Brief overview
- Symptoms: pain, swelling, bruising, limited mobility and difficulty walking
- Treatment: Immobilization (splints, bandages), cooling, compression (pressure bandage), elevation, pain-relieving medication, physiotherapy, surgery
- Prognosis: With early treatment, the chances of recovery are good. Late effects such as pain on exertion often occur despite treatment.
- Examinations and diagnosis: Palpation of the joint, joint function tests, X-ray examination, magnetic resonance imaging (MRI).
- Causes and risk factors: Sports and traffic accidents, one-sided and overloading of the ankle; previous injuries to the foot, certain sports increase the risk of twisting an ankle.
- Prevention: Stable and suitable footwear, muscle and balance training, warming up before sports, supportive bandages or tapes
What is a torn ligament in the foot?
Torn ligaments in the foot happen quite often, especially during sports. If too much force is applied to the ankle, one or more ligaments partially or completely tear. Most often affected are ligaments at the ankle joint, which are very important for the function of the ankle.
The ankle joints and their ligaments
A distinction is made between the lower ankle joint (USG) and the upper ankle joint (OSG).
In addition to the ankle bone, the other tarsal bones as well as the calcaneus are involved in the structure of the lower ankle joint.
Various ligaments stabilize both joints and limit their movements. In this way, dislocations can be avoided.
The ligaments are the three-part external ligament (ligamentum collaterale laterale), the four-part internal ligament (ligamentum deltoideum or deltoid ligament) and the syndesmosis ligament. When a ligament is torn in the foot, one or more of these ligaments are injured.
External ligament tear
An external ligament tear involves an injury to one or more of the three lateral ligaments that secure the ankle joint on the outside. This often happens in sports accidents or when wearing shoes with very high heels.
Pain on the outer ankle indicates a tear of the outer ligament. You can read more about this in the article External ligament tear.
Inner ligament tear
If the pain is more localized to the medial malleolus, you may have a tear of the medial ligament (deltoid ligament). It consists of four different parts that run from the tibia to the tarsal bones.
Much more common is a rupture of the medial collateral ligament at the knee joint, which involves the medial collateral ligament.
You can learn more about rupture of the lateral medial ligament of the knee in the article Inner Ligament Rupture.
Syndesmosis ligament tear
In addition to the ankle bone, the other tarsal bones as well as the calcaneus are involved in the structure of the lower ankle joint.
Various ligaments stabilize both joints and limit their movements. In this way, dislocations can be avoided.
The ligaments are the three-part external ligament (ligamentum collaterale laterale), the four-part internal ligament (ligamentum deltoideum or deltoid ligament) and the syndesmosis ligament. When a ligament is torn in the foot, one or more of these ligaments are injured.
External ligament tear
An external ligament tear involves an injury to one or more of the three lateral ligaments that secure the ankle joint on the outside. This often happens in sports accidents or when wearing shoes with very high heels.
Pain on the outer ankle indicates a tear of the outer ligament. You can read more about this in the article External ligament tear.
Inner ligament tear
If the pain is more localized to the medial malleolus, you may have a tear of the medial ligament (deltoid ligament). It consists of four different parts that run from the tibia to the tarsal bones.
- Much more common is a rupture of the medial collateral ligament at the knee joint, which involves the medial collateral ligament.
- You can learn more about rupture of the lateral medial ligament of the knee in the article Inner Ligament Rupture.
- Syndesmosis ligament tear
- Elevate: Position the injured foot above heart level.
If necessary, painkillers from the group of non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, will help to relieve the pain.
These measures should be continued for about three days to stop possible inflammation and swelling. To rest the injured foot, crutches often help until normal walking is possible again.
Doctors usually recommend complete immobilization of the foot only in the case of a third-degree torn ligament in the foot. From a second-degree injury, however, a splint (orthosis) or an elastic bandage (bandage) is useful for stabilization.
Physiotherapy / physiotherapy
Experts recommend starting physical therapy within the first week. When the acute pain has subsided, simple exercises without weight bearing can be performed. Then slowly increase the load.
Wearing an orthosis prevents extreme movements during training and provides additional support. Exercise your balance as well as your muscles.
Surgical treatment
Only in rare cases is surgery performed on a torn ligament in the foot. Surgery is often necessary for people with more severe injuries or for professional athletes with special needs.
How long does it take to heal a torn ligament in the foot?
How long the healing process takes for a torn ligament in the foot or a possible inability to work depends greatly on the severity of the injury. Also, when and if treatment is given is critical. In most cases, it takes up to six weeks or more for complete healing.
The initial severe pain of a torn ligament usually decreases significantly over the course of two weeks. However, about one third of those affected still report pain after a year. Doctors refer to this as stress pain, as it usually occurs in connection with certain movements.
A possible consequence of a torn ligament in the foot – especially syndesmosis ligament tears – is (partial) ossification of the affected ligament (heterotopic ossification). This sometimes leads to permanent movement restrictions.
Doctors therefore advise that after a torn ligament in the foot, sports should only be resumed once the pressure pain has subsided and mobility has been restored. This means that all typical sports movements should be possible again and the joint should be stable.
How is a torn ligament in the foot diagnosed?
- How did the accident happen?
- Were you able to walk after the injury?
- Do you have pain? Always or only in certain situations?
- Where exactly does it hurt?
- Have you already experienced similar injuries?
- Do you suffer from chronic diseases like diabetes mellitus?
This is followed by a physical examination. The doctor examines the injured foot and looks for, among other things, relieving posture, swelling, bruising and other findings in the injured area.
He then checks the blood flow, movement and sensitivity of the affected area (blood flow, motor function and sensitivity, DMS). He palpates the foot and lower leg, trying to identify pain points.
The leg is moved to check what movements are possible for the affected person and to find out how much function is limited compared to the other leg. A comparison is made between the movement of the leg by the doctor (passive) and the movement by the patient’s own muscle strength (active).
If bending the foot outward or inward triggers pain, this is indicative of a torn ligament in the ankle region.
If possible, the physician observes the gait of the affected person. The type of gait provides important information about malpositions and movement patterns and thus provides further evidence of a possible torn ligament in the foot.
Imaging
If the joint is not swollen, there is no bruising, and the examinations do not cause pain, imaging is not usually necessary. Only very rarely is a so-called stress X-ray still performed for a torn ligament in the foot. In this case, the doctor x-rays the foot in the stress position.
Magnetic resonance imaging (MRI) is useful if a torn ligament in the foot causes pain for a long time (six weeks or more) despite treatment.
Torn ligaments in the foot: classification
Based on the results of the examination, the doctor distinguishes between different degrees of severity of a torn ligament.
- Grade I: Mild ligament strain with only microscopically visible tears. Slight swelling, minor pain. The joint is stable and walking is possible with little pain.
- Grade II: At least one ligament is significantly torn. Symptoms are more severe than in grade I. Range of motion is limited.
- Grade III: A complete ligament tear of the foot with involvement of multiple ligaments. Severe symptoms; walking is usually impossible. The function of the foot is significantly impaired.
How does a torn ligament in the foot occur?
A tear of the medial ligament is most often caused by trauma when twisting the ankle. The ankle joint twists especially during sports and when walking or running on bumpy or slippery surfaces.
A tear of the syndesmosis ligament usually occurs as part of a sports accident during contact or collision with other players. This typically results in increased external rotation of the foot, which is bent upwards (dorsoflexed). Dorsoflexion is the term used to describe the upward movement of the foot.
The most important risk factor for a syndesmosis ligament tear is playing aggressive competitive sports such as American soccer, lacrosse and soccer. Men are three times more likely than women to be affected by a syndesmosis ligament tear.
How can a torn ligament in the foot be prevented?
Anyone who has ever torn a ligament in the foot has nearly a fivefold increased risk of re-injury to the same area. Regular training and stretching of the muscles (also in the legs) has a preventive effect.
Balance training on a wobble board is also helpful: it trains the coordination of the leg muscles. Orthotics, bandages or tapes on the ankle may also help to prevent a renewed tearing of the ligaments in the foot.
