With regard to the swelling, the following should be noted
Swelling is one of the main symptoms of torn ligaments in the ankle joint, along with bruising and ankle pain when walking. The main reason for this is the bleeding that results from the torn ligament. In addition, the swelling after a torn ligament also develops due to the fact that water is stored in the tissue as a result of the injury to the ankle joint.
The swelling is particularly pronounced in the evening, when the affected foot is laid down all day. This is because the hydrostatic pressure exerted by gravity acts on the vessels and tissue and the water is displaced into the interstitial space. The swelling is uncomfortable on the one hand because it makes it difficult to wear shoes or a splint and possibly leaves pressure marks after wearing them.
On the other hand, the swelling is unpleasant because it causes pain and a feeling of tension. The swelling can be improved by elevating the leg and cooling the area affected by the torn ligament. Immobilising the ankle joint can also have a positive effect on the reduction of swelling, as the healing process can progress unhindered.
The duration of the swelling can vary and is directly influenced by the treatment. It is possible that the swelling will last for several weeks. If appropriate measures are taken, it can disappear earlier.
At the anatomical course of the respective ligaments, bruising (haematoma) and pressure pain (pressure dolence) occur. Often patients also report that they heard a cracking or cracking sound at the moment of the injury. The injury also results in joint instability or stiffness. A fracture can be ruled out by an X-ray examination. For the exact classification of the torn ligament and to determine how many ligaments are damaged, an MRI of the foot (magnetic resonance imaging) is performed.
Classification
Ligament injuries in the upper ankle joint are divided into three degrees of severity. With grade 1 injuries, the ankle joint can still be loaded and only minor bruising is found. Ligament rupture has not occurred with grade 1 injuries.
With grade 2 injuries, the ankle joint can only be loaded to a limited extent and there are clear bruises. Patients are often only able to stand or walk for a short time because the pain is too strong. A grade 3 injury means that the ankle joint is not able to bear weight immediately after the injury (post-traumatic) and a clear swelling with bruising can also be seen. In children, the torn ligament predominates, which means that the ligament tears at the point of attachment to the bone.
Therapy & Rehabilitation
The therapy of torn ligaments depends on the number of torn ligaments. If the anterior fibular-talar ligament (ATFL) ruptures alone, surgical intervention is not necessary. Important for all types of ligament ruptures is the RICE principle, which is an acronym for rest (rest), ice (ice), compression (compression) and elevation.
The patient wears a pneumatic stabilisation splint for about 12 weeks, or after one week he gets a stable shoe, which he has to wear for 4 -8 weeks. If the fibular calcaneus ligament (CFL) travels in addition to the AFTL, a night splint is prescribed for the first 6 weeks in addition to the pneumatic stabilization splint. The pneumatic splint or a stable shoe must then be worn for 3 -6 months.
Rarely a rupture of all outer ligaments occurs. If this injury does occur, surgical therapy is the first choice. The ligaments are surgically sutured and if necessary reattached to the bone.
A plaster cast is then applied to the lower leg. However, surgical therapy is controversial in the literature, as rehabilitation takes longer and a longer period of absence from sport is the result. However, if at least two ligaments are torn as well as minor bone splinters as a result of the rupture, the structures can rarely be restored so well without surgery, so that the patient can then resume unrestricted sports activities.
Depending on the activity and age of the patient, the times until the patient is fully loaded again can vary. The return to sports is gradual as soon as physiotherapy and/or everyday life can be completed without pain. If a relapse in the symptoms subsequently occurs, the injury must be re-examined and a different therapeutic strategy must be chosen. In addition, an ankle joint orthosis can also be used as one of several therapy options.
