Roddy White's Ankle Injury: A Look at His High-Ankle Sprain, Fantasy Value

Dave Siebert, M.D.@DaveMSiebertFeatured ColumnistSeptember 11, 2013

ATLANTA, GA - JANUARY 20:  Wide receiver Roddy White #84 of the Atlanta Falcons looks on before taking on the San Francisco 49ers in the NFC Championship game at the Georgia Dome on January 20, 2013 in Atlanta, Georgia.  (Photo by Kevin C. Cox/Getty Images)
Kevin C. Cox/Getty Images

Many expected the Atlanta Falcons to limit star wide receiver Roddy White during Week 1 as he continues to nurse an ankle injury he suffered last month. What followed, however, came as a surprise.

According to D. Orlando Ledbetter of the Atlanta Journal Constitution, White admitted that his ankle sprain is, indeed, of the high-ankle variety—something previously denied by head coach Mike Smith. He does not expect to perform at his normal level for possibly a few more weeks.

Unfortunately, that's likely an accurate statement.

High-ankle sprains are entirely different from their low-ankle counterparts, and they are infamous for a reason.

A closer look at the anatomy of the ankle makes it clear why.

What Is an Ankle Sprain?

The ankle is the joint where the lower leg meets the foot. Specifically, it is where the tibia and fibula—the bones of the lower leg—meet the bones of the heel.

Like in all joints, ligaments—tough bands of tissue that connect one bone to another—stabilize motion at the ankle and allow for the complex motions of the lower leg and foot.

Unfortunately, similar to a rubber band, ligaments can overstretch or tear—called a sprain.

Grade-one sprains—the mildest type—are mere overstretches with only microscopic tearing. On the other hand, a grade-two sprain is a partial ligament tear, while a grade-three sprain implies the complete rupture of a ligament into two separate pieces.

High-grade sprains require a longer recovery and more complex treatments, up to and including the surgical reattachment of the two ends of a fully torn ligament.

What's the Difference Between a Low-Ankle Sprain and a High-Ankle Sprain?

Several ligaments maintain the proper anatomical position and functionality of the ankle.

To simplify things, it helps to think of the ankle ligaments as falling into two groups:

  1. Ligaments that connect the tibia or fibula to the top or outside of the back heel bones.
  2. Ligaments that connect the tibia and fibula to each other—called the "syndesmotic" ligaments.

Doctors term sprains of the first group "low-ankle sprains," while a "high-ankle" sprain implies damage to one or more of the syndesmotic ligaments.

How Does an Athlete Suffer Each Type of Ankle Sprain?

As mentioned, sprains occur when a hit or fall forcefully overstretches or tears a ligament.

In the case of the low-ankle sprain, one classic injury cause is the rolled ankle.

When an athlete rolls his or her ankle, the lower leg moves over the outside of the foot, stretching the ligaments that connect the outside portion of the lower leg to the heel.

Conversely, high-ankle sprains occur when the tibia and fibula move about one another, extending the ligaments that connect them. This occurs when the lower leg sharply rotates outward.

In football, high-ankle sprains can occur when, for example, a wide receiver lands on his toes on one side and collapses toward the opposite, forcing his toes to turn outward.

Why Are High-Ankle Sprains so Much Nastier?

Unlike low-ankle sprains, high-ankle sprains can compromise the very integrity of the lower leg.

Since they stabilize the tibia and fibula, healthy syndesmotic ligaments are crucial to safely bear weight. Without them, the tibia and fibula could rotate about each other, collapse and fracture.

In the worst-case scenario, a complete rupture of one or more syndesmotic ligaments could result in an unstable lower leg, necessitating surgery to restore function and fix the bones in place.

Fortunately, most low-grade high-ankle sprains will heal on their own. But for that to happen, an athlete must allow them to rest.

That said, resting syndesmotic ligaments is much more difficult than it sounds.

While a walking boot can help with a low-ankle sprain by preventing the application of inversion stress on the healing ligament, there are fewer options for a high-ankle sprain.

Unless an athlete assumes an entirely non-weight-bearing status—crutches or a wheelchair, for example—healing syndesmotic ligaments will continue to receive their share of mechanical burden whenever the athlete bears weight.

How Did Roddy White Play with a High-Ankle Sprain?

As long as White's ankle sprain is on the lower end of the severity spectrum—a grade-one injury, for instance—it is possible to play through it.

Nevertheless, that doesn't necessarily mean he can play at full strength.

While he did start Week 1, Gregg Rosenthal and the staff at NFL.com noticed that White did not factor much into the outcome. More specifically, it seemed like he could not push off his injured ankle.

Additionally, according to NFL.com's Chris Wesseling, White only played 37 snaps.

In other words, neither White nor the Falcons wanted to risk further injury by pushing forward too quickly.

Since injured ligaments are weaker ligaments, working a sprained ankle too hard—even a low-grade one—risks worsening the injury.

When Will White Return to Full Speed?

Since he played through it, it is reasonably safe to assume White's injury is—at worst—a mild grade-two sprain that is already a few weeks into the healing process. A lingering grade-one sprain is also possible.

However, even grade-one sprains can require several weeks of rest, rehabilitation and physical therapy to completely heal. 

Eventually, White's ankle will catch up to the demands of the NFL‚ but until then, the star wideout will likely sit out of most practices and function only as a decoy during games.

What does that mean for his fantasy owners?

Look no further than White himself for advice:

As long as he suffers no setbacks—a large assumption in and of itself—White could work his way back into his usual role within the Falcons offense by Week 4—and maybe even earlier. Such a time frame would constitute an approximate six-week recovery, typical for a mild sprain.

All of that said, he probably isn't a safe start until he has at least one productive game under his belt, thereby signifying his true return to his elite wide receiver status.

Dave is a resident physician at the University of Washington who plans to pursue fellowship training in Primary Care (non-operative) Sports Medicine.