The talonavicular joint is the connecting link between the anterior navicular and inferior calcaneus bones. This joint is a kind of support for the foot, so any damage to it can lead to diseases of other joints and cause disturbances in the motor functions of the lower extremities. The most common pathology is arthrosis of the talonavicular joint, a characteristic feature of which is longitudinal flatfoot.
This type of arthrosis is a dangerous disease that leads to joint deformation. In this case, complications such as scoliosis, deforming arthrosis and pathologies of the hip and knee joints are possible.
This type of arthrosis of the calcaneal-phalangeal joint is characterized by the following features:
There are a large number of reasons that can provoke the development of arthrosis affecting the talocaleonavicular joint. The most common of these include the following factors:
All of the above reasons lead to depletion of bone and cartilage tissue and ultimately cause their deformation.
Arthrosis of the talocaleonavicular joints can develop in any person. However, experts identify a group of people most susceptible to this disease. These include:
This type of pathology is characterized by all the main signs of arthrosis. These include:
In addition, the symptoms of talonavicular arthrosis largely depend on the degree of the disease. According to the international classification, there are three degrees of this pathology. Let's look at them in more detail.
At the initial stage, the disease manifests itself as minor pain, which makes itself felt mainly during physical activity or minor injuries to the foot. In addition, the following symptoms are observed:
Stage 2 of this type of arthrosis is characterized by increased manifestation of symptoms of the previous stage. Other signs also appear:
Stage 3 is characterized by the following manifestations:
It should be emphasized that the pathology of the metacarpophalangeal region is a fairly serious disorder, fraught with numerous complications on nearby joints and muscle tissue.
In its advanced form, the disease can even lead to disability, therefore, if at least a few of the above symptoms are detected, it is recommended to immediately seek advice from an orthopedic doctor, surgeon, traumatologist or rheumatologist.
This type of articular arthrosis is diagnosed based on studying the general clinical picture during a medical examination. The fact is that this type of pathology of articular joints is characterized by certain visual signs. These include:
However, the symptoms of arthrosis of the calcaneonavicular joint are in many ways similar to the symptoms of a number of other diseases (gout, fracture of the foot bones, etc.). To avoid medical errors, the following types of studies are used to confirm the diagnosis and determine the degree of pathology:
Timely diagnosis and a properly selected therapeutic course will greatly facilitate the treatment process and avoid possible complications.
Treatment of this type of pathology is selected individually by the attending physician.
Therapy depends on the degree of arthrosis, the general condition of the patient, and the presence or absence of certain diseases.
However, to achieve a favorable result, treatment must be comprehensive and systematic. In most cases, the following therapeutic procedures are used to combat this pathology:
In addition, the patient will need to give up fatty and fried foods, alcoholic beverages and nicotine. But fresh vegetables, fruits and calcium-rich dairy products should certainly be included in the daily diet.
The talonavicular joint is a support that takes on most of the load during movement, so pathologies of this joint can lead to serious health consequences. To prevent this from happening, the patient must undergo the necessary course of treatment, strictly following all the recommendations of the orthopedic doctor. As a rule, according to statistical data, if these conditions are met, in 75% of cases this pathology can be completely cured without subsequent relapses.
If a person is overweight, the situation gets worse.
Diagnosis of this type of arthrosis, like all other types, is carried out through x-ray examination. An X-ray image gives a clear clinical picture of the main signs characteristic of arthrosis of the talonavicular joint. It consists of a narrowing of the joint space and the formation of a cyst (a cavity filled with joint fluid); concomitant sclerosis of the subchondral bone is also observed (a pathological process in bone tissue in the form of its deformation and proliferation, developing as a result of chronic damage). Treatment of the disease requires a long time, but with the right approach and the patient fulfills all the necessary conditions, you can get rid of it.
Medicine divides the main factors that provoke pathology into primary and secondary. The primary causes are the above-mentioned injuries that do not go away without a trace (severe ankle bruises, dislocations, subluxations, sprains, fractures). Experts identified secondary causes as inflammatory processes occurring in the joint, provoked by the presence of infection in the body or hypothermia (polyarthritis, rheumatoid arthritis, etc.). Up to 85% of men and women whose age exceeds 55 years suffer from primary and secondary arthrosis.
Other factors in the development of the disease: genetic predisposition, wearing tight shoes and high heels, articular dysplasia (congenital abnormalities in the structure of the foot that affect its functioning), incorrect location of the joint, ligamentous disorders. All of them entail rapid wear and tear of the bone and cartilage tissue of the joint, and its deformation.
The following can also cause arthrosis: metabolic disorders, endocrine diseases, flat feet and excess body weight.
This form of the disease manifests itself in the same way as its other varieties. First of all, the patient experiences severe swelling of the foot and ankle, a rough crunching sound when moving the foot (a consequence of osteophytes - bone growths - appearing on the articular surfaces). The most pronounced symptoms: pain when flexing and extending the foot, pain in the ankle when walking. Prolonged pain of aching or acute nature significantly complicates movement, sometimes becoming unbearable. As a result of the lesion, the muscles adjacent to its source are injured, which leads to the spread of inflammation to other joints. The patient loses the ability to move his leg freely, and a feeling of stiffness appears. The more advanced the disease, the more intense the pain syndrome. If you experience the first pain in your foot or ankle, even if it is minor, you should consult your doctor immediately.
At the initial stage, arthrosis manifests itself weakly, so its presence can only be detected by x-rays. As the pathology progresses, the symptoms become more pronounced and painful for the patient.
Depending on the clinical signs, this pathology of the talonavicular joint is divided into three degrees.
The first degree represents the initial stage of the development of the disease. It is characterized by periodic pain in the back of the foot, fatigue and pain after physical activity (especially long-term).
The second degree is expressed by pain of greater intensity. At this stage, the head of the so-called metatarsal bone thickens, and osteophytes are formed, which slightly limit the mobility of the joint.
The third degree of arthrosis is accompanied by pronounced deformation of the joint, the thumb is practically immobilized. It goes down, while the patient can move it very slightly and exclusively in the direction of the sole.
Therapy for arthrosis of the talonavicular joint is prescribed by a specialist. It is complex and, as a rule, includes: taking medications, physiotherapy, wearing special orthopedic devices, physical therapy (physical therapy), proper nutrition, and sometimes unconventional methods of influence. If time has been lost and the disease has become chronic, only surgery can save the functioning of the joint and relieve the patient from suffering.
Medicines of various effects are used in the form of tablets, injections, ointments, intra-articular and intramuscular injections. For example, non-steroidal anti-inflammatory drugs (NSAIDs) suppress the inflammatory process and relieve pain. Muscle relaxants relax muscles and prevent spasms caused by pain.
To avoid complete muscular dystrophy (in an advanced form, the muscles stop working), it is necessary to perform physical therapy exercises. This moderate load will restore mobility to the foot and strengthen the ligaments, thereby reducing the load on the affected joint.
Non-traditional therapy for arthrosis of the scaphoid joint includes various techniques, such as: herbal medicine, acupuncture (acupuncture), apitherapy (treatment with live bees and bee products), pelotherapy (clay and mud therapy), oriental practices, hirudotherapy (treatment with medicinal leeches ), folk recipes, etc.
There are a huge number of recipes for potions from medicinal plants. The advantage of phytotherapeutic methods is the absence of chemicals in medications, which makes them more harmless to the body, and their ability to strengthen the immune system and the body as a whole.
Apitherapy and hirudotherapy are widespread medical practices. They improve blood circulation through the vessels, facilitating the supply of oxygen and nutrients to the affected joint tissues. At the same time, special natural elements are added that have a positive effect on ankle health.
According to critics, herbal medicine and traditional medicine in general require a lot of time, weeks, and sometimes many months to prepare tinctures, decoctions, compresses, etc., and then to use them, wasting precious time when you need to immediately save functionality of the foot. In fact, the secret to effective treatment of the talonavicular joint with arthrosis is complex treatment, which certainly combines traditional therapy and traditional medicine. Both should be prescribed by the attending physician or done after consultation with him, since self-medication can cause irreparable harm.
Other important components in the fight against arthrosis are massage, proper nutrition and giving up bad habits, which normalize metabolic processes in the body. A healthy lifestyle is the best prevention of this joint disease.
Our feet bear a significant load - the weight of the body. They give us the opportunity not only to stand, but also to run, jump, climb mountains, and walk on tiptoe.
In order to successfully cope with these tasks, they have a complex structure.
The human foot includes 26 bones connected to each other by many joints. This helps them bend, straighten and even rotate as needed.
What diseases are our joints susceptible to?
Joints, like any other organ, are susceptible to many diseases. Any articular pathologies are divided into main groups:
When flexing and extending the foot, pain appears. At first it is intermittent and can only be felt when walking on an uneven surface. But over time, the pain intensifies and in the future can be felt even at rest.
Arthrosis of other joints of the feet occurs much less frequently and usually in old age - as a manifestation of age-related osteoarthritis. Their main symptoms will be pain in the legs when walking and limited movement.
But orthopedist Sergei Bubnovsky claims that a truly effective remedy for joint pain exists! Read more >>
The articular center of the foot includes the talocalcaneal-navicular joint; it is spherical in shape, thanks to which the foot can perform many movements.
Behind and below it is the heel bone, in front is the middle part of the foot - the metatarsus, to which the phalanges of the fingers adjoin.
Fast walking, running, heavy weights, inflammation, incorrectly selected shoes, unbalanced nutrition will definitely affect the health of our joints. More often this happens in old age. But with the intense pace of life, diseases become younger, and foot problems are no exception.
Of course, the most mobile joints suffer the most. The more movements, the higher the load and the greater the risk of microtrauma.
These include the talocaleonavicular and first metatarsophalangeal joint - the junction of the metatarsus with the first toe. Unlike the other fingers, it is the first one that has:
And therefore, arthrosis of the first metatarsophalangeal joint is a common disease of the legs.
The main symptoms of this disease are pain and swelling. With arthrosis, the thumb becomes enlarged and may turn red or deviate to the side. His skin will feel hot to the touch due to a slight increase in temperature. Often a person begins to limp in order to ease the load on the affected area and reduce pain.
A deformed joint is easy to detect - at the junction of the metatarsus with the first toe, a dense “bump” is felt or simply visible. But all these symptoms do not appear immediately. In its development, metatarsophalangeal arthrosis goes through 3 stages:
If you notice arthrosis at the first stage and eliminate the cause - change shoes, give up high heels, reduce stress, then the disease will stop. At the third stage of arthrosis, only surgery can help.
Since the talocaleonavicular joint is located almost in the center of the foot, the load on it will come from both above and from the sides. And the main reasons for the development of arthrosis will be:
Deformation of the talocalcaneal-navicular joint also develops with injuries to the ankle joint. When it ceases to perform its function, the direct load on the talocalcaneal joint increases, which leads to its damage. Sometimes the disease is complicated by the addition of an inflammatory process - arthritis develops.
With talocaleonavicular arthrosis, the feet swell in the upper part, closer to the ankles.
Sometimes there is severe deformation of the talocaleonavicular joint, pain also appears when palpating the top of the foot. You can also feel a crunching sensation in the upper part of the foot, especially when flexing or extending it, and stiffness of movement.
Radiography is widely used for diagnosis. In difficult cases, computed tomography is used. Ancillary methods include a biochemical blood test for suspected arthritis (rheumatic tests).
The basis of treatment is analgesics for pain relief and anti-inflammatory drugs in case of arthritis. Chondroprotectors are successfully used to restore cartilage.
For deforming arthrosis of the metatarsophalangeal joints, movement limiters - splints - are used. In severe cases, surgical treatment is performed.
But orthopedist Sergei Bubnovsky claims that a truly effective remedy for joint pain exists! Read more
Heel arthrosis is a deforming disease of the joint. It manifests itself in the form of inflammation of tissues and the formation of a small growth on them. Such changes are caused due to poor circulation in the foot and improper metabolism in the cartilage.
Arthrosis of the heel bone is a fairly common disease among lovers of high heels. This arthrosis resembles a small protrusion on the heel. Also, arthrosis of the heel bone can develop due to a recent leg fracture or flat feet; strong physical stress on the legs (important for athletes and runners) can also be a cause. The disease develops quite quickly, but luckily it can be treated.
The main symptoms of this disease:
Symptoms of heel arthrosis:
As you can see, the symptoms of the disease are quite pronounced.
Only an x-ray can detect arthrosis in the early stages, since at first there are no visual changes on the heel, and the symptoms are insignificant for a long time.
The etiology of calcaneal arthrosis is different. The causes of the disease may depend on impaired metabolism, excess body weight, inflammatory processes in the body, injuries received during life, joint dysplasia, as well as arthrosis of the spinal column, kneecaps and hip joints.
Unlike any other type, it is quite easy to cure arthrosis of the heel bone. However, this does not mean that going to a specialist should be put in a dark box. Already in the first stages of the disease, you need to consult a doctor so that you can be promptly prescribed treatment. And remember, the main goal of treatment is to prevent surgery.
It is important to know: treatment of heel arthrosis takes place in a mixed manner and has a complex form. That is, both medicine (medicines, physiotherapy, and so on) and traditional treatment (compresses, ointments, and so on) are used in treatment. Today we will look at each of them in detail.
For the treatment of arthrosis of the first degree, the following is used:
Treatment of arthrosis of the second and third degrees takes longer and is not as simple as the previous one:
In addition, symptoms of degrees 2 and 3 are more pronounced and much more noticeable.
Non-steroidal and anti-inflammatory drugs, as mentioned above, relieve inflammation in the diseased area and hide the symptoms of the disease. But, at the same time, this group of drugs has a number of contraindications. For example, they are contraindicated for people with problems related to the kidneys, liver and heart.
It is important to know: if you fall into the category of those for whom these medications are contraindicated, then an injection into the sore joint will help relieve pain (symptoms).
Although physiotherapy is a rather controversial method of treatment (some doctors claim that it helps a lot in treatment, while others say the opposite), and the treatment is quite lengthy, it also allows you to restore joint mobility and relieve inflammation for a long period of time (unlike ointments and medications whose duration of action is limited to a few hours).
Therapeutic exercises are an excellent method for restoring joint mobility, as it relaxes the joints and perfectly tones the muscles.
It is important to know: therapeutic exercises should be moderate, as this is a load on the joints, which, as you already know, should be avoided.
Foot surgery is the most extreme treatment and is used when all of the above methods have not worked or arthrosis is detected at a late stage.
Surgical methods:
Even despite the abundance of all kinds of medical methods for treating a particular disease, people will still turn to folk remedies when the symptoms of the disease do not allow them to lead a normal life. These include tinctures, compresses, and all kinds of ointments that act as additional treatment. Let's find out more about everything.
A universal compress that allows you to treat heel arthrosis: pour three tablespoons of oatmeal with two glasses of boiling water and boil this mixture for ten minutes. You need to apply the compress to the sore spot for one hour.
Ointments are also quite popular. They can be purchased at any pharmacy, and the instructions for use are the same for all of them (apply overnight and during this time it will be absorbed by itself).
Ankle injuries received by a person during his life can result in an unpleasant disease called “arthrosis of the talonavicular joint.”
Unfortunately, this pathology and its symptoms can develop at a fairly young age, after 20 years, when growing young legs experience excessive stress, sprains and bruises caused by an active lifestyle.
Extra pounds on the body only aggravate the situation. Arthrosis of the talonavicular joint takes a very long time to treat, but strict adherence to all medical recommendations allows you to get rid of the disease forever.
One of the main provoking factors for heel disease is injuries to the lower limb. These can be subluxations, dislocations, severe bruises, fractures, and ankle sprains. Not a single injury like this goes away without leaving a trace.
Doctors consider the second cause of heel arthrosis to be inflammatory processes occurring in the patient’s body. The development of arthrosis of the talonavicular joint can provoke rheumatoid arthritis.
Doctors call the third reason congenital joint dysplasia - a deviation in the structure and functionality of the foot. Problems with the ligamentous apparatus and incorrect positioning of the joint lead to bones and cartilage tissue wearing out and deforming faster. In addition, arthrosis in the heel can cause flat feet.
Another negative factor that can cause navicular arthrosis is excess weight. Therefore, a person must control his body weight, for this he must follow proper nutrition standards.
Deforming arthrosis of the foot or arthrosis in the heel area of the first degree has mild symptoms. Therefore, it is only possible to determine the abnormalities that have arisen in the joint using x-rays. An X-ray will mainly indicate:
Significant manifestations of arthrosis of the talonavicular joint include severe pain that occurs when walking on an inclined surface. The higher the stage of the pathology, the more painful and intense the pain becomes when moving.
Complex treatment of talonavicular arthrosis is prescribed by a doctor. What techniques are included in the therapeutic complex? Most often, measures to save the affected joint include:
In order to overcome the main symptoms of the disease, drugs of various groups are prescribed. To suppress the inflammatory process, non-steroidal anti-inflammatory drugs are used, and they also relieve pain.
Muscle relaxants help relax the muscle structure, and they also prevent spasms caused by pain. The drug treatment proposed by conservative medicine is:
Despite the rapid effectiveness of pharmaceuticals, almost all of them leave a negative mark on other human systems and organs. In addition, some strong non-steroidal and steroidal medications designed to combat osteoarthritis completely destroy cartilage and aggravate the already bleak picture of the disease.
In other words, injections will cope with excruciating pain, but will accelerate the destruction of cartilage tissue, which will cause the progression of arthrosis.
Cartilage restoration is ensured by taking chondoprotectors. These drugs are extracts from animal bones. The active ingredients in chondoprotectors are glucosamine and chondroitin. They are also part of the structure of cartilage.
In the initial stages of arthrosis, chondro-medicines in combination with other medications will completely relieve the patient of the disease. In the second stage of arthrosis, they slow down the destructive process and degenerative changes in the joints.
To prevent the patient from developing complete muscle atrophy, in the later stages of arthrosis it is recommended to perform moderate physical exercises, which are included in the course of therapeutic and recreational measures. Exercise therapy is aimed at restoring the lost range of motion to the foot and strengthening the ligamentous apparatus, which will reduce the main symptoms of the disease.
Non-traditional methods of treating arthrosis of the scaphoid joint include:
Traditional healers offer a huge number of recipes, which are based on medicinal mixtures.
Getting rid of talonavicular arthrosis using bee stings and leeches are very common methods. Both of these types of treatment provide increased blood circulation in the blood vessels, which carries nutrients and microelements to the organs and tissues of the suffering joint.
Thus, the patient’s body is enriched with natural elements that can have a positive effect on the health of the ankle.
Opponents of alternative methods of treatment argue that traditional medicine and herbal medicine cannot provide a complete and rapid recovery. During the preparation of potions, decoctions and compresses (their preparation sometimes takes several months), the patient only loses precious time, which he can successfully spend on complex treatment with medications.
But any drug treatment should be prescribed only by a doctor. Self-medication for arthrosis of the talonavicular joint can provoke the development of more serious and dangerous inflammatory processes, in which the symptoms of the disease will only worsen. In this case, any therapy will be powerless.
During the evolution of the foot, its main function was laid down - to ensure a stable vertical position of the human body. The body's weight is distributed over a fixed surface area, so the taller the person, the wider the foot. Violation of this pattern - the correct distribution of the load - is likely to be the culprit of arthrosis of the talonavicular joint, and this is fraught with a decrease in the mobility of the foot.
The conditional line of gravity runs beyond the hip joint, crosses the plane of the knee and rests on the talonavicular joint. The position of the talus creates lateral stability, while the main load is placed on the inner fragment of the foot.
Over time, uneven load can give impetus to the formation of arthrosis of the talonavicular joint of the foot and cause its deformation. As a consequence - arthrosis of the knee/hip joint, curvature of the spine.
After the age of 20, the disease very often develops from flat feet. Also, the process of bone tissue growth at this time period has not yet been completed. Excessive loads, bruises and sprains - accompanying the active lifestyle of runners, gymnasts, wrestlers, boxers, dancers - can cause deforming arthrosis of the talonavicular joint at a fairly young age. The chronic form of arthrosis often occurs in women after forty years.
About 80% of women and men aged 55 suffer from arthrosis of the foot.
Impaired mobility in the talonavicular joint due to swelling
Initially, articular cartilage, whose function is to protect bones, is affected. Hence the second name of the disease - deforming arthrosis of the foot. Cartilage tissue loses its elasticity, the process of destruction begins, the shock absorption function is suppressed, tendons and ligaments fail. Blood microcirculation is disrupted.
Due to osteophytes (growths on the bone) formed on the articular membranes, the patient develops a characteristic crunch and pain when moving the foot, and severe external and internal swelling and pain develops in the ankle. These factors lead to the main symptom of deforming arthrosis of the talonavicular joint of the 2nd degree - difficulty in movement, because movement is accompanied by sharp or aching pain. The area of the damaged area increases, inflammation is transferred to muscle tissue and other joints.
There is a feeling of stiffness, the patient is no longer able to move his leg freely.
The more advanced the degree of the disease, the more intense the pain syndrome
Initially, the disease is mild, its presence can only be detected using an x-ray. X-ray examination gives a clear clinical picture inherent in arthrosis of the talonavicular joint: cyst formation, narrowing of the joint space, curvature and hyperplasia of bone tissue. If all the requirements of the attending physician are met and with the correct method chosen, the treatment of arthrosis of the talonavicular joint is, perhaps, very effective.
A conscript with grade 2 arthrosis of the talonavicular joint is not in danger of joining the army.
Running and other loads on the musculoskeletal system, as required by military service, are contraindicated for this disease. The diagnosis is determined by an orthopedic surgeon at a local clinic; the military commissar only refers to the doctor’s opinion.
Specialists take a comprehensive approach to the treatment of arthrosis of the talonavicular joint:
To prevent their destructive effects on cartilage, chondroprotectors (a natural component from animal tissues and bones) are successfully used.
At the initial stage of the disease, they are able to eliminate the source of the disease, and if pathology has already occurred, they slow down the process of degeneration and dystrophy of the joint. It is effective to inject chondoprotectors directly into the joint capsule. Injections of hyaluronic acid have also proven themselves well;
These techniques improve blood flow through the vessels. The result is a more effective saturation of the affected tissues with oxygen and trophic substances.
The combination of traditional and folk medicine is the secret to effective treatment of arthrosis.
In any case, no matter what method you choose for yourself, consultation with a specialist is necessary. In advanced forms of the disease, surgical intervention can save the function of the joint and relieve excruciating pain.
Sprains of the lateral ankle ligaments usually occur during walking or landing after a jump if the foot is subjected to supination and internal rotation at the moment of contact with the support while simultaneously externally rotating the tibia. If the stretch exceeds the tensile strength of the ligament, damage occurs. The likelihood of injury increases with additional plantar flexion of the foot.
Usually the anterior talofibular ligament is affected, followed by the calcaneofibular ligament. After a rupture of the anterior talofibular ligament, the mobility of the ankle joint in the horizontal plane (internal rotation) sharply increases, which contributes to damage to the remaining ligaments. This factor - the so-called rotational instability of the ankle joint - is often missed when examining the patient. Damage to the lateral ligaments is often accompanied by damage to the ankle joint capsule and subtalar joint ligaments (for the latter, the incidence of damage reaches 80%).
The cause of a sprained lateral ligament may be excessive mobility in the subtalar joint. Facilitated supination may thus cause the rearfoot to roll in and internally rotate in closed-loop motion and lead to damage to the lateral ligaments. Individuals with a rigid supinated foot are likely to have calcaneal varus clubfoot and a lateral deviation of the axis of rotation at the subtalar joint, which predisposes to lateral ligament injury.
Can the peroneal muscles protect the lateral ligaments from damage during rapid supination of the foot? The peroneal muscles begin to contract even before the foot touches the support when descending stairs or landing after a jump. As a result of the preliminary readiness of this and other muscle groups, the tendons become rigid before the foot contacts the surface and help prevent unexpected supination of the hindfoot.
Predisposition to primary ligament injury is O-shaped curvature of the legs, slight subluxation of the foot, poor posture, decreased proprioceptive sensitivity, predominance of pronation over supination and plantar flexion over dorsiflexion. Future prevention studies should consider these risk factors.
Mostly there is supination damage, which may be accompanied by a cracking or clicking sound. At the same time, the joint swells and becomes painful, pain appears when standing and moving.
It is necessary to determine the extent of the lesion: one or more ligaments are damaged, whether tendons, bones, or nerves are damaged. The physician should sequentially palpate the anterior talofibular, calcaneofibular, and posterior talofibular ligaments, the area of the tibiofibular syndesmosis, the medial (deltoid) ligament, and the medial malleolus. It is necessary to determine whether the lateral malleolus is painful to touch at its posterior edge, palpate the tendons of the peroneal muscles and the base of the fifth metatarsal bone. If the anterior talofibular ligament is injured, the anterior drawer sign will be positive, but the ability to evaluate it in the acute period depends on the severity of the pain. During the test, the patient sits with his legs dangling. The doctor, holding the patient's heel, slightly bends his foot towards the sole, after which with one hand he moves the heel forward and the tibia back. For comparison, the test is repeated on the healthy leg. If there are differences, the symptom is considered positive. A supination test allows one to distinguish between injuries to the anterior talofibular and calcaneofibular ligaments: the doctor rotates the foot inward, first of the injured and then of the healthy leg. Supination during plantar flexion allows us to assess the condition of the anterior talofibular ligament, and during dorsiflexion - the calcaneofibular ligament.
To assess the condition of the tibiofibular syndesmosis, the following tests are performed: compression of the tibia above the ankle joint and external rotation of the tibia. The appearance of pain in the lower part of the syndesmosis should be regarded as a sign of damage, at least until the opposite can be proven.
X-rays can exclude fractures of the fibula, anterior calcaneus, lateral or posterior process of the talus, fractures of the transverse tarsal joint, osteochondropathy of the talus trochlea, and separation of the shin bones (the so-called high sprain, indicating damage to the syndesmosis). Ligament damage and contusion can be confirmed with an MRI.
Initial treatment includes rest, ice, tight bandaging, and elevating the leg. Additionally, electrical stimulation and electrophoresis help reduce pain and swelling. In the absence of fractures and damage to the syndesmosis, rehabilitation begins immediately after the pain subsides. It aims to restore range of motion, strength and proprioceptive sensitivity. If you managed to overcome this stage without pain, proceed to the third stage - the restoration of special skills, such as running, jumping, and quickly changing the direction of movement. To prevent re-injury, you should wear a lace-up ankle brace.
Surgery is indicated for repeated injuries, prolonged pain, persistent swelling, or instability of the ankle.
Many techniques have been described to repair the anterior talofibular and calcaneofibular ligaments. Currently, Brostrom's technique, modified by Gould, is predominantly used, giving excellent results among professional athletes and dancers. In this technique, the reconstructed anterior talofibular and calcaneofibular ligaments are strengthened using an extensor retinaculum, which is placed over the ligaments. Unlike other reconstructive surgeries, this method does not require the use of other tendons to strengthen the joint. After surgery, an orthosis or a plaster boot is put on for approximately 6 weeks, and then the restoration of range of motion and normal rehabilitation begin.