Foot & Ankle

Treatment and Diagnosis of Deltoid Ligament Ankle Injuries

By October 24, 2019 No Comments

Anatomy of Deltoid Ligament

The deltoid ligament is a set of tough, fibrous tissues which extend out from the medial malleolus of the lower leg and join it the smaller bones within the foot. This set of tissues is actually 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), we have the tibia, and on the outer side (lateral), there 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 in order to allow for fluidity in motion without overextension.

Though there are 4 sets of distinct ligament groups within the deltoid ligament, for the purposes of 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 characterized by an inciting event such as hyperextension. Degenerative illnesses rarely effect 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 of choice 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 which seldom goes away and often develops into a worse injury overtime.

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 overtime, but this does not mean that the issue is solved. Every subsequent use of the ankle will put the deltoid ligament at higher risk of worsening the condition of the injury.

Symptoms of an issue include:

  • Swelling
  • Pain
  • Tenderness
  • Instability 
  • Reduced load bearing capacity
  • Reduced range of motion or articulation of foot movements
  • Bruising
  • Ankle deformities

Though these symptoms are common, if they last longer than a few days, the issue is likely much deeper than at-home treatments will be able to handle. 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 in an effort 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 actually the issue. To resolve any doubt, they will likely move on to the use of medical imaging technology in order 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 planned 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. Some of the most common are listed below.

Physical Therapy

Physical therapies are simply those treatments by 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.

Additionally, physical therapy can be an involved process – weekly consultations with a physical therapist – or may simply be applied at home – self massage to the interior ankle. 

Medication

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 which reduce swelling and help increase bloodflow throughout the body. 

If over-the-counter medications are not enough to treat the acute pain involved in a deltoid ligament injury, doctors may prescribe stronger dosages of the same medications or move on to more radical medications which block the brains 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

Steroidal injections are a popular treatment for any soft tissue injury. By reducing swelling, these treatments unconstrict the nerves within an injured region and help calm ensuing pain. While these treatments have proved effective, their side-effects can be dangerous.

Steroidal injections have been shown to degenerate tissue and lead to further complications when used overtime. As more tissue is lost or damaged, symptoms will become worse. Any recommendation for a steroidal injection should be taken with a grain of salt. 

Surgery

Surgical intervention is typically a last resort for any injury. Typically, only patients with chronic pain which has not succumbed to less invasive methods will resort to surgery of the deltoid ligament. Surgery is a time-consuming process which may leave a patient immobile for long periods of time as well as require the application of 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, there exist several alternative treatment methods which may be a better fit given the patients lifestyle and functional goals.

Regenerative Therapy for Deltoid Ligament Ankle Injuries

Once treatments reserved for the wealthy, 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 health.

At CELLAXYS we offer two varieties of regenerative therapies – Platelet Rich Plasma, or PRP therapy and Stem Cell Therapy.

PRP Therapy

Platelets are cells found naturally in blood. When a person is injured, the body dispatches platelets to the site of injury. Once there, these platelets clot together and attach themselves to the injured tissue. They send out chemical impulses which attract proteins and other growth factors to the injury and then use those tissues to repair any damage. 

By extracting blood from a patient, isolating the platelets and adding them to a mix of growth factors, then reinjecting this mix directly to the site of an injury, the body’s healing response is amplified and damaged tissues are repaired much quicker than if left alone. 

Stem Cell Therapy

Similar to PRP, stem cell therapy involves extracting tissues (fat or bone marrow), processing them, and then reinjecting these tissues into the site of injury. Doctors have found a way to create a pseudo-stem-cell by processing adipose (fat) or bone marrow tissues in such a way that they are brought back to their earliest, most malleable state. 

Once injected into the site of injury, these tissues create an environment suitable for repair and then call on the body’s natural healing mechanisms to restore damaged tissue.

After processing these tissues, our doctors use advanced medical imaging technology to find the best location to perform the injections. These treatments go a step beyond conventional methods as they actually help treat the cause of pain, not just the pain itself. 

Patient’s typically report results within the first month after these treatments are applied and these results can last from 6 months to a year thereafter.

Conclusion

While there are many conventional treatment methods for a deltoid ligament ankle injury, these treatments may fail to meet the functional goals a patient. Conventional treatments fail to address the causal factors in the ensuing symptoms of a deltoid ligament injury and can be highly invasive. Regenerative therapies are conservative treatments with minimal recovery periods and highly effective results.

If you would like to learn more about what regenerative therapies are and how they may be able to help you, contact the CELLAXYS offices today to learn more about what we can do to help.

Dr. Matthew HC Otten

Dr. Matthew HC Otten

Director of Orthopedic & Orthobiologics
Fellowship-trained & Board Certified in Sports medicine
Director Angiography at Harvard Clinical Research Institute
Michigan Stage University Alumni