Tendon or ligament injury
Tendons attach muscle to bone and ligaments attach bone to bone. The pain experienced can feel the same which can make it difficult to be exact when diagnosing an injury. Tendon or ligament injuries can occur in many different parts of the body. The lower limb and foot is a very complex structure (see picture – and that is just one side view!!) with many tendons and ligaments. Overuse or abnormal function can lead to increased stress placed on these structure and result in injuries.
Both tendons and ligaments are made up of connective tissue called collagen fibres. In a tendon the fibres are parallel, allowing for more elasticity which makes them more suited to connecting the muscle to the bone. The fibres in ligaments however criss-cross to keep the ligament stable and ultimately to support, stabilise and strengthen the bone joints.
Like with ligaments, tendons if over strained can become damaged and even snap. A partially torn tendon can cause swelling and discomfort but can be healed over time whereas a clean break in a tendon can cause a complete loss of movement and may result in permanent damage and surgery.
One of the most common tendon injuries in athletes is damage to the Achilles Tendon which connects the heel to the muscle in your lower leg and is caused by over strain or improper footwear or poorly aligned feet. In order to prevent injury to this area, is to ensure that you warm up sufficiently before any vigorous sporting activity and also wearing supports which are specifically designed for that area to offer support and/or realignment (orthotic insoles) if needed.
Although ligaments are strong and rigid by nature, strains and sudden forces can cause them to rupture and tear which is a common sports injury, especially in sports where sudden stop-start and turning movements are key. Damage is caused when the fibres become torn. The severity depends on the extent to which they have torn and the pain experienced as a result. Because of the lack of blood supply to the tissue, sometimes damage can become permanent. If a ligament is stretched past a certain point or repeatedly injured, it can result in the ligament never returning to its original state or strength.
The most common ankle ligament injury results from a lateral ankle sprain or rolling over on the outside of your ankle. There are three main outer ankle ligaments. The anterior talo-fibular ligament, the calcaneo-fibular ligament and the posterior talo-fibular ligament. Any one of these can be over stretched due to excess rolling motion. The severity of a ligament injury can be classified by a grading system. Grade 1 is a mild “stretch” of the ligaments, Grade 3 is a complete tear of the ligament and Grade 2 is everything in between.
It can be very difficult to be able to distinguish between a ligament and tendon injury due to their symptoms being very alike. X-rays or scans can be effective but due to their expense and the symptoms presented, in most minor cases this would not be necessary. As the symptoms are similar this also means the treatment options are very alike too. The most important thing is to make sure you do not leave any injury untreated to prevent further damage. The following treatments are typical for tendon or ligament injury:
> RICE –Rest / Ice / Compression / Elevation
>Medication initially if pain is severe
> When swelling and inflammation have ceased lower limb and ankle stretches/strengthening exercises can begin
> The time scale for returning to activity depends on the severity and how consistent you are in following a recovery/strengthening program
> It may be necessary to support the ankle with strappings or taping for a short period after returning to activity
> Returning too quickly can increase chance of injury reoccurring
> Orthotic insoles – if the alignment or positioning of the ankle and/or foot are abnormal, this can result in increased risk of sprains. Insoles may be helpful to realign and offer maximum support and reduce risk of reoccurrence.
> Total immobilisation may be necessary in severe cases (ankle boot/ crutches)
> Surgery may be required in very severe cases.