Ankle Ligament Injuries

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Ankle Ligament Injuries
Ankle Ligament Injuries
Video: Ankle Ligament Injuries
Video: Ankle Pain, ankle ligaments sprain - Everything You Need To Know - Dr. Nabil Ebraheim 2023, February
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Ankle ligament injuries

Ankle ligament injuries are very common, especially when exercising. They are also often called a sprain. The injury occurs when a joint is moved beyond its normal range of motion and is overstretched. The injury can range from a slight overstretching or strain to a complete tear in a ligament and other injuries to the capsule-ligament apparatus. In most cases the upper ankle is affected and only very rarely the more stable and better protected lower ankle.

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The upper ankle bones are connected and stabilized by numerous ligaments. Three outer ligaments run on the outside of the joint (outer ankle). The inner ligaments on the inner ankle also consist of several strands. The tibia and fibula are held together by elastic ligaments, the anterior and posterior syndesmosis, and form the ankle joint.

Ligaments of the ankle © Bilderzwerg

What are the causes of an ankle ligament injury?

A common cause of a sprain (distortion) is an ankle twisting of the foot outwards over the outer ankle. This injury is also known as supination trauma. This can overstretch one or more of the ankle ligaments and tear.

Injuries to the inner ligaments (delta ligament) and syndesmosis are rare. The cause is a twisting of the foot over the inner ankle (pronation trauma).

What types of ligament injuries are there?

Ankle ligament injuries are classified according to the location and severity of the sprain and usually affect several ligaments, rarely just one ligament alone.

  • Grade 1 sprain: Slight overstretching of the ligaments, slight swelling and tenderness, no instability in the ankle.
  • Grade 2 sprain: Tear of the ligaments, moderate swelling and pain, slight instability and restricted mobility.
  • Grade 3 sprain: Complete rupture of the ligaments, severe pain, swelling, bruising. The ankle joint is unstable and cannot be loaded.

How to prevent ankle ligament injury

The risk of a supination trauma is increased in practically every sport with running or jumping elements, for example game sports such as basketball, handball, soccer or volleyball, but also in martial arts such as judo or fencing.

Wearing a special brace or taping the ankle may reduce the risk of an ankle sprain, especially in high-risk sports and if a sprain has occurred before. Special training to stabilize the ankle joint, possibly under the guidance of a physiotherapist, can reduce the risk of injury.

What are the symptoms?

Depending on the extent of the injury, the following symptoms can occur in the ankle area:

  • Pain,
  • Swelling,
  • Bruise,
  • possibly restricted mobility and
  • Pain when the foot is loaded.

First aid

First aid measures for a sprain include:

  • Cooling, for example by means of "Coolpack". Ice must not be placed directly on the skin! For example, wrap it in towels.
  • Immobilization of the ankle, for example with a bandage.
  • Elevate the foot, if possible above the level of the heart.
  • Ev. take over-the-counter pain reliever medication such as ibuprofen or paracetamol.
  • Immobilization or protection of the ankle for several days until the pain subsides.

A mild sprain usually heals in seven to ten days. The pain can persist for a long time until it has completely subsided. If you have a severe sprain, seek medical help immediately! For more information, see Emergency: Injuries and Sports Injuries.

How is the diagnosis made?

First of all, the doctor collects the medical history (anamnesis), asks how the accident happened and carries out various examinations and tests. For example, the mobility of the ankle is checked. Based on the clinical examination, the doctor will assess the degree of the sprain and the need for imaging tests.

X-ray examinations will clarify any suspicion of an ankle fracture. If the symptoms persist and to clarify certain ligament injuries, e.g. injury to the syndesmosis, the doctor can prescribe magnetic resonance imaging (MRI).

How is an ankle ligament injury treated?

The treatment depends, among other things, on the type, location and severity of the sprain as well as other accompanying injuries, e.g. fracture, capsule ligament injury, etc.

Treatment without surgery

A torn ankle ligament is usually treated conservatively (without surgery).

The acute treatment is based on the PECH rule (break, ice, compression, elevation). The aim is to relieve the pain and swelling.

The doctor prescribes medication, usually so-called NSAIDs, to treat pain.

Temporary immobilization (immobilization) depends on the degree of the sprain.

  • In the case of a grade 1 sprain, the ankle is usually immobilized for a few days with an elastic sling or a bandage (e.g. zinc glue bandage).
  • In the case of a grade 2 sprain, the ankle is usually also stabilized and immobilized for a few weeks with a rigid splint, e.g. an aircast.
  • In the case of a degree 3 sprain, treatment can be carried out through prolonged immobilization, for example using a plaster of paris or splint alone or by immobilization in conjunction with slight mobilization.

To support the restoration of mobility, the doctor can usually prescribe exercise therapy (functional therapy) after the immobilization.

Treatment with surgery

An operation may be necessary in the case of a severe ligament injury, e.g. a tear in several ligaments or syndesmosis. The ligament is fixed, for example using special screws, or reconstructed using plastic cords or your own tissue, thereby stabilizing the joint as a whole.

Whom can I ask?

If you suspect an ankle ligament injury, you can contact the following for diagnosis and treatment:

  • Emergency doctor or rescue (144) for acute complaints
  • Accident outpatient clinic in a hospital
  • General practitioner
  • Specialist in orthopedics and traumatology
  • Specialist in orthopedics and orthopedic surgery
  • Specialist in trauma surgery
  • Specialist in physical medicine and general rehabilitation

An inpatient stay in the hospital is necessary for surgical treatment.

The movement therapy can be performed by a doctor established by physiotherapists / physical therapists or occupational therapists / occupational therapists.

How are the costs going to be covered?

The e-card is your personal key to the benefits of the statutory health insurance. All necessary and appropriate diagnostic and therapeutic measures are taken over by your responsible social insurance agency. A deductible or contribution to costs may apply for certain services. You can obtain detailed information from your social security agency. Further information can also be found at:

  • Right to treatment
  • Visit to the doctor: costs and deductibles
  • What does the hospital stay cost?
  • Prescription fee: This is how drug costs are covered
  • Medical aids & aids
  • Health Professions AZ

and via the online guide to reimbursement of social insurance costs.

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