What is the treatment for a grade 2 torn ligament on the dorsal aspect of the foot?

Treatment for Grade 2 Torn Ligaments of the Dorsal Aspect of Foot

Functional support with an ankle brace for 4-6 weeks combined with early exercise therapy is the recommended treatment for grade 2 torn ligaments of the dorsal aspect of the foot. 1

Initial Management (First 72 hours)

• Pain and Swelling Control:

  • NSAIDs are recommended to reduce pain and swelling 1
  • Paracetamol (acetaminophen) is an equally effective alternative if NSAIDs are contraindicated 1
  • Note: While NSAIDs help with symptoms, they may potentially delay natural healing as they suppress inflammation necessary for tissue recovery 1

• Limited Immobilization:

  • If pain and swelling are severe, a short period (<10 days) of immobilization with rigid support may be beneficial 1
  • After this initial period, transition to functional treatment is essential 1

Primary Treatment Approach (Weeks 1-6)

• Functional Support:

  • Use of an ankle brace is superior to elastic bandages or compression stockings 1
  • Maintain functional support for 4-6 weeks to protect the healing ligament 1
  • Ankle brace shows greater effects compared with other types of functional supports 1

• Early Exercise Therapy:

  • Begin exercise therapy as soon as possible 1
  • Focus on neuromuscular and proprioceptive exercises 1
  • Early exercise therapy has established efficacy in reducing recurrent injuries and functional ankle instability 1
  • Can be performed at home after proper instruction 1

• Manual Mobilization:

  • Consider manual joint mobilization in combination with exercise therapy 1
  • This combination enhances efficacy and helps increase ankle joint dorsiflexion ROM 1

Rehabilitation Phase (Weeks 2-8)

• Progressive Exercise Program:

  • Gradually increase intensity of exercises focusing on:
    • Proprioception
    • Strength
    • Coordination
    • Functional movements 1

• Return to Activities:

  • For light work: Return at 2 weeks with restrictions (mostly sitting work, limit standing/walking on uneven surfaces) 1
  • For full return to former activities: 3-4 weeks for minor injuries, 6-8 weeks for more severe grade 2 tears 1
  • For sports: Supervised exercises focusing on proprioception, strength, coordination, and function 1

Surgical Considerations

• Surgery is NOT recommended for most grade 2 ligament tears 1
• Functional treatment is preferred over surgical therapy for most patients 1
• Surgery should only be considered in specific cases:
  • Professional athletes who require quicker recovery 1
  • Patients with chronic instability who have not responded to comprehensive conservative treatment 1

Monitoring and Follow-up

• Re-examination at 3-5 days after injury is important to distinguish partial tears from frank ligament ruptures 1
• Assess for improvement in:
  • Pain levels
  • Swelling
  • Range of motion
  • Functional stability

Pitfalls and Caveats

• Avoid prolonged immobilization: Immobilization for more than 10 days leads to less optimal outcomes compared to functional treatment 1
• Don't neglect exercise therapy: Failure to implement early exercise therapy increases risk of recurrent sprains and chronic instability 1
• Don't rely solely on passive treatments: Modalities like ultrasound, laser therapy, and electrotherapy have no proven added value 1
• Beware of inadequate rehabilitation: Insufficient rehabilitation may lead to chronic pain, decreased range of motion, and joint instability 1
• Monitor for complications: Watch for signs of excessive stiffness, impaired mobility, or persistent instability that might indicate need for specialist referral 1

This treatment approach balances the need to protect the injured ligament while maintaining mobility and promoting proper healing, which optimizes outcomes in terms of morbidity, mortality, and quality of life.