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Professional evaluation of Cordy Glenn’s high ankle sprain

Our in-house Doctor of Physical Therapy, Nick Malize, checks in to give his professional evaluation of Cordy Glenn’s injury.

NFL: New York Giants at Buffalo Bills Timothy T. Ludwig-USA TODAY Sports

Buffalo Bills stud left tackle Cordy Glenn is reportedly out for the preseason with a high ankle sprain. While this is obviously not good news, some may be wondering “what exactly is a high ankle sprain?” or “what is the difference between a regular ankle sprain and a high ankle sprain?” In this article, we will examine those two questions along with the prognosis for Glenn.

A high ankle sprain could be considered a misnomer, as it really isn’t in the ‘ankle’. A high ankle sprain is an injury sustained to the tissue that connects the tibia and fibula. The tissue that connects the tibia to the fibula consists of ligaments, called the ‘tib-fib’ ligaments, and an interosseous membrane that helps connect the tibia to the fibula.

In the photo above , the picture is depicting a high ankle sprain with the red lines. The one between the two bones is the interosseous being torn, and the one just below that is a tib-fib tear.

The difference between a regular ankle sprain and a high ankle sprain is the location and tissue affected.

A regular ankle sprain usually involves the lateral ankle ligaments (showed in photo above) that connect the fibula to the foot. In layman’s terms, a high ankle sprain is damage to the structures that connect the two lower leg bones together, while a traditional ankle sprain is damage to the structures that connect the leg bone (usually the outer one) to the foot.

Now that we understand what a high ankle sprain is and the difference between a high ankle sprain and the more traditional ankle sprain, it is time to discuss which is worse and why.

In terms of which is worse for a football player, although there are many factors that can add to this, the generic answer is a high ankle sprain. To understand why, it is important to understand the tibia and fibula joint. The tib-fib joint is a syndesmosis joint, which is held together by the above mentioned structures. Damage to these structures compromises the integrity of the joint. Think of it as the two bones no longer being ‘glued together’ or as being ‘wedged apart’.

Another reason a high ankle sprain is generally worse to suffer as a player is the sheer number of structures damaged. In a traditional ankle sprain, damage is often localized to one or two ligaments. In a high ankle sprain, besides the ligaments and interosseous membrane, the capsule that surrounds the ankle can also be damaged. Another point to make is that the with a traditional ankle sprain, the damaged structure is usually not being stressed unless the foot is in a specific position to stress the damaged ligament.

In a high ankle sprain, anytime the person is weight bearing, the syndesmosis joint (the joint between the two leg bones) will be stressed and pulled apart, further stressing the damaged structures. It is for this reason that Glenn is in a walking boot, as this will prevent the damaged tissue from being further stressed.

As far as a prognosis, this greatly depends on things such as how much damage was done to the interosseous membrane and ligaments, how much separation, if any, has occurred between the tibia and fibula, and if any other structures were damaged. The Bills medical staff will not make this public.

The fact that Glenn is expected back for the regular season opener leads me to believe that there is no separation between the two bones and surgery is not on the table, and conservative treatment is the course of action, which should take about 6 weeks. The Bills and Glenn should all be happy that this injury happened early in camp, as these are the types of injuries that can linger all season long if they are rushed back.