Distortions (sprains) often occur in the arms and legs during sporting activities, but also in everyday life. Most incidents do not result in serious structural damage, i.e. an injury with permanent consequences. Nevertheless, a torn ligament or tendon can occur. A clinical-manual and imaging examination is usually necessary for a definitive diagnosis.
Achillodynia
Achillodynia is the term used to describe painful damage to the Achilles tendon. The condition occurs almost exclusively in people who are active in sports (especially runners, triathletes, football and tennis players) and is one of the most common sports injuries. It is usually caused by repeated incorrect or excessive strain on the Achilles tendon. Achillodynia is typically characterised by load-dependent pain in the area of the back of the lower leg and the heel. Non-surgical methods (orthopaedic technology and physiotherapy) are usually used to treat Achillodynia. If the damage is recognised and treated in good time, progression can be prevented or at least slowed down.
In the case of an Achilles tendon rupture, the Achilles tendon is completely severed. This injury is usually caused by overstressing the tendon during sporting activity. When the Achilles tendon ruptures, this is usually associated with a characteristic pop. An Achilles tendon rupture typically affects people between the ages of 30 and 50. If the Achilles tendon is torn, this is known as a partial Achilles tendon rupture. The Achilles tendon is essential for walking and running. Therefore, if the tendon is torn, it is essential to undergo prompt and professional surgical or conservative treatment.
Therapy
The aim of treatment for an Achilles tendon rupture is to restore the tendon’s load-bearing capacity and full functionality in the upper ankle joint. Both surgical and non-surgical methods are available, with conservative, non-surgical therapy being used more and more frequently. In the meantime, the affected foot is no longer immobilised in a cast for several weeks, as was common practice for a long time (both after surgical and non-surgical treatment). This measure has now been replaced by early, limited movement therapy, known as functional treatment. Special shoes are available for this, which – equipped with an appropriate heel elevation and a non-flexible tongue – even allow the affected person to put full weight on the foot after a few days. As it takes at least six weeks to heal after an Achilles tendon rupture, functional treatment is required for just as long.
For conservative treatment to be successful, an ultrasound examination (sonography) should be carried out by an orthopaedic surgeon with ultrasound experience immediately after the Achilles tendon rupture to ensure that the torn ends of the tendon are in contact with each other when the foot is lowered by around 20 degrees in the so-called pointed foot position. The earlier the non-surgical therapy begins, the greater the chance that it will be successful. It may be necessary to wear a plaster cast for about a week. With the help of special shoes, patients can put full weight on the foot after a short time without disrupting the healing process. In the further course of treatment, regular check-ups should be carried out by an orthopaedic surgeon, if necessary with an ultrasound examination.
If the Achilles tendon rupture is treated surgically, the torn ends are stitched back together. After the operation, the foot must be immobilised in a cast for a few days until the skin wound has healed. Early functional treatment, similar to non-surgical treatment after an Achilles tendon rupture, is then possible.
Supination or, more rarely, pronation trauma – commonly known as “twisting your ankle”.
A torn collateral ligament usually does not require surgery. It has been shown that a functionally good result can be achieved without surgery, even with severe injuries to the collateral ligament apparatus. The ankle joint is immobilised for six weeks in a cast, special shoe, splint or orthosis (see illustration). The foot can be loaded as far as the pain allows. Healing takes about eight to twelve weeks. Sports involving contact, impact or jumping should be avoided for at least three months, and in any case until the foot is completely pain-free again.
An ankle ligament tear is a partial or complete rupture of one or more ligament structures. The affected joint shows swelling with pain and haematoma. Torn ligaments are usually treated by immobilisation for 2-6 weeks or surgically by suturing the ligaments or fixing the torn pieces of bone.
The ski thumb is the classic ligament injury of the hand in which the thumb is overstretched outwards, i.e. away from the hand, causing the ligament on the little finger side of the metacarpophalangeal joint of the thumb to tear. The normal function of the ligament is to stabilise the so-called bottle grip. If the ligament were not present, the thumb would bend outwards when forcefully gripping a bottle. Such a ligament tear occurs most frequently when skiing: You fall onto the piste with your thumb or get caught in the strap of the ski pole. However, the ulnar (ulnar-side) capsular ligament apparatus at the metacarpophalangeal joint of the thumb can also be torn when a ball collides with the thumb during a kick, gymnastics, wrestling and self-defence sports.
Typical symptoms of “ski thumb” are pain and swelling in the area of the thumb, which moves outwards abnormally. The first thing to do is to immobilise the thumb with a temporary splint and cool it with ice pads. The joint is unstable when completely torn and a full water bottle can typically not be held in the hand. To rule out fractures or bony ligament tears, a digital X-ray of the thumb in two planes is mandatory. This can also be performed as a manual functional test in real time under fluoroscopy (if necessary in lateral comparison) in order to clarify both bony and ligament injuries or instability. In the case of a strain, it is sufficient to immobilise the thumb in a metacarpal thumb orthosis (see illustration).
In the case of complete instability, however, conservative treatment is not promising and surgical repair is absolutely necessary.