Generally, when you sprain your ankle, you damage the ligaments on the outside of the ankle. However, in some cases, damage may occur on the inside of the ankle to the large deltoid ligament. So, how does a sprain of the deltoid ligament occur, and how do we manage this injury?
What is the deltoid ligament?
The deltoid ligament is a large triangular structure containing superficial and deep fibres. It starts at the tip of the medial malleolus and fans outwards to various bones on the inside of the ankle. Its primary function is to provide stability to the inside of the ankle and medial arch. The deep fibres of the ligament are strong.
How do you damage the deltoid ligament?
Generally, the deltoid ligament is more commonly injured by forceful eversion and external foot rotation. However, in some cases, a classical inversion injury can damage the deltoid and outside ligaments.
Usually, a sprain of the deltoid ligament involves high forces on the ankle, leading to injuries to other ankle structures such as the syndesmosis, lateral ligaments and the bones on the inside and outside of the ankle.
Spain of the deltoid ligament is seen in footballers, court sports, combat sports and off-road or trail runners.
Symptoms of sprain of the deltoid ligament
Often, damage to the deltoid ligament is suspected based on the mechanism of injury and specific clinical findings.
Generally, people report pain and swelling on the inside of the ankle. If instability is present, people describe giving way when walking down a hill or stairs. Often, we find tenderness and swelling at the deltoid ligament and increased laxity on the inside of the ankle.
Imaging of the deltoid ligament
Generally, we use MRI to determine whether there is damage to the deltoid ligament and whether the injury is a partial or full-thickness tear. Also, an MRI will show other injuries to the lateral ligaments, cartilage in the ankle joint or a high ankle sprain (also known as syndesmosis sprain).
Management of sprain of the deltoid ligament
Management depends on whether the deltoid injury is a full or partial tear.
Complete tears of the deltoid ligament often need surgery. Also, they are generally associated with other severe injuries such as fractures, syndesmosis sprain, and cartilage injuries.
On the other hand, partial tears do not need surgery and can be treated conservatively.
Immediate treatment often involves ankle protection in a walking boot for a few weeks. We also suggest regular ice, compression and NSAIDs to reduce pain and swelling.
Once we get the ankle out of the boot, we start with gentle and graduated physiotherapy. Examples of rehab exercises include theraband strengthening of the ankle, calf raises and balance exercises. Initially, it would be more comfortable for the patient to perform these exercises in a pool to reduce weight on the ankle. Exercises to maintain aerobic conditioning include swimming, gentle cycling and cross-training.
Generally, a return to light running should be possible at 6-8 weeks. Taping the ankle to protect excessive pronation will shield the deltoid ligament from further damage. Running progression should be staged and include straight-line running, change in pace, change in direction, and finally, return to training.
Cortisone shot for an ankle sprain: Is it an option?
Every so often, an injection is helpful to help with therapy. For example, a common cause of ankle pain after a rolled ankle or deltoid ligament sprain is persistent inflammation in the ankle joint. A cortisone injection directed to this inflammation can reduce pain and allow for more rehab.
Generally, we perform injections with ultrasound to improve accuracy. A small needle is inserted into the area of inflammation. Ultrasound allows us to avoid essential nerves and blood vessels.
Final word from sportdoctorlondon about sprain of the deltoid ligament
Deltoid ligament sprains are a relatively common ankle injury in change-of-direction sports. Generally, deltoid ligament injuries are often associated with other injuries and take longer to settle than simple lateral ligament injuries.
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