High Ankle Sprain
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The deltoid ligament sits on the inside of the ankle joint, connecting the navicular, calcaneus, and talus bones. It is triangular in shape and consists of 4 ligaments that spread across the inside of the ankle joint. There is a superficial layer whose primary aim is to resist eversion, and the deep fibres act as a stabiliser of the talus bone. Deltoid Ligament Sprains, also known as medial ankle sprains, are much less common than lateral ankle ligament sprains but can be painful and tricky to manage.
This article will explore the common causes and symptoms of Deltoid Ligament Ankle Sprains and how to treat them effectively.
The deltoid ligament is a large fibrous ligament, and due to the articular shape of the medial ankle and the deltoid ligament, considerable force is required to injure it. Common mechanisms of injury are blunt trauma to the outside of the ankle that forces the ankle inwards and overstretching of the deltoid ligament. This may be the result of a tackle in a sport or from a fall.
Alternatively, foot deformity or poor biomechanics can overload the inner ankle and lead to repetitive strain on the deltoid ligament. This slow process occurs in conjunction with a weakening posterior tibialis muscle that progresses into adult flatfoot deformity.
Deltoid Ligament Ankle Sprains are a complex injury. The location of the pain is on the inner ankle, with patients often describing a burning sensation. There may be bruising and swelling when the superficial fibres are torn, while if the deep fibres are affected, there may be no visible signs of injury. It is often painful to walk or rotate the ankle outwards. If the deep fibres are compromised, it may be painful to turn the ankle inwards.
In chronic medial ankle sprains, stiffness in the ankle joint can limit the range of movement available making it difficult to do activities such as climbing the stairs and walking on uneven surfaces.
Establishing a clinical diagnosis through a consultation with a Sports Medicine Doctor or a Physical Therapist is possible. After a clinical interview and physical assessment, a Physical Therapist may carry out a Klieger test to confirm their diagnosis.
In some cases, a referral for imaging may be required. An MRI is the gold standard form of imaging for medial ankle sprains as they can detect bony and ligament injuries. An ultrasound is a cost-effective alternative, while a CT Scan or X-ray cannot diagnose soft tissue injuries.
In the first three days of an acute Deltoid Ligament Ankle Sprain, it is best to apply the P.O.L.I.C.E principle. This involves offloading the injury area as much as possible. After three days, you can begin Optimally Loading the ankle within a pain-free zone or at least with movements that don’t worsen symptoms. Apply ice as an analgesic to help reduce pain levels and compress the ankle with a compression sock or bandage to minimise swelling.
The Optimal Loading phase is when Physical Therapy is most beneficial. Treatment may include ankle taping to reduce pain and facilitate a regular gait pattern. You may require an ankle brace or walker boot in more severe cases to provide additional stability to the ankle joint.
Rehabilitation will progress to more challenging strengthening, dynamic proprioception, and plyometric exercises. An exercise protocol involving theraband exercises, bodyweight strengthening, and balance exercises are beneficial in the early stages of rehabilitation. A Physical therapist may provide soft tissue massage and mobilisations to help restore the range of movement to the ankle.
The final stages of rehabilitation involve a change of direction in exercises and a return to running or sports protocols. This stage is often completed without the need for taping or ankle support.
A steroid injection may be advised if pain levels are too high to tolerate any rehabilitation. The purpose of an ultrasound-guided injection to the medial ankle joint is to reduce inflammation levels. This is a more common treatment for tears of the deeper fibres.
Surgery is rarely recommended for Deltoid Ligament Ankle Sprain, even if it is a Grade 3 rupture. This is due to the articulation of the medial ankle joint providing natural levels of stability to the joint. In the cases of surgery, a cadaver ligament is often used. You may require time in a boot or cast after surgery before beginning ankle rehabilitation.
This is not medical advice. We recommend a consultation with a medical professional such as James McCormack. He offers Online Physiotherapy Appointments for £45.
Related Article: Walker Boot for Sprained Ankle
Deltoid Ligament Sprain Recovery Time?
Grade 1 Deltoid Ligament sprains can recover within 2 weeks. In most cases, it takes 4-6 weeks for a Deltoid Ligament Ankle Sprain to heal while severe sprains of the deltoid ligament can take 12 weeks to recover.
Can you still exercise with a Deltoid Ligament Sprain?
In mild cases, it is possible to return to linear non-impact activities such as static cycling and swim within the first few days of injury. If there is no pain while doing exercises, it is generally okay to continue with this when you have a Deltoid Ligament Ankle Sprain.
Can the deltoid ligament be repaired?
Yes, a deltoid ligament can be repaired. A repair is usually done with a cadaver ligament, but it is a complex surgery with a lengthy recovery phase afterwards.