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Analyzing Dee Milliner's Injury Prognosis as He Recovers from High Ankle Sprain

New York Jets cornerback Dee Milliner (27) warms up before an NFL football game against the Buffalo Bills Sunday, Sept. 22, 2013, in East Rutherford, N.J. (AP Photo/Bill Kostroun)
Bill Kostroun/Associated Press
Dave Siebert, M.D.Featured ColumnistAugust 12, 2014

The injury bug bit the New York Jets secondary over the weekend when cornerbacks Dee Milliner and Dexter McDougle went down with ankle and knee injuries, respectively.

According to Jets editor-in-chief Randy Lange, McDougle suffered a torn ACL. Unfortunately, the prognosis for such an injury is harsh but simple: It will presumably end his 2014 season before it begins.

Milliner's outlook, on the other hand, is less clear.

New York Daily NewsManish Mehta noted Sunday that the Jets diagnosed the cornerback with a high ankle sprain and expect him to miss a "few weeks."

High ankle sprains involve damage to the ligaments that connect the tibia and fibula—the two bones of the lower leg—to one another. They often occur in football when a tackle or hit causes the toes to suddenly turn outward in relation to the rest of the body. Such a motion can force the tibia and fibula to sharply rotate about each other, stretching or tearing the multiple ligaments that normally keep them firmly in place.

In the above diagram of basic ankle anatomy, red boxes highlight ligaments that may stretch or tear as a result of a high ankle sprain. Low ankle sprains involve the ligaments highlighted in blue.
In the above diagram of basic ankle anatomy, red boxes highlight ligaments that may stretch or tear as a result of a high ankle sprain. Low ankle sprains involve the ligaments highlighted in blue.Wikimedia Commons with edits by the author.

On Monday, Mehta tweeted that the former Crimson Tide standout's availability for Week 1 is in "serious doubt," adding that according to head coach Rex Ryan, the amount of swelling prevented him from undergoing an MRI.

While X-rays assess for fractures—Milliner's were negative, according to ESPN New York's Rich Cimini—MRIs allow for visualization of soft tissues such as ligaments and muscle bodies or tendons.

Without the assistance of an MRI, doctors can rely on the location of an athlete's pain as well as select physical exam maneuvers—such as squeezing the upper calf or turning the foot outward, moves that suggest a high ankle sprain if they elicit pain—to help make the diagnosis.

Special X-rays that look at the space between the tibia and fibula can also help diagnose severe sprains if the bones separate further with certain movements, suggesting instability. Hopefully, Cimini's report of negative X-rays implies the lack of such an increasing gap.

Ankle X-rays that demonstrate increasing separation of the tibia and fibula during stress (not seen here) may suggest an unstable high ankle sprain. The tibia and fibula are the two large bones coming from the top of the above X-rays.
Ankle X-rays that demonstrate increasing separation of the tibia and fibula during stress (not seen here) may suggest an unstable high ankle sprain. The tibia and fibula are the two large bones coming from the top of the above X-rays.Wikimedia Commons.

At some point, Milliner may receive an MRI to help clarify the extent of the damage. In the meantime, he will likely wear the walking boot Cimini mentions, which prevents the joint and bones from continuing to move about.

After all, following a high ankle sprain, recovering and maintaining leg and ankle stability can prove difficult depending on the degree of injury. In the initial rehab stages, minimizing swelling and immobilizing the ankle can start the process.

That said, more frequently than their low ankle counterparts, high ankle sprains can linger. And linger.

A lingering high ankle sprain severely limited Atlanta Falcons wide receiver Roddy White's 2013 season.
A lingering high ankle sprain severely limited Atlanta Falcons wide receiver Roddy White's 2013 season.Kevin C. Cox/Getty Images

And linger.

Just ask Atlanta Falcons wide receiver Roddy White.

Last season, White went down with a preseason high ankle sprain, one that persisted well into the regular season. His early-season production suffered immensely, and he did not eclipse the 100-receiving-yard mark in a single game until Week 13.

Over the coming weeks, Milliner will surely hope to avoid a similar fate.

As his body works to heal the damage, the cornerback will likely slowly begin to bear weight on his ankle, eventually returning to progressively strenuous activity. He might receive numerous rounds of the aforementioned special X-rays while he recovers to monitor for the development of instability.

As long as pain and swelling steadily decrease in the coming days and weeks—and further imaging and physical exam tests do not suggest instability or a more severe injury than originally anticipated—several weeks of rest, physical therapy and other conservative treatment should allow Milliner to return relatively early in the regular season.

Nevertheless, an increasing gap between the tibia and fibula at any point following a high ankle sprain could necessitate surgery to fix the bones in place with metal hardware while the ligament or ligaments heal. Fortunately, nothing yet suggests such a development in Milliner's case.

In other words, for the suddenly cornerback-strapped Jets, no news is good news.

However, Jets fans may want to prepare to start the season without their young defensive back and hope for a pleasant surprise rather than the other way around.

 

Dr. Dave Siebert is a second-year resident physician at the University of Washington and a member of the Professional Football Writers of America. He plans to pursue fellowship training in Primary Care (non-operative) Sports Medicine.

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