The Deltoid ligament sprain is uncommon, reported at 3-4% of all ankle ligament injuries. The mechanism of injury involves a forced foot eversion combined with external rotation. Deltoid ligament sprains are often associated with distal (low) fibula fractures. More severe deltoid ligament injuries as associated with syndemosis ankle sprain, high fibular fractures, and lateral ankle sprains.
The deltoid ligament is an important medial ligament that assists in preventing ankle eversion and external rotation of the foot, as the ligament acts to transmit forces from ankle to foot. The position of the foot appears to have a role in injuries sustained during sprains, with damage typically occurring with the foot planted in dorsiflexion with an external rotation force, typical in court sports when landing.
Signs and symptoms
The diagnosis of a deltoid ligament injury is based on mechanism of injury and specific clinical findings.
- pain in the anteromedial part of the ankle joint.
- A hallmark in diagnosis is the tenderness at the medial gutter of the ankle joint.
- Patients usually give a history of either an eversion-pronation trauma, or a supination-external-rotation trauma.
- patient may present with a flatfoot, with prominence of the medial malleolus
- swelling and tenderness along the deltoid ligament are present.
Treatment
Management of deltoid sprains depends largely on whether the there is a partial tear (superficial section of the ligament), a complete tear ( deep portion), or whether there are concomitant injuries. Severe deltoid ligament injuries are most often associated with fracture of the tibia and/or fibula. Injury to the superficial deltoid ligament has a good prognosis for conservative management, whereas the deep ligament usually leads to instability.
The following home treatment is for a 25 y/o female collegiate volleyball player, who landed in a dorsiflexed position with forced ankle eversion when landing on her teammates leg. The resultant injury was an open distal fibula fracture which required surgical fixation. Patient remained in rigid walking boot for 6 weeks post operatively.
The Kayla
- Bike 15 min warm up 5 min 90-100 RPM, 5 min increased resistance while maintaining close to 90 RPM, 5min spin down high revolutions, low resistance
- Self-mobilization of the foot and ankle with strap 3×10 to improve Dorsiflexion: squat with strap around the ankle, almost at level of foot, strap pulls forward towards toes, fixated in door. Strap needs to remain taught throughout the squat phase
- Theraband inversion strengthening starting from neutral foot position, progressing into inversion 4×25 progression to 5 min daily
- Resisted squats with theraband around distal thighs 6x 1 min holds
- Single leg gorilla squats 2×10
- Shuffle steps lateral 2×2 min
- Light skips 2x2min
- Agility ladder bipedal hops 4x 10
- Resisted heel raises seated 1×50 35 #, 2×25 35 single leg, progression to single leg standing heel raises in slight plantar flexed position of foot
- Y balance training 6x 6 revolutions
- Single leg dead lifts 3×15
- Side planks with hip taps 2×12
- Progression into running once patient achieves 90 degrees or greater of dorsiflexion and a normalized walking pattern. Running will include 30 sec run time followed by 30 sec walk time. This will occur 3x per week rather than bike warm up.