Frank Gore is reported to be out at least three weeks after MRI results "revealed" Monday that he suffered a right ankle strain and a right hind foot sprain on the first play from scrimmage in last week’s game against the Vikings.
Coach Mike Singletary said the injury was not related to his ankle sprain he suffered two weeks prior against Seattle.
Really? (Say out loud like SNL skit.)
1. In 15 years, I have never had an MRI report from a radiologist with the diagnosis ankle strain and hind foot sprain.
2. I also have never seen a hind foot sprain; though that doesn’t mean one hasn’t seen me.
3. I have seen lots of ankle sprains and hind foot strains.
Could this just be an example of the telephone game where the words got mixed up?
Sports Medicine Nomenclature 101:
1. A strain is an injury to muscle or tendon, involving overstretching or tearing, partial or complete. Muscles connect to bone via tendons. A complete tear of a tendon at its attachment to bone would be a rupture or avulsion.
2. A sprain is a torn ligament, partial or complete. Ligaments hold together joints, connecting bone to bone.
3. The hind foot primarily consists of two bones, the talus and the calcaneus.
4. A hind foot sprain would involve the ligaments that hold together the talus and calcaneus joint, known as the subtalar joint.
5. A hind foot strain could mean injury to the Achilles tendon, though there are other tendons on each side of the Achilles as well.
6. An ankle strain could mean injury to the tendons on the medial or lateral side of the ankle, usually the peroneal (lateral) or posterior tibialis (medial).
7. Strains and sprains are diagnosed clinically from physical examination. MRI is used to confirm the diagnosis and look for other injuries such as bone bruises and stress fractures that usually would not show up on x-ray. An MRI can be completely normal with strains depending on severity of injury.
In the scientific article, Persistently Painful Sprained Ankle by Dr. Renstrom, he writes, “the subtalar sprain has remained a mysterious and little known clinical entity." The incidence is unkown, but is widely accepted that most hind foot sprains occur together with the common lateral ankle sprain.
In a study of 40 patients with lateral acute ankle sprains diagnosed by stress x-ray (ankle joint was lax under stress and documented on x-ray), 32 were also found to have significant subtalar sprains, whereby dye injected into the subtalar joint (arthrography) leaked out of the joint indicating torn ligaments in the hind foot as well. This test is rarely performed.
Google Hind Foot Sprain and the first 10 pages include only animals and one athlete, Frank Gore.
What’s the prognosis for the "run of the mill" lateral ankle sprain: 48 percent will have recurrent sprains and 26 percent will report frequent sprains. Eighty-one percent will experience recurrent sprains if mechanical laxity is documented on x-ray on stress views.
If it is just a case of mixing up the words, strain and sprain again, then we’ll see Frank back in 3 weeks though not at 100 percent. Don’t expect that for at least 6-8 weeks.
If the MRI truly did reveal a hind foot sprain, then the prognosis is much worse for Frank Gore and the 49ers.
Marc Silberman, M.D.
New Jersey Sports Medicine and Performance Center