Diagnostics
The beginning of the diagnosis of a ligament rupture is the anamnesis interview. During this discussion, the physician wants to know the course of the accident in order to be able to exclude the first structural lesions. This is followed by the clinical examination in which the stability test is the main focus.
After that, whether the ligament injury is stable or unstable, the resilience is tested. Here it is relevant to know whether passive or active mobility is possible. If a haematoma has formed, this site can be punctured in order to be able to determine from the blood whether the ligament injury is old or fresh.
The finding that the ligament is freshly torn may have a positive effect on the prognosis. On the one hand, the treatment spectrum is wider and on the other hand the chances of recovery are better. The further procedure includes an X-ray.
Here the held image is preferred. Since a normal x-ray only shows a rupture of the ligament at the point of attachment of the bone, the “held image” also helps to detect torn ligaments at other locations. For this purpose, the joint whose ligament structure has torn must be brought into an extreme position so that malpositions due to the torn ligament can be detected. In principle, the MRI of the foot (= magnetic resonance imaging) is the more advantageous diagnostic tool, since it shows tissue and organs and a torn ligament can be detected better. Experienced doctors can also make the diagnosis “torn ligament” using sonography.
Therapy
In the case of a ligament injury to the foot, some first aid measures must first be taken immediately after the accident or injury. The foot should be cooled, carefully bandaged and stored up. In this way, further swelling can be reduced and unpleasant pain caused by the high pressure of the swollen tissue can be avoided.
The so-called PECH scheme is easy to remember: Pause (immediate relief), ice (cooling), compression (light pressure bandage), elevation. It is essential to relieve the foot immediately and not, for example, to continue the football match that has begun. In addition, a doctor should generally be consulted relatively quickly to avoid consequential damage.
The doctor usually diagnoses a torn ligament in the foot by means of an examination, during which increased mobility in the joint can be determined, since ligament stabilisation is limited. Often an X-ray is taken, on which a torn ligament is not visible, but can be excluded due to the injuries to the bone. As a rule, a torn ligament is treated conservatively and no surgery is performed.
Special walking splints, so-called orthoses, allow safe movement in the foot without endangering the injured area. This gentle treatment allows the foot to roll normally without bending over again. This prevents muscle degeneration and usually such a splint is worn day and night for about six weeks.
Physiotherapeutic therapies can have a supportive effect, and simple sports activities should also be carried out to further build up the muscles. However, these should be discussed with the treating physician to avoid overloading the damaged foot. Particularly in the case of injuries to several ligaments of the foot or in the case of competitive athletes, where the foot and the ankle joints are subject to heavy strain, surgery is often recommended.
In the case of a complicated course of a torn ligament on the foot, accompanying injuries or for planning an operation, a magnetic resonance tomography (MRT) is usually carried out. With this examination, the ligaments can be displayed very precisely. Surgery for a torn ligament in the foot involves the same risks as any other operation, such as infections or wound healing disorders, about which the patient must be informed in advance.
If the joint is very unstable or if bone or cartilage at the ankle joint is injured, surgical treatment may be advisable. Surgery is particularly recommended in cases of high stress, such as in professional sportsmen and women. Very seldom the torn ligament does not heal properly with conservative treatment and an operation may become necessary as a result.
The operation consists of suturing the torn ligament and possibly fixing injured bone or cartilage parts. If the ligament is severely damaged, an autologous tendon can be transplanted to the site and the torn ligament reconstructed. After the operation, the foot is immobilised for about six weeks, similar to conservative treatment. Overall, the long-term results for torn ligaments in the foot after conservative treatment are comparable to those after surgery.
