Ankle injuries are widely regarded as one of the most common injuries suffered by football players, and current estimates suggest that upwards of 1 in 5 ankle injuries involves a syndesmotic sprain. These types of sprains are more complex than basic lateral sprains, as they often involve more pain and a longer recovery period. Syndesmotic ankle sprains, often referred to as high ankle sprains, fell a good deal of football players each and every year. The typical mechanism of the injury involves the forced external rotation of the foot and an internal rotation of the leg, putting stress on numerous ligaments and structures. Because of this, doctors have had a difficult time accurately predicting when a football player may be able to return to the field after a high ankle sprain, until now.
New research published in Foot and Ankle International suggests that MRIs and other diagnostic techniques are making it easier for medical personnel to predict how many practices and games an NFL player may miss after suffering a high ankle sprain.
Researchers noted that traditional radiographs were limited in their usefulness for diagnosing the extent of damage during a syndesmotic sprain, so they turned to MRIs and other diagnostic measures. For their research, they looked at data provided by three professional football teams over the course of 15 years to look for incidences of ankle sprains involving injury to the interior tibio-filbular ligament (AITFL). After finding all the cases of high ankle sprains, researchers cross-checked the medical records to see what other tests were conducted to help diagnose the extent of the injury. Some of the clinical measures involved:
- Length of tenderness up the leg
- The “squeeze test,” which involved a mid-calf squeeze to measure for distal pain
- An external rotation stress test
Researchers also tracked the number of practices and games the players missed as a result of their high ankle sprain.
High Ankle Sprain Study Results
After compiling all their data sets and pouring over their findings, researchers came up with a set of conclusions:
- An MRI was the most helpful tool to determine if an AITFL injury had occurred.
- Once a high ankle sprain had been diagnosed, researchers found that a positive squeeze test was the “most valuable prognostic test” for predicting the number of missed practices and games.
- Increased tenderness up the leg was associated with an increased likelihood of more missed practices and games.
- Combined lateral ligament and syndesmotic sprains may result in increased number of missed practices relative to isolated syndesmotic injuries but this was not correlated with increased number of missed games.
- The average number of missed games after suffering a high ankle sprain was 3.3, and the average number of missed practices was 16.7.
In the end, researchers concluded that MRIs are very useful in their ability to diagnose the extent of a syndesmotic sprain, and when combined with squeeze test, medical professionals may be able to make a more accurate prognosis of how much time a football player may be forced to miss while he recovers from the high ankle sprain.