The deltoid ligament is a set of tough, fibrous tissues that extend out from the medial malleolus of the lower leg and join the smaller bones within the foot. This set of tissues is 4 distinct ligament groups which each provide stability to different types of foot movement.
The different anchor points from the medial malleolus to the talus help to prevent hyperflexion and overextension of the muscles within each foot.
The lower leg is supported by two bones – on the inner side (medial), is the tibia, and on the outer side (lateral), is the fibula. The first anchor point of the deltoid ligament is the medial malleolus, which is the prominence on the inner side of the ankle formed by the end of the tibia.
The deltoid ligament fans out from the medial malleolus in a triangular shape and joins it to several of the smaller bones within the foot. Between the deltoid ligament and other connective tissues, all foot movement is restricted to allow for fluidity in motion without overextension.
Though the deltoid ligament has 4 sets of ligament groups, for evaluation doctors typically classify an injury to the deltoid ligament based on its location. Injuries to the deltoid ligament will be referred to as either posterior (back), middle, or anterior (front).
Causes of Deltoid Ligament Ankle Injuries
Injuries to the deltoid ligament are caused by an incident such as hyperextension. Degenerative illnesses rarely affect the deltoid ligament, though they can break down the anchor points between the deltoid ligament and the bones it connects to.
Injury to the deltoid ligament is common in athletes whose sport involves extended and articulate foot use. Practicing ballet, soccer, and gymnastics are all risk factors for deltoid ligament injury.
Additionally, acute trauma to the inside of the ankle may cause microtears in the fibers which make up the deltoid ligament and lead to a worse injury if not properly allowed to heal. Any ankle injury should be approached with caution and allowed proper rest to fully recover. Microtears are a problem that seldom goes away and often develops into worse injury over time.
Symptoms and Signs of Deltoid Ligament Ankle Injuries
Due to the causal factors of deltoid ligament ankle injuries, the symptoms will be highly expressed and acute immediately following an incident. These symptoms will slowly wane over time, but this does not mean that the issue is solved. Every subsequent use of the ankle will put the deltoid ligament at a higher risk of worsening the condition of the injury.
Symptoms of an issue include:
- Reduced load-bearing capacity
- Reduced range of motion or articulation of foot movements
- Ankle deformities
Though these symptoms are common, if they last longer than a few days, the issue is likely severe and requires more than just at-home treatments. If symptoms last longer than a few days, a medical evaluation is highly recommended.
Diagnosing Deltoid Ligament Ankle Injuries
Deltoid ligament injuries can be easily diagnosed due to their immediate effects. If the symptoms have been allowed to heal and a person senses something is still amiss, the clinical evaluation may be a little more difficult.
A typical evaluation will begin by examining the patient’s medical history. Past injury to the ankle or abnormal bone structures within the foot will provide valuable insight into the condition of the deltoid ligament.
A physical examination is soon to follow. The doctor will ask their patient to relax the foot as they begin lightly applying pressure to the inside of the ankle. The doctor will start to rotate the ankle to flex the deltoid ligament and as they do, they’ll record the patient’s reactions.
Based on the physical examination, the doctor will have a better idea of whether or not the deltoid ligament is the issue. To resolve any doubt, they will likely use medical imaging technology to get a view of the tissues within the ankle.
CAT scans and MRIs will give doctors a detailed view of the condition of the deltoid ligament. Localizing tears or abnormalities will help doctors create a treatment plan which specifically targets the injured portions of the deltoid ligament.
Conventional Treatments for Deltoid Ligament Ankle Injuries
Based on the results of the medical evaluation and a discussion of the patient’s functional goals, doctors will create a treatment plan aimed at targeting as many of the patient’s concerns as possible. Whether a patient wants to reduce pain or increase their mobility, each plan will likely involve multiple treatments.
Physical therapies are simply treatments through physical means. Massage, guided exercise, stretches, acupuncture, and hot/cold therapy are some of the most commonly applied physical therapies for deltoid ligament injuries.
These treatments can help boost the strength of neighboring tissues to help support the deltoid ligaments and increase blood flow to the deltoid ligaments thereby amplifying the body’s repair mechanisms.
Medications are not aimed at restoring the health of the deltoid ligament but instead focus on quelling the pain it may cause. Ibuprofen, naproxen, and acetaminophen are popular over-the-counter medications that reduce swelling and help increase blood flow throughout the body.
If over-the-counter medications are not enough to treat the pain involved in a deltoid ligament injury, doctors may prescribe stronger dosages of the same medications or move on to more radical medications that block the brain’s response to pain.
All medications should be heavily researched before their application and it should be noted that their effects wane over time.
Steroidal injections are a popular treatment for any soft tissue injury. By reducing swelling, these treatments reduce pressure on the nerves within the injured region and help calm ensuing pain. While these treatments have proved effective, their side effects can be detrimental.
Steroidal injections have been shown to degenerate tissue and lead to further complications when used over time. As more tissue is lost or damaged, symptoms will become worse.
Surgical intervention is a last resort for any injury. Typically, only patients with chronic pain will resort to surgery of the deltoid ligament. Surgery is a time-consuming process that may leave a patient immobile for a long time as well as require medication and a physical therapy routine.
While conventional treatment options are the most studied and popular treatments, they may not always be the most effective given a patient’s functional goals. If these treatments fail to meet the needs of a patient, alternative treatment methods may be a better fit given the patient’s lifestyle and functional goals.
Regenerative Therapy for Deltoid Ligament Ankle Injuries
Advances in regenerative sciences have led to increased exposure and application of these treatments. By pulling tissues from a patient, processing them, and reinjecting them into the site of an injury, these treatments help to amplify the body’s natural healing processes and restore damaged tissues to good health.
At CELLAXYS, we offer two varieties of regenerative therapies – platelet-rich plasma (PRP) therapy and cell-based therapies.
PRP therapy involves drawing blood out of the patient and isolating platelets from it. Platelets are healing components in our body that release 10 Growth Factors to stimulate the growth of healthy tissues. They also send chemical signals to attract healing cells from the blood and produce a web-like structure called fibrin that boosts the development of new tissues in the injury site.
Platelets amplify the body’s healing response and repair damaged tissues much quicker than if left alone. The process is completed within 45 minutes and is an outpatient procedure, which means you can go home after the process.
Also known as stem cell therapies, cell-based therapies involve extracting “autologous” tissues from the patient, processing them, and then reinjecting them into the injury site. Doctors have found a way to perform cell-based therapies in two methods:
- Minimally Manipulated Adipose Tissue (MMAT) transplant. It involves replacing the damaged cells of your ankle with healthy cells from the adipose (fat) tissue. MMAT can be performed in multiple locations at the same time.
- Bone Marrow Concentrate (BMAC). The process replaces the damaged cells with highly concentrated cells of your bone marrow.
Both cell-based therapies are performed within 1.5 to 2 hours. Like PRP, MMAT and BMAC are both outpatient procedures, and you’ll be under anaesthesia during the process. The doctor will use a live X-ray or ultrasound to detect the injury site in your ankle.
A patient typically reports results within the first month after these treatments, lasting from 6 months to a year.