be caused by a fall, jump, impact, or non-physiological flexion of the limb during sporting activities. Track and field athletes, hockey players, soccer players, basketball players, gymnasts and skiers are particularly susceptible to such injuries. Ligament tears from sports and household injuries are usually isolated. Occasionally, ligament tears occur in motor vehicle accidents and may be associated with pelvic and limb fractures, thoracic trauma, blunt abdominal trauma, CMT, and other injuries.

Ligaments are dense connections made of connective tissue that connect individual bones and organs to one another. They usually look like ribbons, less often like flat plates. Depending on where they are placed, they can enhance, guide or restrict movement in a joint. They have a limiting function and ensure that the joint surfaces come together. Depending on their main function, they can have an inhibiting, leading or supporting effect.

The ligaments of the large joints of the lower limbs (ankles and knees) are particularly stressed and are therefore more susceptible to tears despite their high strength. But ligament injuries can also occur in other joints: hip, shoulder, wrist, etc. This can be a complete tear (all fibers are torn) or an incomplete tear (part of the fibers are torn), a tear of the ligament tissue at different levels or a tear in the ligament where it attaches to the bone. In the latter case, a small piece of bone is often torn off along with the ligament.

Predisposing factors that increase the likelihood of ligament rupture include scarring from previous trauma, repeated microfractures from overuse, and osteoarthritis, in which pathological changes occur in all components of the joint, including the ligaments. All ligament tears can be classified as traumatic (caused by an injury) or degenerative (caused by wear and tear or previous damage and scarring).

Ligament injuries: classification, diagnosis and treatment

In accident medicine, three levels of injury are distinguished, which depend on the location of the injury:

• Grade I (sprain) – Part of the ligament fiber is torn, but the continuity and mechanical integrity of the ligament is maintained. This injury is commonly referred to as a sprain, although the ligaments are actually inflexible and cannot stretch. It is accompanied by moderate pain. There is no bleeding and only minimal swelling. There is a slight limitation of the musculoskeletal system.
• Grade 2 (rupture) – Tearing of most of the fibers of the ligament. Swelling and bruising. Movement is painful and restricted. Mild instability of the joint may occur.
• Grade 3 (torn ligament). Severe pain, severe bruising, significant swelling and instability of the joint.

The diagnosis of a ligament tear is made based on the mechanism of injury and examination results. In general, the more pronounced the clinical signs, the more fibers of the ligament are torn. However, swelling and bleeding increase over time, so a recent tear may be less serious than one that lasts 2-3 days. An ultrasound or MRI scan of the joint is indicated to assess the extent of the ligament injury.

Ligament injuries are differentiated from fractures and sprains. In the event of a dislocation, the bones are significantly displaced relative to one another, the joint is severely deformed, the normal anatomical relationships are disturbed, movements are not possible and a spring-like resistance is observed when attempting passive movement. With a ligament injury, the appearance of the joint is only changed by swelling, the anatomy is intact, movement is possible but limited due to pain, and there is no spring resistance.

When a fracture occurs, deformation, crepitation, and abnormal mobility are usually observed. However, these are not necessarily signs of a disorder of bone integrity and may be absent in some cases (e.g., a lateral malleolus fracture without dislocation). The other symptoms of a fracture (swelling, limitation of movement, pain and reduced support) are similar to the clinical signs of a ligament injury, so radiological examination is required to make a definitive diagnosis. If necessary, an MRI or ultrasound scan is also indicated.

Ankle ligament injury

This is the most common ligament injury. It usually occurs when the foot is turned inwards. The ligaments between the fibula and talus or between the fibula and heel are often damaged. In Grade 1 injuries (sprains), the patient complains of mild to moderate pain when walking, the joint is mildly to moderately swollen, and walking function is not impaired. A grade 2 ligament injury (tear) is accompanied by severe swelling extending to the outer and anterior surfaces of the foot; there is significant limitation of movement and walking is difficult but usually possible. Grade 3 (complete rupture) causes severe pain, swelling and bleeding that spreads to the entire foot, including the sole, and walking is often impossible.

MRI scan of the ankle shows a partial or complete tear of the ligament. X-rays of the ankle joint are completely free of lesions in the first and second degrees of ligament injury, while in the third degree a small bone fragment can sometimes be seen that has separated from the bone at the attachment site of the ligament.

Treatment for sprains includes cold and tight bandages for the first 24 hours. Physiotherapy is recommended from the 2nd to 3rd day: UHF, an alternating magnetic field, followed by paraffin or ozokerite. Recovery usually occurs after 2-3 weeks. If ligaments are torn, a cast is required for 10 days or longer. In other cases, treatment is the same as for sprains, with a recovery time of several weeks. If there is a complete tear, a bandage is first applied to the joint, and after the swelling subsides, the cast is relocated and left in place for at least 2 weeks. The cast is then modified so that it can be removed for physical therapy and massage treatments. The cast is left in place for up to a month, after which a special ankle brace or elastic bandage is recommended for two months to prevent re-injury to the ligament. Surgical treatment is usually not necessary.

preventive measures

To prevent sprains, you should follow the following advice from traumatologists

• Choose comfortable, casual shoes;
• Use special sports shoes and accessories to protect the ligaments during increased loads;
• regular exercise or gymnastics to keep ligaments and muscles under tension;
• avoid excessive physical exertion;
• Walk slowly and carefully on slippery paths.

Therapeutic exercises: basic principles of movement

Physiotherapy should only be started after approval from the trauma surgeon. In some cases, simple exercises can be performed as early as 3 days after the injury, but active exercises do not begin until about a month after the injury. The exercises are selected by the instructor depending on the type and extent of the injury. The aim is to improve blood circulation and strengthen muscles and ligaments. If pain occurs during training, the exercises should be stopped and postponed until the next day. Exercise should not be completely excluded during rehabilitation. Muscles and ligaments are replaced by connective tissue, limiting their mobility.

Stretching is the most important part of physical therapy. It is necessary to avoid contraction of the injured muscles and ligaments. The exercise usually lasts 15 seconds and should be repeated 2-3 times per day. For chronic injuries, you should increase the duration of the stretch to 30 seconds and the number of repetitions to 3 to 5 times per day. If you do it right, you won't feel any pain the next day. However, if discomfort occurs, it means that the muscles are overstretched and the intensity of the stretch should be reduced.

Symptoms of sprains

The first symptom that indicates an injury is severe pain. This occurs immediately after a micro-tear of the ligament. When the injury occurs, a characteristic sound is heard, described by some as a cracking sound. After some time, the patient feels the following symptoms:

The pain associated with the sprain constantly bothers the affected person. It can get worse when you try to move the joint. The intensity of the pain depends on the size of the injury. With a mild sprain, the affected person can stand on the leg and even move slowly. If the tissue is completely torn, attempting to stand or put weight on the injured limb causes excruciating pain. A severe dislocation is also accompanied by:

• a local swelling of the limb;
• local fever;
• Bruise..;
• crepitations (crunching when moving).

Dislocations are often accompanied by damage to other structures. So this injury sometimes occurs in combination with intra-articular fractures and dislocations. In rarer cases, injuries to the spinal cord, limbs, pelvis, and thoracic spine involve dislocations.

causes

The injury is always caused by loads that exceed the elasticity and strength of the joint. When a sprain occurs, some of the fibers in the ligament tear and the ligament loses its function. Athletes are the most common victims of such injuries. An ankle ligament sprain is often caused by abruptly straightening the foot during sudden braking. This injury is therefore very common:

A violent swing of the arm can cause the ligaments in the shoulder joint to sprain. People who play basketball, shot put, volleyball and tennis are at risk for this injury. Such injuries can also be caused by shoulder strain. Bodybuilders and powerlifters are particularly at risk for this reason.

Experts point out that the true causes of sprains may be hidden. For example, pathological changes in the patient's body can cause such an injury. Injuries occur against the background of arthrosis, osteochondrosis, endocrine disorders, as well as some infectious diseases.

Sprains can be caused by falls or impacts. In women, for example, the problem occurs when the foot is turned upwards when walking in high-heeled shoes. Excess weight and uneven strain on the limbs are also triggers.

Which doctor can help?

The help of a specialist should not be underestimated. If the ligaments do not heal properly, the affected person can experience serious problems. The patient then suffers, for example, from chronic pain and constant inflammation of the joint. The deterioration of blood circulation in the injured area leads to tissue dystrophy. It is therefore important that severe sprains are treated by a qualified person:

types of injuries.

Hand ligament injuries occur in both adults and children. They can have different causes. These include domestic injuries (falling on an unprotected hand, which can result in joint dislocations and subluxations), sports injuries caused by improper movement or overexertion of the hand. Ligament injuries often occur in children when adults misjudge their strength and forcefully lift or pull a child while holding their hand.

The most common hand ligament injuries are:

• Wrist ligament sprains are injuries to nerve fibers and vessels on a microscopic level
• Hand ligament tears are partial or total damage to the integrity of the fibers. Rarely, the ligaments detach completely from the bone or a piece of the bone detaches (a ligament tear is complicated by a bone fracture).
• Inflammatory processes that occur in the hands. These include periarthritis (inflammation of ligaments and tendons), carpal tunnel syndrome, arthritis, etc.

Symptoms and location of pain

When the wrist ligaments are sprained, the following symptoms occur:

• Pain of varying intensity
• Swelling and stiffness of the hand
• limitation of hand mobility
• Increased pain when moving the wrist
• Ruptured blood vessels can lead to a hematoma on the injured hand
• With a tear, the pain syndrome intensifies, a cracking sound is heard, and the joint moves with an unusually high amplitude.

Symptoms of hand ligament injuries can vary depending on the location of the source of the pain. For example, it can be a ligament tear in the wrist, damage to the finger ligament or a separate ligament tear in the thumb.

Causes of torn ligaments in the foot and ankle

This injury usually occurs in winter when the foot twists on icy steps or flat surfaces. Injuries can also occur when jumping from a height or making other movements.

Factors that increase the risk of injury include:

• overweight. Excess weight increases the constant strain on joints and ligaments.
• Metabolic disorders. Such diseases cause ligaments and joints to lose their mobility.
• Age-related changes. These inevitably occur in the musculoskeletal system due to tissue wear.
• previous trauma.
• Congenital deformities.
• Wearing uncomfortable footwear (including high-heeled shoes).

Diagnosis of torn ligaments in the foot and ankle in the clinic

An experienced traumatologist can make the diagnosis after reviewing the patient's complaints, medical history and objective examination. When the front ligaments are torn, the foot is free to move forward. If the lateral ligaments are torn, the lateral mobility of the foot is increased. The examination is carried out by a trauma surgeon in comparison to a healthy joint.

Our doctors have all the necessary skills and knowledge to make a quick diagnosis. If necessary, they will order instrumental examinations.

Sprained or torn ligaments: how to recognize them?

Joint ligaments are a combination of individual connective tissue fibers. They serve to connect the bony elements of a joint, strengthen it and limit the range of motion in the joint.

The most common types of ligament injuries are tears and sprains. How do ligaments tear or stretch? How to tell if a ligament is torn or stretched after a joint injury?

A ligament strain is a pathological condition characterized by the tearing of individual fibers of the ligament, but in which the anatomical continuity of the organ is preserved. The causes of this condition can be different. It occurs with sudden and violent movements that are not specific to the joint.

Ligament rupture is a traumatic condition resulting from a complete rupture of the ligament due to transverse severing of the connective tissue fibers. The causes of a ligament tear are the same as a sprain, but the force exerted on the joint is much greater.

The difference between a torn ligament and a sprain is not obvious at first glance. There is no clear difference between these pathological conditions. In both cases the integrity of the fibers is compromised. However, there is one exception: a sprain is a partial injury and a rupture is a complete injury.

What does the clinical picture look like?

Specialists distinguish three main degrees of severity of articular ligament damage, the variations of which determine the features of the clinical picture of the pathological condition:

• Grade I, or minor injury, is the appearance of minimal tears in individual fibers and the development of a small area of tissue damage. This condition is characterized by moderate pain and the ability to move the joint. Mild types of ligament tears do not cause a hematoma.
• Grade II (moderately severe) or so-called incomplete ligament rupture. In practice, the injury is manifested by a severe pain syndrome in the injured joint, pronounced swelling of the soft tissues and a sudden restriction of movement.
• Grade III, that is, a severe rupture, is a complete separation of the fibrous elements, which is characterized by acute, severe pain, severe swelling of the injured joint, bleeding with the formation of a hematoma and limited motor function. The joint has a specific clicking sound and pain, as well as abnormal mobility or instability when moving.

The symptoms of these injuries can vary from patient to patient and depend on the condition of the patient's body. With severe sprains or complete tears, some people's mobility is severely limited, while others can move despite pain. This depends on the individual pain threshold, fitness and level of fitness.

ligament strains

ligament strains Sprains occur when a person makes sudden movements with a force that exceeds the joint's allowable force range. When a ligament is strained, the joint capsule that strengthens the joint is partially damaged or torn.

The most commonly strained muscles are the ligaments of the ankle (especially when turning the foot) and the wrist. Damage to the ligaments of the knee joint is less common. In high-heeled shoes, the foot often twists inward and stretches the Achilles tendon.

degree of sprain

The following degrees of ligament injuries are distinguished:

• grade 1The band is mechanically intact, although individual fibers are torn. Slight swelling without bleeding is characteristic. The patient may experience moderate pain with limitations in movement and support;
• grade 2The joint capsule is partially damaged, with multiple fiber tears, frequent blood loss, and moderate swelling. The hold is difficult and the movement is quite painful and restricted. There is some instability of the joint.
• grade 3Complete tear of the ligament with severe pain, swelling and bruising. The instability of the joint is noticeable during movements.

In the case of grade 1 and 2 ligament tears, conservative treatment is usually sufficient.

Complete ligament tears are treated surgically.

torn ligaments

Torn ligaments – A common injury among people whose work involves long physical exertion. A torn ligament is usually a side effect of a sprain or fracture, but can also be an independent injury.

Depending on the cause of the injury, a distinction is made between traumatic and degenerative ligament tears. While the first type can be caused by trauma, the second type occurs with the aging process of the body.

The symptoms of a torn ligament are:

• Pain and limitation of the joint (inability to stretch and lift the injured arm or leg);
• swelling, hematoma;
• change in the outer contour of the injured joint (joint instability);
• Numbness and tingling in the injured limb.

A special case of torn ligaments is a meniscus rupture.

Diagnostic methods for ligament tears and injuries

Since the ligament tear is similar to other periarticular and intraarticular injuries, an x-ray is taken to make the diagnosis. An x-ray can be used to rule out a bone injury. A CT, MRI, or ultrasound scan may be performed to assess the extent of the injury.

Standard treatment algorithm for ligament injuries

• Maximum immobilization of the injured limb;
• administration of analgesics;
• applying a cold compress to the injured area;
• a tight bandage or plaster cast.

To achieve rapid tissue healing, this regimen should be followed for several days. Once the swelling has subsided, strengthening exercises are recommended to restore mobility to the joint.

If the joint is completely torn or conservative treatment is unsuccessful, surgery is performed. Physiotherapy, UHF therapy, heat packs and massages can help the cartilaginous structures and function of the injured ligament recover quickly.

Treatment and rehabilitation for mild sprains can take five to 10 days, or up to six months in more complicated cases.

Tips for prevention and treatment

Sprains and torn ligaments are easy to treat and generally do not cause complications. Unpleasant consequences can occur only after a complete rupture. These include functional limitations of the affected arm or leg, loss of sensation in the limb and the development of a tendency to sprain. It is therefore advisable to see a doctor as soon as possible in the event of an injury.

Recommendations for preventing ligament tears:

• When practicing sports, it is important to wear comfortable shoes and equipment;
• Extreme caution should be exercised during intensive physical activity;
• The development of pathological processes in the tissues that develop as a result of untreated injuries should be excluded.

The doctors at the Mother and Child Clinic are ready to help with ligament injuries. Our main priorities are the accuracy of the diagnosis and the use of effective therapeutic methods.

• Injury to the ligaments of the ankle.
• ligaments in the ankle.
• Treatment of torn ligaments in the ankle.
• Ankle ligament strain, ICD.
• Ligament damage in the right ankle.
• Partial tear of the ligaments of the ankle.
• Rupture of the ligaments of the ankle.
• Damaged ligaments of the ankle.