Deltoid Ligament Strain

Abstract

Patients with deltoid ligament strain complain of pain just below the medial malleolus. Plantar flexion and eversion of the ankle joint exacerbate the pain. Often, patients with injury to the deltoid ligament note a pop, followed by significant swelling and the inability to walk.

On physical examination, patients have point tenderness over the medial malleolus. With acute trauma, ecchymosis over the ligament may be noted. Patients with deltoid ligament strain have a positive result of the eversion test, which is performed by passively everting and plantar flexing the affected ankle joint. Coexistent bursitis and arthritis of the ankle and subtalar joint may also be present and may confuse the clinical picture.

Keywords

deltoid ligament, strain, sprain, ankle pain, sports injury, magnetic resonance imaging, diagnostic sonography, ultrasound guided injection, avulsion fracture, ankle eversion test

ICD-10 CODES S93.429A

Keywords

deltoid ligament, strain, sprain, ankle pain, sports injury, magnetic resonance imaging, diagnostic sonography, ultrasound guided injection, avulsion fracture, ankle eversion test

ICD-10 CODES S93.429A

The Clinical Syndrome

The deltoid ligament is exceptionally strong and is not as easily strained as is the anterior talofibular ligament. However, the deltoid ligament is susceptible to strain from acute injury resulting from sudden overpronation of the ankle or repetitive microtrauma to the ligament from overuse or misuse, such as long-distance running on soft or uneven surfaces. The deltoid ligament has two layers, both of which attach to the medial malleolus above it ( Fig. 123.1 ). The deep layer attaches below to the medial body of the talus, and the superficial fibers attach to the medial talus, the sustentaculum tali of the calcaneus, and the navicular tuberosity.

Signs and Symptoms

Patients with deltoid ligament strain complain of pain just below the medial malleolus. Plantar flexion and eversion of the ankle joint exacerbate the pain. Often, patients with injury to the deltoid ligament note a pop, followed by significant swelling and the inability to walk ( Fig. 123.2 ).

On physical examination, patients have point tenderness over the medial malleolus. With acute trauma, ecchymosis over the ligament may be noted. Patients with deltoid ligament strain have a positive result of the eversion test, which is performed by passively everting and plantar flexing the affected ankle joint ( Fig. 123.3 ). Coexistent bursitis and arthritis of the ankle and subtalar joint may also be present and may confuse the clinical picture.

Testing

Plain radiographs are indicated for all patients who present with ankle pain ( Fig. 123.4 ). Magnetic resonance imaging (MRI) and ultrasound imaging of the ankle are indicated if disruption of the deltoid ligament, joint instability, an occult mass, or a tumor is suspected ( Figs. 123.5, 123.6, and 123.7 ). Radionuclide bone scanning should be performed if occult fracture is suspected. Based on the patient’s clinical presentation, additional testing may be warranted, including a complete blood count, erythrocyte sedimentation rate, and antinuclear antibody testing.