Inner Ankle Sprain

DELTOlD LIGAMENT INJURY "Medial Ankle Sprain"
Robert H.  Sheinberg, D.P.M., D.A.B.F.A.S., F.A.C.F.A.S.

The deltoid injury consists of five ligaments that connect the lower leg bone (tibia) to the foot.

CAUSES:

  • Usually caused from a traumatic event where the ankle gets hit from the outside causing the foot to roll in.  Injuries to the deltoid ligament may be partial or complete and also may be associated with fractures to the tibia or fibula.
  • Severe flatfoot deformities cause the foot to move in a down and in position.  Over time all the motion is taken up by the foot and further motion is necessary, causing the ankle to tilt, injuring the deltoid ligament (tilted ankle).

SIGNS AND SYMPTOMS:

  • Injuries to the deltoid ligament when acute cause pain with any attempted weightbearing, diffuse swelling, tenderness and often ecchymosis (discoloration).
  • For simple injuries the patient may be able to weightbear.  For severe injuries the injured person will not be able to put any weight on the foot and ankle.
  • Extreme tenderness is present to palpate some or all of the deltoid ligaments. It is important to rule out other injuries that may have occurred at the same time. This can include injuries to the syndesmosis and/or tibia and fibula.
  • Standing or weightbearing examination may be needed to rule out severity of a flatfoot deformity. Tilting of the ankle may be easily seen clinically.

X-RAYS:

  • X-rays are necessary to rule out any bony injury or an increase in the space between the talus and the tibia.
  • A tilted ankle where there is an increase in joint space in the inside of the ankle may also be seen with severe or chronic injuries to the foot and ankle.

MRIs:

  • MRI may be necessary to rule out other injuries to the ankle and to fully evaluate the injury.

TREATMENT:

  • For simple injuries to the deltoid without associated bony injuries (fractures), immobilization in a cast or boot may be necessary. This immobilization may be necessary for 2-6 weeks. Depending on the injury, crutches may be needed during that time.  Following removal of immobilization, physical therapy is started to restore range of motion, strength and stability back to the ankle.
  • Surgery is rarely if ever necessary for isolated deltoid ligament injuries.

PROGNOSIS:

  • If the deltoid ligament is isolated (not associated with any bony injuries), prognosis 1s excellent and patients may return to sports within 4-12 weeks, depending on the number of injuries in the deltoid ligament complex. Bracing may be needed for 3-4 months to prevent recurrence of injuries.
  • If the deltoid ligament is associated with other bony fractures, the fractures may need to be openly reduced and fixed.  During the immobilization of these injuries the deltoid ligament will heal most often primarily without any long-term issues.
  • If severe foot deformities are present, it may be necessary to treat these deformities to prevent worsening of a tilted ankle.
  • If  pain,  stiffness  and  impingement  are  present  status  post  deltoid  ligament  injury, arthroscopic debridement to  remove scar tissue may be  needed to  allow a complete recovery.

BiMalleolar Equivalent Fracture With Displaced Fibula Fracture and Deltoid Rupture treated with ORIF Fibula with 2 Arthrex Syndesmotic Tightropes.

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