Written by Sander van Bergen12-12-2013 20:08:54. Posted in Ankle

Test your knowledge: medial ankle stability.

Question:

The most common trauma to the ankle is the lateral ankle sprain, mainly seen in sports. Have a look at this young man (aged 26) visiting the practice after a medial ankle sprain injury. Pictures were taken 8 hours after the injury: you can see hemorrhage at the medial side of the ankle and in the tibialis posterior and flexor digitorum longus tendon sheaths. The other pictures are taken 6 and 12 weeks after injury. After ultrasonography of the ankle there was concern about the integrity, form, function and color of a medial ankle structure that you can see at the other ultrasonographic picture. 

- Which structure is sprained or totally ruptured? 
- What is in your opinion the best treatment for this ankle? Would orthopedic reconstruction be an option? (Especially those familiar with surgical procedures, please reply!)

The answer to the question can be read underneath the picture below.

Answer:

The injury of this young man was caused by a soccer accident; when landing after a jump he sprained the medial part of his ankle. The ultrasonography (after one week of rest) raised the suspicion of a total tear of the deltoid ligament of the ankle and no tears of the tibialis posterior and flexor digitorum longus tendons. Two weeks after injury, MRI confirmed this diagnosis. According to the orthopedic surgeon, surgical intervention is not a option in this case, only conservative treatment. Do you agree or would you recommend a second opinion? Let us know!