Foot Ligament and Tendon Tears

Ankle sprains are a fact of everyday life, and these common foot injuries are the No. 1 reason for missed participation in athletics.

“Acute ankle sprains are among the most common musculoskeletal injuries, and up to 70 percent of individuals who sustain an acute ankle sprain may develop residual physical disability, which may include chronic ankle instability,” says a 2019 study published in the Journal of Athletic Training. “Acute ankle sprains occur at high rates across all levels of sports participation and among other active populations such as active duty military personnel; however, half of all ankle sprains treated in US emergency departments reportedly did not occur during sport activity.”

Ankle sprains occur at a high rate with an estimated 25,000 happening each day in the U.S. Even a slight sprain may include microscopic tearing of the ligament fibers and more severe ankle sprains may result in the partial tearing or complete tear of the ligament.

“An ankle sprain occurs when the strong ligaments that support the ankle stretch beyond their limits and tear. The severity of a sprain can vary greatly depending on the number of ligaments involved and the extent to which the ligaments are torn,” says the American Academy of Orthopaedic Surgeons.

Ligament tears and tendon tears in the foot region sometimes seem interchangeable but they are separate injuries. Let’s examine each closer.

Foot Injuries: Ligament Tears vs. Tendon Tears

Ligament tears, particularly in the ankle, are more common than tendon tears in the foot and ankle region. Ankle sprains, which involve ligament injuries, are among the most frequent musculoskeletal injuries.

The most common ligament injury in the ankle is the lateral ankle sprain, which affects the ligaments on the outside of the ankle, particularly the anterior talofibular ligament (ATFL). This often occurs due to sudden twisting or rolling of the ankle.

In comparison, tendon tears in the foot and ankle, such as Achilles tendon ruptures, are less frequent. While still a significant injury, Achilles tendon ruptures have an incidence rate of about 5 to 10 times lower than ankle sprains.

However, it's important to note that the prevalence of specific injuries can vary based on factors such as age, activity level, sports participation, and overall health. Athletes and active individuals may be more prone to certain types of injuries compared to the general population.

What You Need to Know About Foot Ligament Tears

Foot ligament tears, also known as sprains, are common injuries that can occur in anyone but are more common in athletes.

The foot's complex anatomy and biomechanics can lead to many opportunities for injury, and the feet and ankles are under constant stress and strain.

Different Types of Ligament Tears in the Foot

• Lateral ankle sprains (ATFL, CFL, PTFL).
• Medial ankle sprains (Deltoid ligament).
• Syndesmotic sprains (High ankle sprains).

Causes of Ligament Tears in the Foot

• Sudden twisting or rolling of the ankle.
• Excessive stretching or overextension of ligaments.
• Sports activities involving jumping, pivoting, or contact.
• Uneven surfaces or improper footwear.

Symptoms of a Foot Ligament Tear

• Pain and tenderness around the affected ligament.
• Swelling and bruising.
• Instability or giving way sensation in the ankle.
• Difficulty bearing weight or walking.

Diagnosis of Foot Ligament Tears

• Physical examination by a healthcare professional such as doctor of podiatric medicine (DPM) who has specialized training in foot and ankle surgery.
• Imaging tests (X-ray, MRI, ultrasound) to assess severity.
• Stress tests to evaluate ligament integrity and stability.

Treatment Options for Ligament Tears in the Foot

• RICE protocol (Rest, Ice, Compression, Elevation).
• Immobilization with a brace or cast.
• Physical therapy to restore strength and range of motion.
• Pain management with NSAIDs or other medications.
• Surgery for severe tears or instability (ligament repair or reconstruction).

Prevention of Foot Ligament Tears

• Proper warm-up and stretching before physical activities.
• Wearing appropriate and supportive footwear.
• Participating in balance and proprioception training.
• Gradually increasing intensity and duration of exercises.
• Maintaining good overall physical conditioning.

What You Need to Know About Foot Tendon Tears

Tendon tears may be rarer than ligament tears in the foot region but there are multiple tendons that run from your lower leg to your foot, including the Achilles tendon, which connects your calf muscle to your heel bone.

A rupture of the Achilles tendon can be seen as one of the more severe injuries to suffer in sports with a long recovery time that stretches from six to nine months.

Different Types of Tendon Tears in the Foot Region

• Achilles tendon ruptures.
• Posterior tibial tendon tears (tendon starts in the calf and extends down to the inner part of the ankle where it is connected to the bone in the middle of your foot).
• Peroneal tendon tears (strong bands of tissue connect muscles in your lower leg to the bones in your foot to help stabilize your foot and ankle).

Causes of Foot Tendon Tears

• Overuse or repetitive strain on the tendon.
• Sudden explosive movements or direct trauma.
• Degeneration or weakening of the tendon over time.
• Certain medications (e.g., fluoroquinolone antibiotics).

Symptoms of Foot Tendon Tears

• Sudden, severe pain at the site of the tear.
• Audible popping sound at the time of injury.
• Weakness or inability to bear weight on the affected foot.
• Swelling, tenderness, and bruising in the affected area.
• Visible deformity or gap in the tendon (complete ruptures).

Diagnosis of Tendon Tears in the Foot and Ankle

• Physical examination to assess tendon function and integrity.
• Thompson test for Achilles tendon ruptures.
• Imaging tests (MRI, ultrasound) to visualize the extent of the tear.

Treatment Options for Foot Tendon Tears

• RICE protocol (Rest, Ice, Compression, Elevation).
• Immobilization with a cast or walking boot.
• Physical therapy to regain strength and mobility.
• Pain management with NSAIDs or other medications.
• Surgery for severe tears or complete ruptures (tendon repair or grafting).

Prevention of Foot Tendon Tears

• Gradual increase in intensity and duration of physical activities.
• Proper warm-up and cool-down routines.
• Wearing appropriate and supportive footwear.
• Addressing any underlying conditions or biomechanical issues.
• Cross-training and varied exercise routines to avoid overuse.

If you suspect you have a foot ligament or tendon tear, reach out to Sweeney Foot & Ankle Specialists today for a complete diagnosis and treatment. Both D. Sean Sweeney, D.P.M., and Christy N. Leahey, D.P.M., are certified by the American Board of Foot & Ankle Surgery and prepared to get you back on your feet as quickly as possible.