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Deltoid ligament injury / sprain

Also referred to as:
Medial ankle ligament sprain/injury • Medial Talocrural Joint Ligament sprain/injury

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What is the deltoid ligament?

The deltoid ligament is a strong structure that lays across the inside of the ankle joint. It is made up of four ligaments which attach to various bones of the foot and then to the underside of the medial malleolus (the lumpy bone on the inside of the ankle) they cross the ankle joint and offer support and stability.

The image to the right shows the locations of the ligaments:

ATTL – Anterior TibioTalar ligament

PTTL – Posterior TibioTalar Ligament

TCL – TibioCalcaneal Ligament

TNL – TibioNavicular Ligament

Sprains and ligament injuries occur when the foot is bent too far in one direction relative to the leg and the ligaments become over stretched or slightly torn. For this to occur to the deltoid ligament, the foot needs to be bent into an everted position, so bent outwards relative to the leg. This is a more uncommon injury because the foot is very strong in this direction. It is more common for people to sprain the lateral ankle ligaments which are on the opposite side, as the feet tend to readily turn in more easily than they turn out.

It is possible that if you have a pronated or flat foot shape, this can excessively load the deltoid ligament and cause stress over time. This may also occur in PTTD/ adult acquired flat foot.

How can I help myself?

If ankle sprains keep reoccurring or are left untreated, they can lead to chronic problems, changes to the cartilage in the ankle (osteochondral defects) and ankle osteoarthritis. So if you are suffering from this problem, it is important that you don’t ignore it.

If you sprain your ankle, following the POLICE acronym (see important safety information) in the short term may help. If it is a serious injury, you should seek appropriate medical advice or attend A and E as an X-ray may be needed to rule out a fracture.

If you are prone to ankle sprains, but don’t have a specific or current injury, strengthening exercises may be useful to help rehabilitate the area. Avoiding footwear that puts you at more risk of spraining the ankle is important too, like unstable heeled shoes for example.

When to see a Podiatrist?

Ankles sprains are a common problem that we see in Podiatry, but all too often people come to see us a long time after having had the original injury, or perhaps they tell us that this has happened multiple times.

People seem to be at more risk of recurrent ankle sprains after it has happened the first time. This is because the ligaments and other soft tissues become more lax and the nerves that control movement and help protect us can become less responsive.

If you have a recurring problem or have a sprain that is not getting better, seeing a Podiatrist is a good idea. We try to firstly ascertain the level of injury and the history of the injury (if it is a recurring problem). We may also use something called the Ottawa Ankle Rules if we are concerned about a fracture.

We often find people have been to A and E and may have even had x-rays, but unless there was an avulsion fracture, where a bit of bone comes away with the ligament, it is unlikely the x-rays will show anything if it’s a sprain.

People are usually told to rest at the time, which is appropriate to begin with (see important safety information).

However it is after the period of initial rest, assuming that there was not significant soft tissue damage or any deformity, that we can reassess.

We may advise further imaging, strengthening exercises, footwear advice and even foot orthoses based on your underlying biomechanics and the mechanism and history of the injury.

So if you are recovering from a sprain but aren’t happy with your progress, or if you have recurrent ankle sprains, then contact a podiatrist and book in for a consultation.

If you book an appointment, it is a good idea to take the footwear your usually wear so that the Podiatrist can assess and advise on this too.

Deltoid ligament