Ligament injury on the lower leg

I have highlighted from time to time about occurrence of ankle injuries especially sprains and dislocations.

Today, I will look at a different kind of injury that happens just slightly above the ankle joint. This is the injury of the ligament that connects the two long bones on the leg just before they form the ankle joint.

A ligament is a strong fibrous tissue that helps join two bones. In this particular case this ligament lies just above the ankle. When this connective tissue is placed under too much stress, tearing of the connective tissue can occur.

This injury can range from a small tear resulting in minimal pain, to a complete tear resulting in significant pain and disability. Most often these injuries typically occur traumatically during more severe ankle sprains whereby forces push the two bones apart.

The sportspersons with this condition usually experience a sudden onset of pain during the causative activity. Symptoms may increase during weight-bearing activity and on  twisting of the ankle. The individual may be unable to weight bear at the time of injury due to pain and may develop bruising and stiffness over the coming days.

Symptoms are commonly felt in the front of the ankle, although occasionally the back and/or sides of the ankle may be affected. Pain may also increase on firmly touching the joint area.

A thorough subjective and objective examination from an experienced sports medicine expert is usually sufficient to diagnose this joint injury.

Investigations such as an X-ray, MRI or CT scan are often required to confirm diagnosis and rule out other injuries (particularly fractures). Most individuals with minor joint injuries heal well with an appropriate physiotherapy programme.

In these instances, recovery is usually a matter of weeks. Those with more severe injuries whereby the two bones are separated on X-ray may require surgery with a lengthy rehabilitation period to follow.

It is important that this is detected early as untreated severe injuries may rapidly lead to ankle joint arthritis. It is therefore recommended that all patients see their physiotherapist as soon as possible for accurate assessment and diagnosis.

Appropriate treatment in the first 48-72 hours is vital to reduce bleeding, swelling and inflammation. This should involve following the R.I.C.E regime which comprises of rest from aggravating activity (crutches or an Ankle Brace are often required), regular icing, the use of a compression bandage and elevation of the affected limb.

Anti-inflammatory medication may also be particularly useful in this early phase.

Despite appropriate physiotherapy management, some sportspersons with this joint injury do not improve adequately. When this occurs, a bone scan, corticosteroid injection or review with a specialist who can advise on any procedures that may improve the condition cap apply.

The writer is a physiotherapist, Harambee Stars and Mathare United

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