Ross Hauser, MD, Danielle Matias, PA-C, Demi Foster, APRN
The deltoid ligament is a strong, dense, triangle-shaped ligament on the inner (medial) ankle. It provides a counterbalance to the weaker outer ankle ligaments, which are more prone to damage in injury. These are the anterior talofibular (ATFL), the calcaneofibular (CFL), and the posterior talofibular (PTFL).
Isolated deltoid injuries are considered very rare and most happen when your ankle rolls outward or in combination with a high ankle sprain. As pointed out in a May 2023 paper in the Journal of Orthopaedic Surgery: (1) “When a prompt diagnosis is not formulated, ligament tears can remain untreated, and chronic ankle instability can result after acute lateral or medial ankle sprain. When the medial ligament complex (MLC), in particular the anterior fascicle of the deltoid ligament (tibiotalar joint stabilizer), is involved, rotational ankle instability can develop.”
Management in the acute phase of deltoid injury remains a subject of debate
Also pointed out in a May 2023 paper in the Journal of Orthopaedic Surgery: (2) In the acute setting, deltoid insufficiency often coincides with multi-ligament injury to the ankle joint; syndesmosis injury, or ankle fractures. Management in the acute phase remains a subject of debate. Some orthopedic surgeons have a tendency towards repair, whereas most trauma surgeons often treat the deltoid nonoperatively. In the chronic setting, the ligament complex is often elongated (stretched) as a result of prolonged strain.
Diagnosis of deltoid injury remains a subject of debate
A February 2024 study in the journal Foot and ankle surgery (3) acknowledges: “There is no consensus on diagnostic criteria (clinically, by imaging and by arthroscopy), on indications for non-operative and operative treatment, and on standards for repair and reconstruction of the ligament complex. There is no current evidence to support acute repair of deltoid ligament injury. Reports on the effect of isolated deltoid ligament reconstruction are very sparse. (In other words, the surgery is not often done).
Treating ligaments
Since ligaments do not heal well on their own, ankle instability quickly becomes a chronic, painful condition. It allows for destructive joint motions every time the ankle joint is used, wearing down the cartilage and causing further structural damage.
Our providers understand the need for ankle stability to prevent the long-term damage resulting from ankle instability. We work to restore the ligament integrity and strengthen the joint function. Helping to prevent continued cartilage degeneration through destructive joint motions and allows the ankle a chance to heal.
Other articles
Chronic Ankle Instability Surgery
In the patients we see, they have at some point considered surgical intervention for their chronic ankle instability because they are basically done with treatments that are not effective. The reason they have not jumped right into surgery is because of its risks and the possibility that it will not help. But clearly, surgery does address ligament and tendon problems. These problems can also be addressed in a non-surgical manner.
References
1 Aicale R, Maffulli N. Rotational ankle instability: A current concept review. Journal of Orthopaedic Surgery. 2023 Jun 7;31(2):10225536231182347. [Google Scholar]
2 Loozen L, Veljkovic A, Younger A. Deltoid ligament injury and repair. Journal of Orthopaedic Surgery. 2023 Jun 8;31(2):10225536231182345. [Google Scholar]
3 Obionu K, Palm H, Astrup Y, Lange NB, Krogsgaard MR. A clinical guide to the medial ligaments of the ankle: Anatomy, function, diagnosis of injuries and treatment of instability-a narrative review. Foot and Ankle Surgery. 2023 Nov 2. [Google Scholar]