Essential Insights In Treating Medial Ankle Sprains

Christopher Corwin, DPM, MS

Ankle sprains are one of, if not the most, common injuries in sports. The incidence of injuries appears to be increasing with the higher number of people participating in athletics through all phases of their lives. It is estimated that 30,000 ankle sprains happen each day.1 Lateral ankle sprains are by far the most common with only 5 to 6 percent of ankle sprains occurring medially.2,3 Medial ankle sprains can be more debilitating and have longer recovery times than lateral sprains.

   In order to effectively diagnose and treat medial ankle sprains, one must have a strong understanding of the anatomy of the medial aspect of the ankle. The deltoid ligament is made up of two parts, the superficial deltoid and the deep deltoid. The superficial deltoid ligament arises from the anterior portion of the medial malleolus and inserts into the navicular, talar neck and the calcaneus at the sustentaculum tali. Portions of the ligament extend medially and plantarly to the navicular to the level of the spring ligament. These fibers are aligned in the sagittal plane. The superficial deltoid primarily resists hindfoot eversion.

   The deep deltoid ligament is a very short, thick, strong ligament, which arises off the posterior portion of the medial malleolus and inserts into the medial aspect of the talus. It is associated with the medial capsule of the ankle joint. The deep deltoid ligament fibers are primarily directed in the transverse plane. These fibers prevent external rotation of the talus and prevent lateral subluxation of the talus and medial gutter widening. Although the deltoid plays a role in preventing lateral displacement of the talus, accompanying injury to the lateral malleolus or lateral ligament complex is usually required for lateral shift of the talus.

   Deltoid ligament injuries are the result of an external rotation of the talus that may or may not be associated with a rearfoot eversion. There are a variety of ways in which athletes can suffer injuries to the deltoid complex.

How Athletes Can Be Susceptible To Deltoid Ligament Injuries

Gymnasts may have a deltoid ligament injury when they excessively evert the heel while missing a landing. Ballet dancers in positions one through five are vulnerable as each of these positions has the feet in 180-degree alignment with varying spacing between the feet and can cause a forced heel eversion or talus rotation.

   Soccer provides many opportunities for deltoid injuries. Running on uneven ground can cause injury, especially when athletes are playing in early or late season matches when fields may be in less than ideal shape. “Fifty-fifty balls,” in which both players strike opposite sides of the ball at the same time with the inside of the forefoot, result in an external rotation force to the rearfoot and the potential for injury. Repetitively striking balls with the instep may lead to injury. Many deltoid ligament injuries are also caused by an opposing player performing a slide tackle to the lateral ankle, causing eversion of the rearfoot.

   Basketball players may land from a jump on another player’s foot, allowing the rearfoot to move excessively into valgus.

Keys To Assessing Deltoid Ligament Issues And Related Injuries

Evaluation of the deltoid ligament begins with a thorough history and physical. Patient recall of the mechanism of injury can lead to clues about the deltoid injury and other associated injuries. However, players often recall nothing more than a collision with another player and subsequently being on the ground.

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