What is a torn ligament?
To fulfil its seemingly simple function, the foot is built from a perfectly matched framework of bones and ligaments. The three outer ligaments of the ankle play an important role in stabilising it. They connect the tip of the outer ankle bone with the heel bone and the talus. If the foot turns over, for example during sport, one or more of these outer ligaments can be injured.
The types of injury differ: in an overstretch, the ligaments are only strained, which is nevertheless very painful. If one or more ligaments are partly but not completely torn, this is called a partial tear. Only a complete tear is a torn ligament. Not only athletes are at risk, but also people who wear high-heeled shoes.
How do you recognise a torn ligament?
The main symptoms of an injured outer ligament are severe pain on pressure and movement in the affected area, especially when stepping on and putting weight on the foot. With a torn ligament, a bruise usually forms at the outer ankle, and the swelling is clearly visible.
The person affected usually cannot tell for themselves whether it is a tear or an overstretch. The doctor does not rely on clinical impression alone either: the central diagnostic tool, besides questions about how the accident happened and examination of the foot, is the X-ray. It first rules out a bone injury. If it is still unclear after checking the joint stability whether there really is a tear, a “stress” X-ray is also taken. The foot is placed in a holder and the joint is gently opened. The degree to which the joint can be “opened” shows the condition of the ligaments, because the joint opens much further if the ligaments are injured.
Non-surgical treatment
Immediately after the injury, you should cool the ankle, keep it still and elevate it. This counteracts the formation of a bruise and therefore swelling of the ankle. Next, you should see a doctor to make the diagnosis and start treatment. Please take this medical assessment seriously, because an untreated overstretch of the outer ligament can lead to permanent instability of the joint and even osteoarthritis.
For an ordinary tear of the outer ligament, non-surgical treatment is the treatment of choice. The healing rate is about 97%. Besides an anti-inflammatory medicine, you will usually receive a functional ankle brace, which stabilises the ankle while still allowing you to walk. Only in exceptional cases with extremely severe pain and swelling is a plaster cast still applied. Once the swelling has gone down, the patient must start to put weight on the leg carefully. Modern braces make it possible both to stabilise and protect the joint and to move and put weight on it again. In most cases, these measures are enough for the ligaments to heal and the joint to stabilise. If there are problems with movement and coordination, physiotherapy exercises are also needed. If treatment is not successful, surgical suturing of the ligament is still possible after a few months.
Surgical treatment
There are 2 indications for surgical suturing of the ligament:
- Additional injury to bone and cartilage
- Non-surgical treatment has not been successful
Surgery is recommended as the first choice only in exceptional cases, because it does not necessarily lead to faster or more complete healing. As with any operation, complications can occur, although rarely. These include infections and injuries to nerves and blood vessels. In the worst case, the mobility of the joint can remain permanently restricted. Both non-surgical and surgical treatment carry a risk of deep vein thrombosis because the leg is immobilised. After surgery, the ankle is immobilised in a lower-leg plaster cast for several weeks. The subsequent physiotherapy plays a major role. The strengthened muscle should stabilise the joint during movement so that the ligaments are put under less strain. If the ankle is loaded too early or treated incorrectly, the risk of tearing it again is very high. Athletes should therefore only put full weight on it again after a rest period of several weeks.