Foot and Ankle
Our feet and ankles are being used everyday for various daily activities. Hence, injuries to the foot and ankle are very common.
The ankle is made up of 3 bones that meet at the ankle joint: the tibia (shinbone), fibula (smaller bone of the lower leg) and talus (small bone in between the tibia and fibula and the calcaneus). The ankle joint where these 3 bones meet are encased by a joint capsule, which contains synovial fluid. This synovial fluid is important as it allows for smooth movement of the joints. The ankle is surrounded by ligaments, which help to stabilise it.
The foot is a complex structure of the body, consisting of 26 bones, 33 joints, 107 ligaments, and 19 muscles. The bones can be categorised into 3 sections:
The forefoot consists of your toes (phalanges) and metatarsals
The midfoot consists of bones that make up the arch of your foot
The hindfoot consists of the heel and ankle, where the talus and the calcaneus (heel bone) are found.
Muscles, ligaments and tendons in the foot help stabilise your foot and allow for complex movement and motions. As there are many bones in the foot, fractures can occur at many locations in the foot, such as toe fractures, metatarsal fractures or calcaneus fractures. Another type of fracture that can occur in your foot is a stress fracture, which develop due to stress overtime.
WHAT IS A LIGAMENT TEAR?
A ligament is a tough band of fibrous connective tissue that connects bone to bone, usually holding structures together to keep them stable. When the ligaments get stretched or torn due to a force that is beyond the normal range of motion, this results in a ligament tear and leads to a sprain.
Ligament tears commonly occur in different parts of the body, such as the ankle.
In an ankle joint, the lateral ligament complex is usually the area that gets torn, which consists of the anterior talofibular (ATFL), the posterior talofibular (PTFL) and the calcaneofibular (CFL) ligaments.
WHAT ARE THE SYMPTOMS OF AN ANKLE LIGAMENT TEAR?
Common symptoms of an ankle ligament tear include:
- Swelling and bruising at the ankle
- Tender to the touch
- Muscle spasms
- A “pop” sound may be heard when the injury occurs
- Inability to move the ankle
WHAT ARE THE CAUSES AND RISK FACTORS OF AN ANKLE LIGAMENT TEAR?
Common causes of an ankle ligament tear include:
- Direct blow to the ankle joint
- Awkward landing after a jump
- Twisting motion of your ankle
WHAT IS THE DIAGNOSIS OF AN ANKLE LIGAMENT TEAR?
A history of the injury and a physical examination of the ankle will be conducted by the Doctor. He may gently press on your ankle and move your ankle as well to check on your range of motion.
Imaging tests will be taken, such as x-ray to rule out other causes of pain such as a fracture, and a MRI scan to confirm the type of ligament tear.
Often, an ankle ligament tear leads to an ankle sprain. Sprains can be classified into 3 categories:
- Grade 1
Mild ankle sprain with no significant tearing to the ligament
- Grade 2
Moderate ankle sprain with a partial tear to the ligament
- Grade 3
Severe ankle sprain with a complete tear to the ligament
WHAT ARE THE TREATMENT OPTIONS FOR AN ANKLE LIGAMENT TEAR?
The treatment method for an ankle ligament tear depends on the type of sprain sustained. Patients who sustain a grade 1 and grade 2 sprain can recover with nonsurgical treatment methods, such as:
- RICE therapy (rest, ice, compression, elevation)
- Medication such as over-the-counter pain relievers (acetaminophen) and nonsteroidal anti-inflammatory drugs (ibuprofen) to relief pain and swelling
- Walking supports such as a brace or crutches to support your weight and let your ankle heal
- Physiotherapy such as strengthening exercises to regain strength in your ankle and restore your range of movement. This is done when the initial pain and swelling has subsided and you are able to move your ankle
For patients who have sustained a grade 3 sprain or nonsurgical treatments have not helped after a period of time, surgery may be recommended.