It’s Football and High Ankle Sprain Season. Why NFL Players are Dropping Like Flies.

High Ankle Sprains in the NFL

With the professional football season barely 6 weeks old, we’re already hearing the term “high ankle sprain” on a very regular basis. Here are just a handful of the growing legion of large limping men in the NFL:

  • Odell Beckham (NY Giants)
  • Reuben Foster (SF 49ers)
  • Garett Bolles (Denver Broncos)
  • Benny Cunningham (Chicago Bears)
  • Mitchell Loewen (New Orleans Saints)
  • Myles Garrett (Cleveland Browns)

We’ll tell you more about these guys later, but since we’re a Foot and Ankle medical practice, let’s talk about the ankle joint and what happens with a high ankle sprain.

What’s a high ankle sprain?

The ankle joint is a complex hinge with both bone and ligament structures playing a role in stability. Ligaments are soft-tissue bands that connect bone to bone. They are divided into two groups – the lateral ligaments are on the outside of the ankle and the medial ligaments are on the inside of the ankle. A high ankle sprain occurs when tearing takes place in the medial ligaments.

How’s a “high ankle sprain” different from a regular ankle sprain?

A common, or low ankle sprain, occurs when the foot is turned inward, damaging and tearing the outside ankle ligaments. Low ankle sprains are about 90% of all ligament injuries to the ankle. A high ankle sprain involves forcibly tearing the ligaments on the inside of the ankle joint usually from a contact injury. It’s rare to experience both a high and low sprain at the same time since the force of impact generally moves the ankle in one direction or the other.

How does one get a high ankle sprain?

A high ankle sprain typically occurs when the foot is slammed with excessive outward twisting while it is planted on the ground. If the force is great enough, there is also damage to the ligaments spanning the lower leg bones – the tibia and fibula. These injuries are only 10% of all ankle sprains and are most common in impact sports like football and soccer. A greater occurrence of high ankle sprains may be due to the increased traction of artificial turf fields as well as the lighter, more flexible cleats that players now use.

What symptoms does one have with a high ankle sprain?

Symptoms of a high ankle sprain include pain along the ligament and localized tenderness with swelling and bruising. The bruising is generally higher on the ankle and often shows on the lower leg. You will have difficulty walking and when the ankle is rotated and toes and foot pushed upward, the pain will be significant.

How do doctors diagnose a high ankle sprain and what’s a squeeze test?

High Ankle Sprains, University Foot and Ankle SprainThese are good questions. It can be difficult to diagnose a high ankle sprain and differentiate it from a low ankle sprain. A thorough examination isolating the suspected injured ligaments is imperative. Patients who have a high ankle ligament tear usually will have pain just above the level of the ankle. Two important tests are the “squeeze test” and the “external rotation test.”

When the leg is squeezed right below the knee, pain radiating to the high ankle area suggests a high ankle sprain. With the external rotation test, the knee is bent and the foot placed in a neutral position. The foot is then turned to the outside and if pain ensues, this indicates a high ankle injury.

X-rays are very important to rule out any broken bones. They will also help diagnose any injuries to the tibia and fibula of the lower leg. If a clinical exam and x-rays are inconclusive, it’s time for an MRI. An MRI will reveal soft tissue damage to ligaments, tendons and cartilage.

What treatments do doctors use to treat high ankle sprains?

Treatment of a high ankle sprain involves ensuring that the tibia and fibula remain in the correct position with the ankle. This is usually done with RICE (Rest, Ice, Compression, Elevation). Also, if the ankle joint is well aligned and there is no associated fracture, you want to wear a cast or walking boot. This allows the ligament to heal and reduces inflammation.

Once acute inflammation ends, physical therapy helps re-strengthen the ligaments and tendons. The therapist will move the ankle in a passive range of motion to help avoid stiffness.

If the ankle joint is not well aligned or there is a bone chip or fracture, surgery will be necessary. If this is the case, you will need to be in a cast followed by a walking boot for about 12 weeks.

How long will one be hobbling around before recovering from a high ankle sprain?

It usually takes 4-6 weeks to recover from a high ankle sprain. Sometimes high ankle sprains can take longer to heal. If the injury is recognized quickly with proper treatment, outcomes are generally good. Most ligaments will heal within 6 weeks.

With sports that involve cutting and pivoting, doctors need to focus on the player’s position. For example, running backs and linebackers change their running direction all the time. So their recuperation time is greater. They also suffer this injury more than others because of this. But all players need to be able to run, jump, cut and pivot without pain.

So, who are some of the NFL’s current high ankle sprain sufferers?

Rueben Foster, San Francisco 49ers
The San Francisco 49ers first-round pick appears to be making good progress. He is starting to walk around like a normal person but missed last week’s game against the Seattle Seahawks.

Odell Beckham, NY Giants
After a strong warm-up routine, we thought Beckham would return to save the flailing Giants offense from football’s cellar. But suffering a pre-season high ankle sprain on August 21 against Cleveland hurt his effectiveness. As fate would have it, Beckham fractured the same left ankle on October 8 in a game against San Diego. We asked our own Dr. Baravarian about the healing of high ankle sprains and he said, “not all ankle sprains are created equal and many are under-treated. It’s important that all ankle sprains be treated like partial dislocations of a joint and properly splinted and protected.” Coach Ben McAdoo announced that Odell Beckham will miss the rest of the year.

Garett Bolles, Denver Broncos
The rookie starting left tackle Garett Bolles will miss “a couple weeks” with a high ankle sprain and deep bone bruise. That’s good news for the Broncos, who feared Bolles broke his ankle. Right now he is in a walking boot with a single crutch.

Benny Cunningham, Chicago Bears
The Bear’s third running-back also has a high ankle sprain, according to Larry Mayer on the Bears’ official website.

Mitchell Loewen, New Orleans Saints
The Saints reported Loewen suffered a high ankle sprain in the fourth quarter against the New England Patriots. There is no timetable for his return.

Myles Garrett, Cleveland Browns
Head coach Hue Jackson’s rookie defensive end and number one draft pick made “huge progress” following a high ankle sprain. His injury was right before the Browns’ season opener. The coach is cautioning fans that he won’t hurry the talented pass rusher back until he is 100% ready, which is the way all teams should take care of their players.

The team of physicians at University Foot and Ankle Institute have decades of combined experience effectively treating ankle sprains and fractures. We are leaders in the field of research and treatment of all ankle and foot injuries and conditions. If you would like more information or to schedule a consultation, please call (877) 475-1678 or visit us at

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