A torn ligament is a typical sports injury. In the event of quick changes of direction or abrupt changes in speed, ligaments can tear partially or completely. However, even simply twisting the joint during day-to-day activities can result in a ligament tear.
There are three different ligament injuries that can occur.
Lateral ligament rupture is a tear in the outer ligament. The most common type of ligament tear is supination trauma, which occurs when the ankle is twisted over the outer edge of the foot.
Pronation trauma – a tear in the inner ligament – is less common. This injury occurs when the ankle is twisted over the inner edge of the foot.
If the injury is severe, a syndesmotic ligament tear may also occur. This is a tear in the supporting ligament between the tibia and fibula (the syndesmosis ligament).
Typical signs of a torn ligament include swelling, bruising and pain in the affected area. These symptoms of a torn ligament occur immediately after twisting the foot, and are accompanied by a sudden shooting pain. In addition to the above symptoms, the individual will also be unable to bear weight on the affected ankle due to the pain, and they may also experience some instability.
The mobility of the joint must be taken into account, as a strain can have similar symptoms. If the joint is unstable and the injured person feels unsafe to use the joint, a doctor should be consulted immediately.
Ligament tears can occur during rapid changes of direction, as well as in situations in which an external influence causes the joint to move beyond its normal range of motion.
Typical causes are slipping while walking or an external blow to the joint, such as when playing hockey or in the event of a fall.
In most cases, doctors are able to diagnose a ligament tear by examining the ankle. The mobility of the joint is tested. There are various methods, such as the drawer test. The drawer test checks whether the ankle bone can be pushed forward against the tibia. This drawer motion is only possible if the outer ligament is torn.
This examination can only be carried out within the first 48 hours after the injury occurred.
In addition to the examinations mentioned above, the patient also undergoes an X-ray or ultrasound examination. In complicated cases, magnetic resonance imaging (MRI) can be used to give the medics a comprehensive overview of the ligament structures.
A torn ligament in the ankle can be treated conservatively (without surgery) or surgically. Which treatment method is carried out depends on the severity and extent of the injury.
In the first few days, it is important to relieve pressure on the ankle by elevating it. It also needs to be cooled to reduce swelling and alleviate pain.
A special splint called an ‘orthosis’ allows the ankle to roll again when walking and prevents twisting from reoccurring. The splint is worn around the clock, usually for a period of six weeks.
In cases where multiple ligaments are torn and the ankle is very unstable, surgery is recommended. For patients who put a lot of strain on their ankle joints (e.g. competitive athletes), surgery is the most common option. During the operation, the torn ligament is sewn up or the ligaments are reconstructed.
After the procedure, the ankle is immobilised for up to six weeks. Normally, a torn ligament takes eight to twelve weeks to heal.
An individual treatment plan is drawn up for the recovery period, which includes immobilisation of the joint using a splint, as well as a tailored course of physiotherapy.
In order to protect yourself from a torn ligament, intensive training of the shin muscles is important. Before sport or exercise, it is advisable to properly warm up and stretch the calf muscles.
If a torn ligament is not properly treated, the ankle may remain unstable forever and the buckling may recur. In the worst case scenario, the imbalanced strain on the joint may lead to osteoarthritis.