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High Ankle Sprains and Sam Bradford

November 14, 2011

This is good news for a Rams football team that’s had a very disappointing season due to injury: on Friday quarterback Sam Bradford took the majority of work with the first unit at practice in preparation for the Rams’ Sunday game against Cleveland.

Coach Steve Spagnuolo said Bradford looked “pretty good. Better than last week. Still didn’t do everything today.” Bradford, as you probably know, is recovering from a high ankle sprain suffered October 16 against Green Bay.

Let’s talk about this injury.

What Is a High Ankle Sprain?

A high ankle ankle sprain is a sprain of the syndesmotic ligament, the ligmament that connects the tibia with the fibula of the lower leg.

They’re called high because the injury occurs on the location of the leg high on the lower leg, just above the ankle. The high ankle sprain is different from a common ankle sprain (where ligaments around the ankle are torn when the ankle twists inward) because the lower leg and foot twist out.

High ankle sprains are common to anyone but most often seen in sports like football, hockey, soccer and basketball. Athletes can usually play through the pain, which occurs a lot in football, which was why Bradford could play last week.

What Are the Typical Symptoms of High Ankle Sprain?

The most common complaint of a high ankle sprain is a dull or sharp pain in the outside-front of lower leg just above the ankle. Pain is usually increased when twisting is involved or pressure is applied to the injured area.

It’s not uncommon for athletes to complain of an ankle injury, be treated for that ankle injury, and then to have a high ankle sprain diagnosis after treatment for the common ankle sprain failed.

Sometimes physicians can miss the diagnosis because swelling is usually minor or not even existent at all compared to a common ankle sprain, thus underestimating the extent of the injury.

There a couple of simple tests that trainers or physicians can use to determine if an athlete has suffered a high ankle sprain. The squeeze test is the most common. The doctor squeezes the leg, usually the calf or lower leg, and slightly turning the leg. Of course CT scans or radiographs are used, which can also spot tibia and fibula displacement, suggesting a severe injury.

How Do You Treat a High Ankle Sprain?

How you treat a high ankle sprain depends on the severity. Some athletes may need half a year to recover. Others can need only a few days rests. However, what’s important is not re-injuring the injury if it’s minor. Bradford was kept out of games because he could be out for the season if he aggravates that injury even more.

Treatment includes reducing movement of the lower leg and foot by wearing a boot, like Bradford has been wearing. And like most sports injuries, you can use the RICE (Rest, Ice, Compression and Elevation) method, or the PRICE method in the case of a high-ankle sprain, P standing for “protection.”

It’s important that a doctor determines if the injury is stable or unstable. A stable high ankle sprain are less severe high ankle sprains because the tibia and fibula stays in place. When an ankle sprain is unstable, two or all three syndesmotic ligaments are torn and the tibia and fibula are free to move around. Unstable injuries usually require surgery, involving two screws into the lower leg for a few months so the ligaments can heal and grow strong. Recovery from surgery takes six months or longer.

Dr. Rick Lehman is a distinguished orthopedic surgeon in St. Louis, Missouri and an articular cartilage reconstruction pioneer. He owns U. S. Sports Medicine in Kirkwood, MO, and LehmanHealth.Learn more about Dr. Rick.


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