Deltoid Ligament Injection

Acute or chronic sprain

Causes and findings:
• Trauma
• Obesity
• Overpronation of the foot
• Pain over medial side of heel below medial malleolus
• Painful: passive eversion of ankle in plantarflexion

Equipment:
Syringe - 1ml
Needle - 25G 0.5 inches (16mm) orange
Kenalog 40 - 10 mg
Lidocaine - 0.75 ml 2%
Total volume - 1 ml

Anatomy:
The deltoid ligament is a strong cuboid structure with two layers. It runs from the medial malleolus to the sustentaculum tali on the calcaneum and to the tubercle on the navicular. Sprains here are not as common as at the lateral ligament, but because they do not seem to respond well to friction and mobilization, injection is worth trying. The inflamed part is usually at the origin on the malleolus.

Technique:
• Patient sits with medial side of foot accessible
• Identify lower border of medial malleolus and mark mid-point of ligament
• Insert needle and angle upwards to touch bone at mid-point of ligament
• Pepper solution along attachment to bone

Aftercare:
Activity should be limited for at least 1 week. To prevent recurrence, the biomechanics of the foot must be carefully checked. Orthotics are almost always necessary and, in the overweight patient, advice on diet must be given.

Comments:
This is an uncommon but usually successful injection.