Ligament instabilities of the ankle joint

Ligament instabilities of the ankle joint are less common in children and adolescents than in adults, but occur more frequently in young people who are active in sports. The most common cause is repeated overstretching or tearing of the outer ligaments, usually as a result of twisting an ankle while running or jumping. These instabilities are not usually congenital, but are caused by accidents or chronic overuse.

When ligaments tear pieces of bone - bony and cartilaginous ligament tears in the ankle joint

Sometimes when you twist your ankle, the ligaments are not only overstretched or torn. Small pieces of bone or cartilage can also tear off where the ligaments are attached to the bone. These injuries are called bony or cartilaginous ligament tears.

A closer look: What happens in the event of a bony or cartilaginous avulsion?

The ligaments are like strong ropes that hold the bones in the ankle joint together. They are attached to the bone at certain points. The younger you are, the higher the proportion of cartilage in the area of the ligament attachment points. In the event of a sudden, heavy load, such as when you twist your ankle, there can be so much tension on the ligaments that a small piece of bone or cartilage is torn off at the attachment point. This can happen on both the outside and inside of the ankle joint.

Those affected complain of pain, swelling and unsteadiness when walking or running. The ankle joint can feel unstable and tends to twist again. In some cases, this leads to restricted movement or permanent discomfort. Pain from a bony or cartilaginous avulsion can last longer and be more intense. Sometimes there is also a palpable or visible deformity if a larger piece is torn off. In the medium term, cartilaginous tears lead to ossification and often also to an enlargement of the torn piece, which can then painfully restrict the mobility of the ankle joint. The reduced ligament tension makes it easier to twist the ankle and those affected often feel significantly less stable than before the tear.

Clinical tests and imaging procedures such as MRI or X-ray are used for diagnosis.

Treatment depends on the severity of the instability. Mild cases can be treated conservatively with physiotherapy, stabilisation training and special supports. The aim is to strengthen the muscles and improve the balance of the ankle joint.

In cases of chronic or severe instability, surgery may be necessary to reconstruct or strengthen torn ligaments. Surgery is followed by a rehabilitation phase with targeted training. Orthopaedic insoles or splints can also contribute to stability.

Without treatment, ankle ligament instability can lead to permanent pain and repeated injuries. This can restrict sporting activity and impair joint health in the long term. With early and appropriate treatment, the chances of recovery are good. Most children and adolescents can return to unrestricted sport after rehabilitation. Targeted prevention through stabilisation training can prevent future injuries.