Thursday, November 8, 2012

High Ankle Sprains

Last night I had the pleasure of sitting in the 2nd row at the Celtics game.  Which, for anyone who's never been that close to a professional athlete, is quite impressive.  The size and speed of these athletes is incredible.  They bounce off the floor with breathtaking speed and agility.  They effortlessly jump higher than most of us could ever think of jumping and seem to not even be trying.  Kicking and twirling all over the place.  And yes, if you hadn't figured it out already, I am talking about the Celtics Cheerleaders! Now this post isn't about me, and most the other guys in the stadium(you know who you are) watching the cheerleaders, well I don't think it is... we'll have to see where this blog ends up :)

But in all seriousness, I was really impressed by what these very small, but very strong, women could do.  Now on the other end of the spectrum are the gigantic basketball players.  These guys also showed some incredible speed, agility, and jumping power.  The human body is remarkable and to see professional athletes perform certainly puts the human body on display.  Now to be clear, this is not about me just going gaga for professional athletes, because I think what professional athletes do should be appreciated, not idolized or deified.  Lets all remember what Charles Barkley had to say about professional athletes (his famous commercial "I am not a role model" for those of you who've forgotten).  

Now I know when I started this blog I had a point... now what was it?  We've really gotten off track here.  Professional athletes, cheerleaders, Charles Barkley... Oh yeah... Ankles!

As I watched the game I noticed the extensive wrapping on many players ankles, clearly to provide more support.  One guy seemed like he was actually playing with pants on because he was so heavily taped.  It seemed nobody had bare ankles.  But why would everyone tape an area of the body that is already so strong and stable?  What happens to the ankle that is so bad?  It turns out that the ankle joint isn't quite as stable as we'd like, especially when pushed to extremes, and some very painful injuries occur when things go wrong.  So the next few posts will be all about the foot and ankle!  Who's excited?  We'll discuss ankle sprains, plantar fasciitis, turf toe, fractures, cuboid syndrome and who knows what else?!!  But today we'll start with what is called a High Ankle Sprain.

Now if you're a football fan then you're probably a fan of America's team the Dallas Cowboys... but if you're not that lucky then you may be a Patriots fan.  And every Patriots fan knows the damage a high ankle sprain can cause.  Both of their tight ends, Gronkowski and Hernandez, have had this injury over the past 2 years.  But why is it so bad?  Isn't it just like any other ankle sprain?  Just higher?  Well not quite.  I'm sure many of you have scoffed at the tv when you saw them unable to run and jump like normal after weeks of not being able to play.  You may even have thought you could recover quicker than these guys... well not so fast.

Every athlete in the world knows what it feels like to sprain an ankle.  You jump up, land wrong and boom, the ankle rolls to the outside and you're out for a few days.  It hurts, it may bruise, but it heals.  The picture below demonstrates this rolling action of what is called an Inversion Ankle sprain.  You get some muscle tissue tearing, maybe some slight ligament tearing, a good deal of swelling, pain and bruising.

This type of sprain is so common because of how the ankle joint is designed.  Right now you could roll your ankle to the outside as you're sitting at your desk with no big problem.  If it went too far, as in a sprain, it would hurt, but normally it's an action the ankle can handle.  But try to roll your ankle to the other side and it's a different story.  Try it.  Roll your ankle from the outside to the inside and it's not as easy.  

An ankle that rolls to the inside is what is called an Eversion Ankle Sprain... which most often causes what is called a High Ankle Sprain.  The image below shows the contrast between inversion and eversion sprains.

As you can see the Eversion sprain causes pain, bruising, tearing, and swelling on the inside of the ankle as opposed to the outside of the ankle.  Seems easy enough right?  Well the issue here is that the inside of the ankle is protected by a huge ligament, called the deltoid ligament, which prevents these types of sprains.  This is why most athletes have never had an Eversion sprain, or a high ankle sprain.  It's as if the body has it's own ankle taping mechanism for the inside of the ankle.  So to get an eversion sprain you have to tear through that taping mechanism which means the amount of force needed is much greater.  So you don't see these in basketball players usually, or dancers for that matter.  You see these injuries in Football players.  Because what you need for these injuries is basically for someone to fall on your leg and twist it outwardly.  The image below shows this injury... now if you're a patriots fan you may want to look away.

As you can see here Gronkowki's ankle is being forced outward, which is normally a very stable area because of that strong deltoid ligament.  As the defenders body weight becomes heavier the deltoid ligament can't prevent the ankle from rolling even further outward.  What happens next is the issue.  That ligament starts to tear and not only that but since there is so much force involved other ligaments start to tear... ligaments that are higher up on the leg called syndesmotic ligaments.  These are ligaments that connect the two bones in the lower leg to one another.  They hold the tibia and fibula together.  The picture below demonstrates this.  

Now not only has the athlete torn a few ligaments in the lower ankle but now they've torn some very important ligaments in the lower leg as well.  These ligaments keep the bones connected so if they're torn the ankle becomes very unstable.  Also, many times the force is so great that part of the lower leg bone(the fibula) actually breaks.  Now for some people the tear, or the break, isn't severe enough to require surgery so they eventually heal.  For others surgery is required, and for many football players surgery is the only option.  These injuries require a 6-week minimum recovery time and in surgical cases it could be months before the player returns.  Which is why Gronkowski had such a hard time moving in last years super bowl, and the fact that he even played is actually very impressive.  The picture below demonstrates all the types of ankle sprains we just discussed.

High ankle sprains are clearly much different than the ankle sprains most of us have experienced, not only are they higher but the mechanism is completely different.  The whole foot rotates outward, not inward, and very important ligaments are torn and bones may be broken.  So the next time you hear that a football player on your favorite team has a high ankle sprain remember that they're probably not weak or just milking the injury.  These injuries are a totally different animal.  

Doctors Note:

1.  There are essentially two types of ankle sprains.  Inversion, where the foot rotates inward.  And Eversion, where the foot rotates outward.  Inversion sprains are common, eversion are not common and usually require someone falling on the ankle to occur.

2.  Inversion ankle sprains can heal usually in 1-4 weeks.

3. Eversion ankles sprains involve much more ligament tearing and damage which requires more time to heal.

4. Eversion sprains usually cause what is called a high ankle sprain where not only are the inside ligaments torn but also the syndesmotic ligaments holding the tibia to the fibula are also torn.  A broken bone may also occur during a high ankle sprain.    

5. Eversion sprains may require surgery and almost always require a recovery time of well over a month.

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