Soft Tissue Injuries — Ligaments, Tendons and Muscles
Not every serious injury involves a broken bone. The ligaments that hold a joint stable, the tendons that move it and the muscles that power it can be sprained, torn or ruptured, and a “clear” X-ray does not mean nothing is wrong. Some of the injuries that do worst when they are missed — a torn syndesmosis, a Lisfranc ligament injury, a ruptured Achilles — show nothing on a plain X-ray at all.
Most soft tissue injuries heal well with the right protection and rehabilitation. The task is picking out the ones that will not, early enough to treat them. If you think a bone may be broken, see the fractures page.
Types of soft tissue injury
Sprains — a ligament stretched or torn. Grade 1 is a stretch, grade 2 a partial tear, grade 3 a complete tear that may leave the joint unstable.
Strains — a muscle or its tendon overstretched or torn, often at the junction between the two.
Tendon ruptures — a complete tear, most commonly of the Achilles, and less often of the patellar or quadriceps tendon at the knee.
Tendon dislocation — the peroneal tendons on the outside of the ankle can slip out of their groove after a twisting injury.
Cartilage injury — the joint surface of the talus (an osteochondral lesion) or the meniscus in the knee can be damaged in the same injury that sprains a ligament.
Injuries Dr Janan treats
Foot and ankle:
Ankle sprains and ankle ligament injury, including chronic ankle instability
High ankle sprains — injury to the syndesmosis, the ligaments joining the two shin bones just above the ankle
Lisfranc (midfoot) ligament injuries
Peroneal tendon tears and dislocation
Turf toe and plantar plate injuries of the big toe
Osteochondral lesions of the talus
Knee:
Medial collateral ligament (MCL) injuries
Signs an injury needs more than rest
A pop or snap at the moment of injury
Being unable to put weight through the leg, or the joint giving way when you try
Swelling that has not settled after two weeks of rest and elevation
Bruising on the sole of the foot after a midfoot injury — a warning sign for a Lisfranc injury
Being unable to rise onto tiptoe on one leg — the key sign of an Achilles rupture
Pain above the ankle, between the two shin bones, that is worse when the foot is turned outwards
Repeated sprains of the same ankle, or a sense that it cannot be trusted on uneven ground
Diagnosis
Examination is where most of the diagnosis happens: which structure is tender, whether the joint is stable when it is stressed, and whether the tendons are working. Imaging then confirms it:
X-ray — to exclude a fracture, or a small avulsion where a ligament has pulled a flake of bone away; weight-bearing views are used to check midfoot and syndesmosis stability
Ultrasound — for tendons, where it shows tears and whether a tendon glides normally
MRI — for ligaments, cartilage and the extent of a tear, and for injuries that are not settling as expected
Treatment
Soft tissue heals differently from bone. Bone needs to be held still; ligaments and tendons heal best with protection early, then controlled movement and progressive loading. For most sprains and strains that means a short period in a brace or boot, followed by a structured physiotherapy program of movement, strength and balance work. How are soft tissue injuries treated differently from fractures?
Surgery is recommended for a smaller group of injuries:
Complete tendon ruptures in active patients, particularly of the Achilles
Unstable syndesmosis and Lisfranc injuries, where the joints will not stay in position without fixation
Chronic instability after a full rehabilitation program has failed
Recurrent tendon dislocation
Avulsion fractures and cartilage fragments that are displaced or loose in the joint
Recovery
A grade 1 or 2 sprain usually settles in two to six weeks. A complete ligament tear, a syndesmosis injury or a Lisfranc injury needs six to twelve weeks of protection and often longer before returning to sport. An Achilles rupture, treated with or without surgery, takes six to twelve months to reach full strength. After ligament reconstruction, return to sport is generally three to six months.
Rehabilitation is not optional in any of these. Physiotherapy is what turns a healed ligament back into a stable joint, and Dr Janan works closely with physiotherapists, including physiotherapy sessions held in the COG rooms, so that the surgical plan and the rehabilitation plan are the same plan.
Dr Janan’s approach
Dr Janan Chandrananth is a fellowship-trained foot and ankle surgeon — with fellowships in Bristol and in Tokyo under Professor Satoru Ozeki — and manages general orthopaedic trauma at Frankston Hospital. Soft tissue injuries of the ankle and foot make up a large part of what he sees after an injury. His preference is to treat without surgery wherever the injury allows, reserving operations for the tears and instabilities that will not recover on their own; where surgery is needed, he uses keyhole (arthroscopic) and minimally invasive techniques wherever they are appropriate.
Sprained, strained or torn something, and it isn’t settling?
Book a consultation with Dr Janan Chandrananth to have the injury assessed and a recovery plan mapped out. Recent injuries are prioritised.
Request an Appointment
FAQs
My X-ray was normal. Does that mean it is just a sprain?
No. X-rays show bone, not ligaments or tendons. A normal X-ray rules out most fractures; it does not rule out a complete ligament tear, a syndesmosis or Lisfranc injury, or a ruptured tendon. If you cannot bear weight, the joint gives way, or the swelling is not settling, the injury needs examination and often an MRI.
Do soft tissue injuries need surgery?
Most do not. Sprains and strains, including many complete ligament tears, heal with protection and rehabilitation. Surgery is for complete tendon ruptures in active patients, joints that will not stay in position, and instability that persists after proper rehabilitation.
How long does a ligament take to heal?
The tissue itself takes around six weeks to knit and several months to regain full strength. How long you are off sport depends on which ligament: two to six weeks for a simple ankle sprain, three months or more for a syndesmosis or Lisfranc injury.
Why is my ankle still swollen weeks after a sprain?
Mild swelling for several weeks is normal. Swelling that is not improving, pain that is worse than it was, or an ankle that gives way suggest something more than a simple sprain — a missed ligament tear, a cartilage injury or a tendon problem — and is worth a review.
Should I get an MRI?
Not for a routine sprain that is improving. An MRI is useful when the examination points to a specific structure, when an injury is not settling after a few weeks, or when surgery is being considered and the extent of the damage will change the plan.
I sprained my ankle years ago and it still gives way. Is it too late to treat?
No. Chronic ankle instability can be treated at any stage — with a targeted strengthening and balance program first, and with ligament repair or reconstruction if that fails. Leaving an unstable ankle untreated for years is what leads to cartilage damage and, eventually, arthritis.