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Why Peyton’s Ankle Needs A Fairytale Ending

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courtesy Dr Dave Hnida

courtesy Dr Dave Hnida

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Written by Dr. Dave Hnida, CBS4 Medical EditorI’ll admit it. I worry Peyton’s ankle could derail his season quicker than his neck.

Let’s face it. We all sweat bullets when Manning takes a sack. Can a neck that’s been surgerized four times hold up to being tossed around like a rag doll? Yet, that jerry-rigged cervical spine seems as strong as ever since he joined the Broncos. Amazing stuff.

But, could a “routine ankle injury” that could happen to any mere mortal be the season-stopper for the Broncos runaway ride to the playoffs and the big prize?

It could. Mainly because it is not a routine, everyday ankle sprain.

Sure, the MRI came back today with “good news.” But in between the lines medical people go “Oh, boy.” That’s because Manning is suffering from a “high ankle sprain.” I’m sure you’ve heard the term if you’re a sports fan, but never really thought much about what “high” means.

In essence, there are “high sprains” and “low sprains.”

Low sprains are the ones you get when your roll your ankle playing hoops or step off a curb funny. The ligaments that go from the outside ankle bone down to the foot get stretched and torn.

When you nail the low outside only, it’s generally a simple sprain of the ligaments –a kind of injury that gets better without a lot of worry. It swells a lot, it hurts, but you generally can brace it and play more quickly than a high sprain.

A high sprain is waaaaaay  different. It involves the ligaments and “syndesmosis” — or thick band of tissue — that holds the two lower leg bones together just above the ankle. (The tibia and the fibula).

The tibia is your shin bone, and holds almost all of your weight when your step or stand. It forms the “inner” ankle bone. The fibula is a thinner chicken wing  that comes down your leg to form the outside bone of the ankle. Those are the two bones you feel when you reach down and touch your ankle.

If you look at my very non-artistic rendering of those structures, you can see how a high sprain is a bigger deal than the low. (It is a very over- simplified production — and not Manning’s actual X-rays).

You get a high sprain when your foot gets twisted outward. Such as … when you get sacked.

The high sprain involves the “heavy lifting” structures of the ankle. When those high ligaments and that thick syndesmosis is stretched or torn, every time you take a step, the two leg bones try to stretch apart and separate. Once again, see the picture.

The high sprains hurt. A lot. And you can’t move very well. Medically, you can’t really brace that injury like a low sprain. (Sure, you try though.)

And as a quarterback, it limits your ability to drop back and push off in the pocket with a throw. (right leg)

You rest it, therapy it, and sometimes a boot or cast will help on off days. We try to mega-tape/brace during a game. But healing for routine high sprains is not much more than time … and fingers crossed.

Peyton Manning

Peyton Manning during the Chargers-Broncos game on Nov. 10, 2013. (credit: CBS)

That’s why we call it the “dreaded high sprain.”

Other players with high sprains have returned to play quickly and do just fine. Jay Cutler, on the other hand, is out  with one– and listed week-to week.

Bottom line: Manning’s MRI did not show a more severe worsening of the sprain. And he’s good to go this week against the Chiefs (heck, he’d go out on crutches or wheelchair if he had to.)

But one more questionable hit, or a mess at the bottom of a multi-lineman pileup — and this season could have a dicey end.

These injuries need a good 4-8 weeks to heal — and that’s without a re-twist.

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