A 23 year old profession footballer sufferd a twisting injury to his right ankle. On examination there is a lot of swelling around the medial malleolus but X-ray doesn’t show any fracture. The structure injured could be-
**Core Concept**
The ankle joint is a complex structure composed of bones, ligaments, and tendons that provide stability and support during movements like twisting and rolling. The medial malleolus is a bony prominence on the inner aspect of the ankle, formed by the distal end of the tibia.
**Why the Correct Answer is Right**
The structure most likely injured in this scenario is the deltoid ligament, which is a strong ligament that provides medial (inner) stability to the ankle joint. The deltoid ligament is composed of two layers: superficial and deep. It is attached to the medial malleolus and the talus bone. In a twisting injury, the deltoid ligament can be stretched or torn, leading to pain, swelling, and instability around the medial malleolus.
**Why Each Wrong Option is Incorrect**
* **Option A:** The anterior talofibular ligament (ATFL) is also a ligament that provides stability to the ankle joint, but it is located on the anterior (front) aspect of the joint and is more commonly injured in inversion injuries (rolling inward).
* **Option B:** The medial collateral ligament (MCL) is a ligament that provides stability to the knee joint, not the ankle joint.
* **Option C:** The Achilles tendon is a tendon that connects the calf muscles to the heel bone and is not directly related to the medial malleolus.
**Clinical Pearl / High-Yield Fact**
In ankle injuries, the location of pain and swelling can give clues about the injured structure. Pain and swelling around the medial malleolus often indicate a deltoid ligament injury, while pain and swelling on the lateral (outer) aspect of the ankle may indicate an anterior talofibular ligament injury.
**Correct Answer: D. Deltoid ligament.**