Pain and swelling in the area under the medial malleolus

Introduction Acute ligament injury symptoms of the ankle, medial malleolar ligament injury, pain, swelling, subcutaneous bruising, and limited foot movement.

Cause

(1) Causes of the disease

Direct violence, indirect violence and muscle strain can cause injury.

(two) pathogenesis

The violence that causes acute ligament injury of the ankle is roughly divided into three types: direct violence, indirect violence, and muscle tension. Among them, indirect violence is the main factor. Most of them are inadvertently lost on uneven roads or up and down stairs. The crotch is in extreme valgus and flexion, causing excessive damage to the lateral collateral ligament. The lighter part of the inferior ligament rupture, the severe ligament can completely break the ankle joint subluxation and total dislocation. Or because of the distal valgus and external rotation of the distal end of the ankle, which directly causes damage to the medial malleolus and/or humeral ligament, most of these injuries coexist with internal hemorrhoids and/or external malleolus fractures.

an examination

Related inspection

Ankle joint extension test

diagnosis

1. External ligament injury: the external malleolus ligament includes the anterior talofibular ligament, the iliac ligament and the posterior ligament. As mentioned above, the humeral head of the lateral malleolus is about 1cm longer than the inner iliac crest. When the ankle is sprained, it is easy to cause varus injury, and the lateral ligament is relatively weak, so the lateral ligament injury is more common in clinic. At the moment of trauma, the flexion and extension of the foot is different, and the involvement of the three groups of ligaments is also different. For example, when the plantar flexion occurs, the anterior ligament injury is more than that of the anterior ligament, while the back extension is the ligament injury after the iliac crest, and the patellofemoral ligament injury is more common in the middle position.

(1) anterior talofibular ligament: When the foot is under normal load, the anterior iliac ligament and the long axis of the talus travel in the same direction; when the plantar flexion, the direction of travel is consistent with the longitudinal axis of the tibia, and becomes tense. When subjected to varus stress, the anterior ligament of the iliac crest produces tear and complete rupture.

(2) sacral ligament: When the ankle joint is in a plantar flexion, if the stress of varus is further increased, in addition to the ligament injury before the iliac crest, the iliac ligament may be damaged. If the ankle joint is in a neutral position, when the ankle joint is extremely varused, damage to the ankle and ligament can first occur. The iliac crest ligament is the main structure in the lateral malleolar ligament, which is relatively tough. When the ankle joint is functional, it acts to limit the inversion of the foot. Therefore, once it is broken, the lateral space of the ankle joint is widened.

(3) posterior iliac ligament: the strongest bundle in the lateral malleolar ligament, mainly limiting the excessive extension of the ankle joint. The ligament injury after the interpupillary distance is mainly caused by overrunning of the foot.

2. Inguinal ligament injury: The medial malleolar ligament, also known as the triangular ligament, is also divided into 3 bundles. The front is the anterior iliac ligament, and the middle is the iliac ligament and the posterior iliac ligament. The ligament is divided into two layers, which are very tough and not easy to break. The main function is to limit ankle valgus and excessive external rotation. In most cases, the medial malleolar ligament injury is caused by valgus or external rotation. This external force usually causes a fracture of the medial malleolus and/or external malleolus. But if the violence comes very suddenly, it can also cause the triangular ligament to break. Among them, simple ligament rupture is rare, and more complicated with external malleolus fracture and/or lower ankle joint separation.

3. Inferior iliac ligament injury: The humeral ligament is located at the lower ankle joint, and its ligament is divided into three parts:

1 anterior tibial ligament: from the humerus, obliquely outward and upward, in front of the humerus.

2 intercondylar ligament: from the lateral side of the lower end of the humerus to the inside of the lower end of the humerus, in fact, the continuation of the interosseous membrane, the strongest.

3 posterior malleolar ligament: from the posterolateral aspect of the lower end of the humerus to the inside of the lower end of the humerus The injury of the lower ligament is mainly caused by valgus and external rotation violence. It is not uncommon in clinical practice, but it is easy to miss diagnosis. The injury of the lower ligament with triangular ligament rupture (with or without external malleolus fracture) is usually the first ligament of the triangular ligament. As a result, the tensile stress of the chin ligament suddenly increases, and once it exceeds its maximum, it causes a fracture.

4. Symptoms: Most of the acute ligament injuries of the ankle joint have a clear history of trauma. Clinically, the patient's anterior and posterior sacral swelling and pain, local tenderness, subcutaneous ecchymosis, limited joint activity, and lameness can be found. Pain is aggravated when the foot is passively flexed and inverted, and pain is relieved when the back is stretched and everted. When it is completely ruptured, the ankle joint is in a sacral position and the talus is displaced forward. In addition to the pain, swelling, subcutaneous bruising, and limited movement of the medial malleolus, the medial malleolus ligament may have swelling and congestion in the posterior medial malleolus; the symptoms of the inferior temporal ligament injury are similar to the above, but the pain and swelling are in The front of the ankle is not in the side.

5. Signs: When the external iliac ligament is damaged, the local area has obvious tenderness. The ligaments below the iliac crest are most obvious, and the ligaments are more limited. They are easy to distinguish from the external iliac fractures. The ligaments of the medial malleolus ligament are more likely to be attached to the lower triangular ligament. The patellar ligament injury is tender in front of the ankle joint.

6. Special examination: When the external malleolar ligament is damaged, the foot is passively inverted, the injured ligament is pulled and the pain is intensified. If the forcible varus is affected, the sacral ligament fracture is enlarged; the medial malleolar ligament injury, forced valgus pain There may be depressions in the ligament rupture, fixing the calf, and pushing the heel forward and backward may have an increase in the inner motion range; when the chin ligament is injured, holding the heel as the lateral or rotational movement of the talus, the range of talus activity can be increased. Big.

A clear history of trauma, when the external iliac ligament is damaged, swelling, pain, local tenderness, subcutaneous ecchymosis, lameness, etc., when the medial malleolar ligament is damaged, pain, swelling, subcutaneous congestion, bruising, foot movement limitation, lower When the patellar ligament is damaged, the symptoms are similar to the above, but the pain and swelling are in front of the ankle joint and not on the side.

X-ray examination and stress imaging can indirectly confirm the existence of ligament injury. In addition, ankle angiography can be performed, and the presence of injury can be confirmed indirectly. MRI can determine the extent of hematoma and identify the existence and extent of ligament tear and fracture damage. .

Differential diagnosis

Swelling of the ankle joint: swelling of the ankle joint and movement of the ankle joint.

Ankle pain: Common symptoms include local swelling, pain, ecchymosis, and limited limb activity.

Ankle fracture: The articular surface of the ankle joint is smaller than the joint surface of the hip and knee joint, but the weight and activity are large, so it is easy to cause damage. It accounts for 3.83% of total body fractures. More common in teenagers. Local swelling, tenderness and dysfunction. When diagnosing, the mechanism of injury should be analyzed first based on the history of trauma and clinical symptoms and the type of fracture shown on the X-ray film.

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