Deltoid ligament sprain

Findings

There is a history of fairly major trauma to the ankle, with tenderness over the deltoid ligaments and on passive eversion of the foot. If there is bruising, check that compression of the talus onto the tibial maleolus is pain-free, as compression pain indicates bone damage may be present.

Cause

An eversion injury to the ankle, from stumbling on rough ground, a blocked side foot kick, or direct trauma. This injury requires a fair degree of force, just below that required to produce a Pott’s fracture, to damage the strong deltoid ligament.

Treatment

Treat any fracture as the priority, but, for ligamentous damage alone, use a cast brace to rest and maintain immobility over 7-10 days. Subsequently, mobilize with crutches, non-weight-bearing, then gradually introduce weight-bearing. Even when non-weight-bearing, active dorsi- and plantarflexion should be maintained, and electrotherapeutic modalities to settle inflammation, plus massage techniques to reduce and control scar tissue, can be added. Management of the injury then follows the regime prescribed for the lateral ligament. A chronic deltoid sprain may require a cortisone injection to release scar tissue and aid mobilization.

Sports

Repetitive deltoid ligament sprains at a low-grade injury are part of the footballer’s ankle.

In the acute phase, it is important to exclude a possible fracture, which might not alter management but defines the extent of the problem. Chronic deltoid ligament pain often does not settle with physiotherapy althouth it does well a cortisone injection. 

"Concise guide to sports injuries, 2^nd edition",Churchill Livingstone, Malcolm T.F. Read,  foreword by Bryan English