Question 1

I sprained my ankle and my doctor said it's a medial ankle sprain (deltoid ligament)—I thought ankle sprains were always on the outside of the ankle. Why is mine different and is it worse?

Accepted Answer

You're right that most ankle sprains (85-90%) are lateral (outside) ankle sprains from inversion (ankle rolling inward). Medial (inside) ankle sprains from deltoid ligament injury are much less common (5-10%) because the deltoid ligament is stronger and the ankle biomechanics make eversion (rolling outward) less common. Here's what makes medial ankle sprains different: WHY MEDIAL SPRAINS LESS COMMON: Deltoid ligament is a strong, thick, fan-shaped ligament complex (actually multiple ligament bands) connecting tibia to talus and calcaneus. It's significantly stronger than lateral ligament complex. Ankle anatomy naturally resists eversion (rolling outward) more than inversion, so it takes higher-energy force to injure deltoid. WHEN DELTOID SPRAINS OCCUR: Usually from: (1) High-energy trauma—falls, motor vehicle accidents, sports collisions; (2) Rotational injuries on planted foot—cutting, pivoting movements; (3) Associated with fractures—deltoid injury often occurs with fibula fracture (called bimalleolar equivalent fracture even though medial malleolus not fractured, because deltoid tear creates same instability). IS IT WORSE? Not necessarily worse, but different concerns: Isolated deltoid sprains generally heal BETTER than lateral ankle sprains (ligament is thicker, better blood supply, less chronic instability). However, must rule out associated injuries: ankle fractures (present in 20-30% of medial ankle injuries), syndesmosis injury (high ankle sprain, present in 10-20%), these require different treatment often including surgery. WHAT TO WATCH FOR: Your doctor should have gotten X-rays (if you couldn't bear weight or had bone tenderness) to rule out fractures. If X-rays showed fracture with deltoid injury, you'd likely need surgery. If isolated deltoid sprain, expect 6-10 weeks recovery with boot/brace and physiotherapy—similar or slightly longer than lateral ankle sprain but lower risk of chronic instability. BOTTOM LINE: Medial ankle sprains are less common because deltoid is stronger, but they're not necessarily 'worse.' Key is making sure no associated fractures or syndesmosis injury, then following proper rehabilitation to allow ligament to heal.

Question 2

I had an ankle fracture 3 months ago (broken fibula) and my surgeon also repaired my deltoid ligament at the same time—my ankle still feels unstable and painful on the inside. Is this normal or did the surgery not work?

Accepted Answer

Some ongoing pain and feeling of instability 3 months after deltoid repair is common and often improves with continued rehabilitation, but persistent significant instability may indicate healing issues. Here's what to expect and when to worry: NORMAL RECOVERY TIMELINE: Deltoid ligament repair (done with fibula fracture fixation for bimalleolar equivalent fractures) typically requires: 0-6 weeks post-op—non-weight-bearing in cast/boot, ligament healing. 6-12 weeks—progressive weight-bearing, still in boot, early physiotherapy. 3-6 months—gradual return to activities, ankle still recovering strength and proprioception. At 3 months, common to have: mild medial ankle discomfort with activities, feeling of 'guarding' or cautiousness on ankle, some swelling at end of day. These typically improve over next 3-6 months with physiotherapy. CONCERNING SIGNS AT 3 MONTHS: Severe pain limiting walking despite physiotherapy, ankle giving way frequently with normal activities, persistent large swelling, inability to progress with rehabilitation. These may indicate: (1) Deltoid repair failure (ligament didn't heal or pulled off bone)—rare but can occur if repair under too much tension or patient weight-bore too early; (2) Syndesmosis instability (if you also had high ankle sprain component that wasn't fully addressed); (3) Malunion of fibula fracture (fibula healed in poor position causing ongoing ankle instability); (4) Ankle arthritis developing from cartilage damage at time of injury. WHAT TO DO: Return to your surgeon for re-evaluation. Exam should assess: medial ankle stability with stress testing, syndesmosis stability (squeeze test, external rotation test), ankle range of motion. X-rays to check: fibula fracture healing and alignment, medial clear space (should be less than 4mm—widening suggests deltoid insufficiency), syndesmosis position. If exam and X-rays show healing deltoid and stable ankle, likely just need more time and intensive physiotherapy focusing on: strengthening (especially eversion muscles that support medial ankle), proprioception (balance training), gradual return to functional activities. If deltoid repair failed or syndesmosis unstable, may need revision surgery. Most patients with properly healed deltoid repair have good ankle stability by 6 months, so don't be discouraged at 3 months—but do get evaluated to ensure healing on track.

Medical Disclaimer

Inside Ankle Sprain (Deltoid Ligament Injury)

📖What is Inside Ankle Sprain (Deltoid Ligament Injury)?

🔬What Causes It?

⚠️Risk Factors

You may be at higher risk if:

🛡️Prevention