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Ligament tear on the foot • Symptoms of ankle distortion

A ligament tear on the foot is one of the most common sports and accident injuries. What are the causes of ligament tears on the ankle, are there typical symptoms and how do you treat ankle distortion?

Ligament tears on the ankle are caused, for example, by bending during sports in rough terrain.
© iStock.com/olegbreslavtsev

The ankle is also known colloquially as an ankle. In the event of severe overstretching, one or more ligaments can tear (ankle distortion).

At a glance:

Kinesio tapes: typical applications

Kinesio tapes: typical applications

Torn ligaments on the foot: Frequently asked questions and answers

What types of torn ligaments are there?

In the case of a ligament tear at the foot, a distinction is made between the outer ligaments that are particularly often affected and the inner ligaments. If the foot bends inwards, this is referred to as supination trauma. The outer ligaments are affected. If the foot bends outwards, one speaks of a pronation trauma and the impact of violence affects the inside (inner band).

Can you walk with a ligament tear on the foot?

Those who have an ankle ligament tear and no bony injuries usually receive a splint for four to six weeks that stabilizes the joint. Even if an orthosis relieves the foot, the joint should not be overstrained. In some cases, doctors recommend using additional crutches when walking to reduce stress on the foot. Depending on the pain, those affected should never just sit. Rather, when walking you should roll your foot as normally as possible, but a little slower and more carefully. In this way, they prevent a strong muscle breakdown and sticking of the connective tissue structures in the healing phase.

Sick leave after torn ligaments on the foot?

How long it takes to be on sick leave after a ligament tear on the foot depends heavily on the job. Patients usually receive sick leave for one to six weeks. Those who perform sedentary work can often return to work after just a few days. In professions with light physical activity, breaks of three to four weeks are common. However, if pain occurs, it is important to take a break, reduce the load or stop altogether. Depending on the healing process, doctors can also extend a sick leave.

Sports and driving after ankle ligament rupture?

Approximately twelve weeks after a ligament tear on the foot, the joint is usually fully usable again and can also be used in sports. However, the treating doctor judges this individually, depending on the type of sport and the level of healing. Driving is generally only recommended as soon as the affected person removes the orthosis after about four to six weeks. Depending on the severity of the injury, it may also make sense to wait longer before driving a vehicle, since a sudden maximum load – for example, when braking hard – definitely has a negative effect on healing.

Causes: Where does a ligament tear on the foot come from?

The shin, fibula and ankle meet in the ankle and thus connect the lower leg bone to the tarsal bone.

One speaks of an ankle distortion when a strong force such as an abrupt twisting leads to the elastic ligaments in the ankle being stretched beyond their elasticity and torn or torn. This often happens in ball sports with quick start, stop and turning movements such as handball and basketball. Even kicking the ankle, for example when playing football, can damage the ligaments.

But not only athletes are affected. Even a careless step on a step or a stone, twisting when walking over cobblestones with high shoes and a quick turn around can result in a ligament tear on the ankle. Generally, people with connective tissue weakness tend to twist.

Symptoms: How do you recognize a ligament tear on the foot?

A ligament tear on the ankle is particularly evident with a sudden onset of severe pain. The pain can sometimes subside after a while, but the instability of the joint remains. The ankle usually swells up in an egg shape and becomes bluish due to a bruise. If there is no blood in the tissue, there is no hematoma.

Possible symptoms of torn ligaments at a glance:

  • sudden pain in the affected joint
  • Pressure or movement of the joint make the pain worse
  • Swelling of the joint
  • Blue staining of the tissue, bruising, hematoma
  • Limitation of joint mobility
  • inflammation
  • Redness

Diagnosis: how does the doctor determine a ligament tear on the ankle?

If a ligament tear on the foot is suspected, orthopaedists, trauma surgeons or sports doctors are the right contacts. During the medical history, you ask questions about the accident itself, the pain and any previous injuries and examine the ankle for symptoms, blood flow and motor skills. The so-called drawer test is used, for example, to check the ankle for the stability of its outer ligaments: The doctor tries to push the foot forward with the knee bent and the shin fixed. Depending on the swelling, hematoma, mobility and pain, the doctor assesses whether X-ray diagnosis is also necessary.

X-ray in the event of ankle ligament tear

X-rays are required to safely exclude bone injuries. It can be used to identify, for example, whether there are broken bones (fractures), bony ligament tears or joint capsule tears. In the case of ankle distortions, X-rays are useful to distinguish a ligament stretch from a complete rupture: The doctor examines the gap between the joint gap using images in different planes. In certain cases, ultrasound or magnetic resonance imaging (MRI) can also be helpful to make connective tissue structures visible.

Treatment for torn ligaments on the foot

Torn ligaments on the foot should be treated quickly and appropriately to avoid possible consequential damage.

PECH rule: First aid for torn ligaments

If you suspect a ligament tear on the foot, the so-called PECH rule applies. If you react quickly, a ligament tear can reduce pain, swelling and the risk of bleeding with the immediate measures:

  • P for break: Stop movement or stress

  • E like ice: Cool the knee with ice or a cool pack to limit bleeding and swelling and reduce pain; Do not put the ice directly on the skin, but wrap it in a towel

  • C for compression: Put on a bandage that is not too tight to reduce the leakage of tissue fluid and blood

  • H like high camp: Put your leg up to reduce swelling and reduce the risk of bleeding

Pain reliever and physiotherapy for torn ligaments on the ankle

Painkiller: Pain relievers such as ibuprofen can help against the pain if necessary.

Immobilization: The subsequent therapy depends on the damage to the injured ligaments. In most cases, doctors recommend conservative treatment for four to six weeks. In doing so, they immobilize the joint with a removable splint. Depending on the severity, it may make sense to initially reduce the load on the ankle using crutches.

Physical therapy: After the acute phase of the injury, doctors usually recommend physiotherapy treatments to restore full mobility, stabilize the ankle muscles and thus reduce the risk of another injury.

If the swelling is very pronounced, lymphatic drainage can also be part of the therapy.

Torn ligament surgery?

Surgery for a ligament tear on the foot is only advisable in certain cases, for example in the case of open ligament injuries, an additional fracture (fracture of a bone) or bony ligament tearing in children. There is no clear operative therapy recommendation for rupture of all three outer ligaments or for competitive athletes. Surgical therapy tends to lead to higher capsular ligament stability, but also to higher stiffness, longer incapacity to work and a slightly increased risk of later osteoarthritis.

Duration and late effects of torn ligaments on the foot

If the ankle distortion is not treated quickly and appropriately, permanent damage can occur – for example, instability of the ankle and, in the long term, even wear of the affected joint (arthrosis).

How long does a ligament tear on the foot last?

Depending on the severity of the ligament tear on the foot, healing with an orthosis usually takes around four to six weeks. After that, you should expect a sports break of several weeks to months. In about 20 percent of those affected, doctors still find instability or pain during exercise. Physiotherapists recommend starting coordination and strengthening exercises as soon as possible in order to strengthen the muscles and ligaments on the legs and feet and to speed up the healing process.

Are there late effects after ankle ligament rupture?

If a ligament tear on the foot is recognized and treated immediately, ruptures have a good prognosis and are usually without consequences after four to six weeks.

Sufferers who repeatedly bend their ankles often have permanent ligament instability or incomplete healing. Discomfort caused by slight over-mobility in the ankle can also be a sign of ligament weakness. About ten percent of all patients with outer ligament injuries are affected by chronic ankle instability. The repeated injuries to the ankle can then damage the articular cartilage and ultimately lead to its wear and tear (arthrosis).

Can you prevent ligament tears on the foot?

You can only prevent a ligament tear to a limited extent. However, coordinative and strengthening exercises can strengthen the muscles around the ankle and stabilize the ligaments. It is also important for non-athletes to exercise the muscles. Because the build-up of muscles around the joints supports the fibers of the ligaments and thus additionally stabilizes the joint system. Good coordination also leads to a significantly lower risk of injury.

In physiotherapy after a ligament injury, coordination exercises and the strengthening of the foot and leg muscles are always in the foreground. Some physiotherapists recommend targeted strength and balance exercises on the wobble board or a foam pad.

The right shoes

When doing sports, you should make sure you have the right shoes. Depending on the sport, different loads affect the ankles. Good specialist advice when buying sports equipment is therefore very important. Stable shoes are recommended during everyday life, which do not encourage ankle twisting, as shoes with high heels do. The attending doctor should clarify individually whether ankle-high shoes are recommended, special insoles or pronation supports.

Stabilize bandages

Within a year of the ligament injury, the likelihood of it twisting again is increased. If you tend to twist, do sports or activities with a higher risk, or feel instability in the joint, you can support your ankle with a sports bandage or tape. Before exercising, you should also warm up your ankles sufficiently:

Exercises: Warm up and strengthen ankles

  • Frequent changes between heel and tiptoe

  • Circles in both directions

  • Stand alternately on one leg

  • Lay an elastic latex band to a loop, put one foot in the loop, place the other on the ends of the band that are placed on top of each other, now pull the foot in the loop outwards against the tension resistance of the tensioned band and lift the stretched leg about 15 times.

  • Wrap the rubber band around the forefoot, tighten the foot and hold both ends with your hands so that the band is tense. Now, while sitting against the resistance of the band, stretch your foot forward and downwards away from your body, repeat 15 times.

  • Wrap rubber band around the forefoot and hold both ends with your hands, lying on your back with your leg bent at right angles in the air, your lower leg parallel to the floor, now stretch your foot forward against the resistance, repeat 15 times.

Blackroll exercises to imitate

Blackroll exercises to imitate