Anatomy of an ankle
In light of Mack’s break, doctor explains range of injuries
How long will UCF quarterback Darriel Mack Jr. be sidelined due to his broken ankle? The school released a statement announcing the injury and adding there is no timetable for Mack’s return, but the Knights confirmed Mack will not be available for training camp, which is set to open in a few weeks.
Just how long the Knights will be without Mack’s services is a hot topic of debate among fans.
What we do know is that depending on the severity, ankle injuries can take anywhere from a few weeks to several months to heal.
“The range of the type of injuries that you can have is really wide,” said Dr. Harrison Youmans, who practices primary-care sports medicine at Orlando Health.
While Youmans isn’t familiar with any of
“Sometimes it takes a little bit longer to regain that range of motion, their strength and their ability to cut, plant and pivot.” — Dr. Harrison Youmans, primary care sports medicine at Orlando Health
the specifics surrounding Mack’s injury, he has seen his fair share of sports-related ankle injuries — particularly ones in football.
“When I talk to my patients, I think of them being in three categories: There are the things that are nonsurgical that we’re going to manage and they’re going to get better; there are the things on the far end that are going to need a surgery as soon as we can do it; and a lot of people fit in the middle with chronic conditions,” Youmans said.
“With a fracture, you tend to kind of know what you’re going to have to do or have to make a decision what you’re going to do from the beginning.”
There are three bones that essentially make up the ankle.
The tibia is the shin bone and runs down the front of the leg to form the bump called the “medial malleolus.” The fibula is the bone on the outer half of the ankle and the talus is the bridge between the tibia, fibula and foot.
Youmans said the most benign type of injury a person can suffer is an avulsion fracture, which is when a tendon or a ligament pulls away a piece of bone from an area.
“If we have someone who is a football player who has an avulsion fracture of what we call the ‘lateral malleolus,’ we would treat
about the same as we would an ankle sprain,” Youmans explained. “If you have an avulsion fracture, you’ve probably sprained a ligament too, and with those they tend to be very small fractures.
“Sometimes you have to put them in a boot for a couple of weeks. But usually you brace them, you start physical therapy immediately and you treat them like an ankle sprain.”
Youmans said the fibula on the outside of the ankle is the most commonly fractured. He said if the fibula is broken higher up and doesn’t require surgery, the ankle is put in a boot and it could take anywhere from six to eight weeks to heal.
“Sometimes people are able to return at that point,” Youmans said, “and sometimes it takes a little bit longer to regain that range of motion, their strength and their ability to cut, plant and pivot.”
Surgery would be required, according to Youmans, if there was any other bone fractured along with it, if that break was displaced and didn’t line back up with the rest of the bones or if the patient has injured the ligament on the inside part of the ankle.
A break in the medial malleolus on the inside of the ankle could result in a screw inserted through the piece of bone to hold it down. The return from this sort of injury could take six to eight weeks or possibly a little longer, depending
on the rehabilitation.
The most concerning injury involving the ankle, according to Youmans, is when the fibula is broken and the inside ligament tears or there is a break in both the fibula and the tibia.
Both of those situations would require surgery.
In the first case, a plate would be inserted on the outside part of the fibula or a pin that runs through the fibula to hold it in alignment.
If both bones are broken, doctors would put a screw that goes across the fibula and tibia in a horizontal fashion or they could try a new technique called a “tightrope procedure.”
Alabama quarterback Tua Tagovailoa underwent a tightrope procedure after suffering a highankle sprain in the SEC Championship Game. Four weeks later, he was ready to play in the team’s College Football Playoff semifinal game.
Surgeons drill a hole through both bones and insert a fiber tape that features buttons on each side. They then use it like a zip-tie in pulling the bones back together. It provides more stability for the athlete.
Youmans said the procedure is becoming quite popular in college football in the last year or so.
Fractures of this magnitude require a longer recovery time, perhaps six to eight weeks to heal, but possibly eight to 12 weeks to be at full strength.