Causes

The most common cause of a torn ligament is twisting. In the case of sports injuries, due to high shoes or on uneven ground, it often happens that we twist our foot. Mostly this happens inwards in supination (inversion).

This is a movement of the upper and lower ankle joint in which the sole of the foot is lifted inwards and the foot is tipped (flexion movement). The outer ligaments are strained and a torn ligament may occur. The front parts of the ligaments tear more often because they are stretched more due to the flexion in the ankle joint.

The inward twisting mechanism is promoted by the anatomical course of the Achilles tendon. Our supinators, i.e. the muscles that pull our foot inwards, predominate in strength. In particular, the large, superficial calf muscles that radiate into the Achilles tendon help with the supination movement and ensure that we tend to bend inwards. This is known as “supination trauma”. Torn ligaments can also occur as a result of direct violence, such as a blow or impact (e.g. in sports such as soccer) against the joint.

Rail

Due to the injury mechanisms and muscular imbalance (see cause), the external ligamentous apparatus is more frequently affected by torn ligaments than the internal ligamentous apparatus. Bounce marks or hematomas are often visible above the outer ankle. Bony injuries to the outer ankle can also occur. Surgery is usually indicated for accompanying bony injuries. Afterwards, the muscles that support the opposite direction, namely the pronation, should be trained in order to prevent further twisting due to muscular imbalances.

When is surgery indicated – when not?

Today, surgery is rarely necessary for ligament injuries. For professional groups, such as athletes or other people who are particularly dependent on the stability of their foot, surgery can be useful to ensure fast and accurate healing of the joint. Even after the operation, however, immobilization for about 6 weeks will be necessary.

A poor or unstable healing process, as it can sometimes occur with conservative treatment, is thus avoided. If a severe instability is still present in the joint after conservative treatment, this is also an indication for surgery for non-athletes after ligament injury in order to restore joint stability and prevent the risk of arthrosis. In surgery after ligament rupture, the ligaments can either be sutured tightly and stably again, or tendon plastic surgery may be necessary in cases of severe injuries.

For this purpose, a tendon from the body is used. Bony tears or concomitant injuries are always an indication for surgery and are fixed by screws or plates. After the operation, immobilization for about 4-6 weeks is indicated, followed by physiotherapeutic training.