What’s a High Ankle Sprain?

The history of a sports-injury trend.

Carson Palmer 

Quarterback Carson Palmer of the Cincinnati Bengals may not play in the team’s final preseason game on Thursday on account of a high ankle sprain that’s kept him sidelined for the last two weeks. The same injury has kept Eagles tight end Tony Curtis off the field in recent days, along with Cowboys linebacker Jason Williams, Broncos guard Chris Kuper, and Jaguars wide receiver Mike Sims-Walker. What’s a high ankle sprain, and when did it become so common in professional sports?

Damaged ligaments at the top of the ankle. The ankle joint is made up of three bones that are held together by ligaments and allow the foot to move up and down. (Side-to-side motion technically comes from a nearby joint called the subtalar.) When the foot is twisted outward, as might happen when players collide, the sudden motion can stretch or tear some of these ligaments, leading to a sprain high on the joint, just below your shins. * As far as ankle sprains go, this is a somewhat unusual injury. More often it’s the opposite motion that causes the problem—the foot twists too far inward, as if you were walking on the outside of your foot—and causes the common “inversion” or “lateral” ankle sprain. In this injury, the ligaments attached to the lower half of the ankle knob are affected.

A high ankle injury can force a player to leave a game right away, but the sprain often appears to be minor; walking doesn’t cause too much pain, and there may not even be a lot of swelling in the ankle. But athletes will probably wince if they try to push off on the injured leg or put a lot of weight on the ball of the foot, since the three bones of the ankle are no longer stable. In fact, each time the foot flexes, the tiny gap that normally exists between the tibia and fibula widens a bit. Treatment for a high ankle injury is similar to that for a lateral sprain but takes longer to heal; athletes can be sidelined for one to two months.

Professional sports seem to be rife with high ankle injuries, but the diagnosis didn’t enter sports parlance until the 1990s. There were few mentions of the unusual sprain before then; in one instance, a UPI story about the 1983 college bowl games * noted that Iowa’s quarterback Chuck Long had to be replaced because of this newfangled affliction. But the condition gained notoriety when two Duke basketball forwards—Grant Hill and Brian Davis—were sidelined in 1992. Coach Mike Krzyzewski called the sprain “the worst kind in terms of quick recoveries.” He should know; as he noted in an interview, ”after having none of that particular kind of sprain for 17 years, we’ve had three this season.” (Eric Meek suffered from the same injury.) According to Nexis, the news that year contained a few dozen mentions of high ankle sprains. But by the end of the decade, the sprain had entered the vernacular and was spreading throughout professional basketball, football, ice hockey, and even baseball, a noncontact sport.

Another relative newcomer to sports medicine is the sports hernia—a tear in the lower abdominal muscles. In 1992, newspaper reporters began spotting the injuries in Canadian hockey players, and over the next several years the affliction moved south, hitting hockey and basketball players on this side of the border. When the Eagles’ Donovan McNabb developed a sports hernia in 2005 that ultimately required surgery—and forced him to sit out the second half of the season—the media closely chronicled his diagnosis and treatment. Some athletes, like Tom Brady and Grant Hill, have been unlucky enough to have endured both high ankle sprains and sports hernias.

Got a question about today’s news? Ask the Explainer.

Explainer thanks Jonathan Chang of the University of Southern California, Mark Doughtie of Tufts University, Susan Norkus of Quinnipiac College, and John Schrader of Indiana University.

Correction, Sept. 2, 2009: The original version used the word syndesmosis as a synonym for “high ankle sprain.” That term describes the part of the ankle that is damaged, not the sprain itself. (Return  to the corrected sentence.)

Correction, Sept. 2, 2009: The original referred to “a UPI story about the 1983 college bowl “playoffs.” There are no playoffs in college football; the story was about an Iowa coach who argued that there should be. (Return  to the corrected sentence.)