Darren McFadden's Injury: A Look at the Dreaded High Ankle Sprain

Dave Siebert, M.D.@DaveMSiebertFeatured ColumnistNovember 7, 2012

OAKLAND, CA - NOVEMBER 04:  Darren McFadden #20 of the Oakland Raiders gets wrapped up by Lavonte David #54 of the Tampa Bay Buccaneers during the second quarter of their NFL football game at O.co Coliseum on November 4, 2012 in Oakland, California.  (Photo by Thearon W. Henderson/Getty Images)
Thearon W. Henderson/Getty Images

The talent is there.

The durability remains a question.

In a scene that Oakland Raiders' fans have gotten to know all too well, Darren McFadden was once again forced to leave a game due to injury.

It was then reported on Monday by head coach Dennis Allen that the former Razorback suffered a high ankle sprain on Sunday during the Raiders' match-up against Tampa Bay.

Coach Allen also noted that McFadden's X-rays and MRI were negative.

In other words, McFadden's X-rays did not show any of the typical bone fractures that sometimes go along with ankle sprains, and his MRI confirmed that the ligaments in the ankle were not torn.

That is the good news.

The bad news is that the words "high ankle sprain" are widely feared in the NFL, as the injury tends to linger for much longer than a low ankle sprain.

To get a sense of why this is, it helps to understand the functions of a ligament.

Ligaments, in the most general sense, support the skeleton.  They are strands of tissue that connect bones to other bones, allowing for smooth and coordinated motion.

They also prevent certain motions.

However, if an outside force (such as from being tackled by an NFL linebacker) overloads a ligament trying to prevent one of these motions, a sprain occurs.

In a grade 1 sprain, a ligament is stretched beyond its normal length and may be microscopically torn.

In a grade 2 sprain, the ligament is partially torn.

In a grade 3 sprain—the worst type of sprain—the ligament is completely torn apart and the bones it once connected are now able to move freely.

In a high ankle sprain like McFadden's, any of the so-called "syndesmotic ligaments" can be injured.

The syndesmotic ligaments connect the two bones that make up the lower leg, the tibia (the shin bone) and the fibula (a thin bone that runs alongside the shin bone), just above where they meet the ankle.

That is why the injury is called a "high ankle sprain."

Usually, this injury occurs when an athlete's foot is forced to rotate outwards while his or her lower leg remains still. Imagine an athlete striding forward and having their toes forcefully pushed outwards.

It can also happen when an athlete's foot is firmly planted and they are tackled in such a way that they are forced to turn their leg inwards.

Although details remain lacking, it can be speculated that because Coach Allen reported that his MRI was negative, McFadden likely suffered only a grade 1 sprain.

Unfortunately, a grade 1 sprain can still hold an athlete out for a few weeks or more depending on injury severity, the amount of swelling and an athlete's individual recovery time.

The reason for this is that when the syndesmotic ligaments are weakened by a sprain, they are no longer able to provide stability to the lower leg.

This hampers an athlete's ability even to bear weight on the injured leg.

In the less severe and less limiting low ankle sprain, an athlete is able bear weight on his or her leg and perform certain motions without pain.

In McFadden's case, in addition to it possibly being difficult to bear much weight on his injured leg, his abilities to plant his foot and cut may also be limited.

Nevertheless, his situation could be worse.

For instance, after a grade 3 high ankle sprain, the tibia and fibula are no longer connected and move freely without coordination.

In this case, surgery would be required to screw the two bones together to prevent further damage and to reconnect the torn ligaments.

It is safe to say that is not what happened in McFadden's case, as he has not even been officially ruled out for Week 10.

However, likely in favor of resting and icing his ankle, McFadden did not practice on Wednesday:


Darren McFadden not practicing Wednesday dlvr.it/2RrRPY

— Rotoworld Football (@Rotoworld_FB) November 7, 2012


He must rest because performing any movements that cause pain can delay healing.

In a high ankle sprain, such a movement can be as simple as walking.  In a low ankle sprain, more complex movements are required to worsen the injury, such as bending the foot inward.

McFadden's negative MRI makes a strong case that he will return this season.

When his swelling is gone and he is able to bear weight on his leg without pain, he will slowly be worked back into practice drills.

Once he shows that he is able to cut and bear weight like he could before his injury, he will likely return to the playing field.

This could take a few weeks, a troubling fact for a Raiders team that already ranked 31st in the NFL in rushing offense.

Fantasy owners, surely frustrated, might look at this as the final straw before looking to trade or drop their once-promising first or second round draft pick.

However, because McFadden felt he was strong enough to return to the game on Sunday, they should hold off for further updates about McFadden's injury.

Nevertheless, given his statistically disappointing season, many will be tempted to find other places for McFadden other than on their roster.

And, at least for this season, maybe rightfully so.


The author of this article is a soon-to-be Family Medicine resident physician with plans to specialize in Primary Care (non-operative) Sports Medicine.  The above injury information was compiled from the author's own anatomical and clinical knowledge as well as from two online articles written by orthopaedic surgeons about ankle sprains.  Dr. Chris Chiodo's article can be found here, and Dr. Jonathan Cluett's article can be found here.


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