Patrick Mahomes played on a high ankle sprain. Here’s why that’s so rare

Two years later, Seattle Seahawks cornerback Richard Sherman had to be carted off the field during Super Bowl XLVIII after suffering a high ankle sprain in the fourth quarter of a dominant win over the Denver Broncos.

Sprained Ankle vs. Broken Ankle: What Are the Differences?

Kristen Gasnick, PT, DPT, is a medical writer and a physical therapist at Holy Name Medical Center in New Jersey.

Published on February 02, 2023

Jordana Haber Hazan, MD, is a board-certified emergency medicine physician and recipient of the Academy for Women in Emergency Medicine Catalyst Award.

She currently works as an academic emergency physician and is based in Nevada.

Table of Contents
Table of Contents

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A sprained ankle and a broken ankle can result from twisting and rolling the ankle. While both conditions cause ankle pain and instability, a broken ankle is a more serious injury that requires different treatment compared to a sprained ankle. This article will discuss the differences between a sprained ankle and a broken ankle, how they are diagnosed, and treatment options.

Symptoms

Symptoms of a sprained ankle and a broken ankle can overlap, with pain and swelling being the most common symptoms among the two types of injuries. Symptoms between the two vary in intensity, however, and can present differently.

Localized ankle pain
Difficulty bearing weight/walking on affected ankle
Ankle instability and poor balance

Diffuse ankle pain around the ankle joint
Inability to bear weight/walk on affected ankle
Visible ankle deformity

Symptoms that overlap between a sprained ankle and broken ankle include:

Swelling
Bruising
Tenderness to the touch
Limited range of motion

Causes

Sprained and broken ankles can result from similar causes. The extent of impact and injury to your ankle, however, will differ. Injuries caused by higher impacts typically cause more severe injuries, like a broken ankle, while milder injuries are more likely to result in a sprained ankle.

Sprained Ankle Causes

A sprained ankle most often results from twisting or rolling the ankle inward. This type of injury can occur with:

Wearing unstable or unsupportive shoes such as flip flops or high heels
Walking or running on uneven ground
Jumping and landing incorrectly
Losing your balance
Slipping off a curb or step

Broken Ankle Causes

A broken ankle is typically a more traumatic injury that results from a greater amount of force with injury. While a broken ankle can result from the same causes as a sprained ankle, it is also more likely to occur with:

High-impact sports injuries, such as twisting a planted foot or falling and landing on top of your foot
Traumatic falls
Motor vehicle accidents

Diagnosis

Diagnosis for an ankle injury begins with a visit to your healthcare provider after the injury to your ankle. Your healthcare provider will ask how the injury occurred and will observe how you can walk or if you can bear weight on your foot. Your healthcare provider will examine the physical appearance of your ankle, check for bruising and swelling, and try to move your ankle in different directions.

Depending on your symptoms, your healthcare provider may take an X-ray. When screening for ankle injuries, healthcare providers typically follow the Ottawa Ankle Rules. These guidelines provide recommendations for when an ankle x-ray should be performed to determine if a broken ankle has occurred.

An ankle x-ray should be performed if you:

Have pain or tenderness over the inner bone of the ankle (medial malleolus of the tibia)
Have pain or tenderness over the outer bone of the ankle (lateral malleolus of the fibula)
Cannot bear weight on your foot immediately after injury
Cannot bear weight for four steps on the affected ankle in the emergency department

Because X-rays produce images of bone, they can be used to determine if you have a broken ankle. Your healthcare provider will be able to see if there is a fracture in one or more of the bones that make up your ankle joint.

If your X-ray is normal, but you have ankle pain, swelling, and/or bruising after an injury to your ankle, you will likely be diagnosed with an ankle sprain. Oftentimes no further tests are needed to diagnose an ankle sprain. Your healthcare provider will typically make a diagnosis based on your symptoms and negative X-ray result.

If you continue to have pain and swelling for several weeks or months after an ankle injury, your healthcare provider may have an MRI of your ankle performed. MRIs examine soft tissues of the body and can be used to determine if a tendon or ligament is torn.

Treatment

A proper diagnosis of your ankle injury is needed to determine the appropriate treatment. Certain methods can be used for ankle injuries to reduce pain, improve range of motion, and increase strength, while more involved medical procedures and precautions are often needed for broken ankles.

Sprained Ankle Treatment

Treatment for a sprained ankle first involves resting your ankle from prolonged standing and walking. An ankle sprain overstretches the ligaments of your ankle, causing damage that weakens its ability to stabilize your ankle joint. When this occurs, resting your ankle from the pressure of weight bearing is needed to reduce pain and irritation.

During this time, applying ice to your ankle can help reduce pain and swelling. If needed, over-the-counter pain medication like Tylenol or non-steroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) or Aleve (naproxen sodium) can also be used to help alleviate pain.

Wearing an ankle brace can also be beneficial to support your ankle joint if it feels unstable. Ankle braces and supportive sleeves can be purchased at most drug stores. If you went to the emergency room following your ankle injury, you might be provided with an ankle brace from the hospital and/or crutches to help you walk if you have a lot of pain.

Broken Ankle Treatment

Treatment for a broken ankle typically begins with a period of immobilization. When a bone breaks, it needs to be immobilized, or prevented from moving, for it to heal properly. Immobilization for a broken ankle will include a cast or boot to stabilize your ankle in place.

Depending on the severity of your broken ankle and how many bones were affected, you may require surgery to realign your ankle joint and hold your bones in place with metal pins and screws for it to heal.

Immobilizing your ankle will also require a period of non-weight bearing for four to eight weeks to reduce pressure on your broken ankle, which can interfere with the healing process. During this time, you will have to use crutches, a walker, scooter, or wheelchair to get around to avoid putting weight on your broken ankle.

Throughout your recovery from a broken ankle, you may use ice and pain-relieving medication to help decrease your pain and swelling.

After your initial immobilization and non-weight-bearing period, your healthcare provider will clear you to begin physical therapy. You will also be cleared to begin weight-bearing on your foot. This typically begins with a protective boot and crutches or a walker for support. As you gain more strength and stability in your ankle, the boot and assistive device will gradually be discontinued under guidance by your physical therapist to help get you back to walking normally again.

Physical therapy visits will involve several months of recovery involving stretching, strengthening, and balance exercises to return you to your prior level of functioning.

Prevention

Preventing ankle injuries starts with wearing supportive footwear to avoid twisting or rolling your ankle. Avoid running on uneven ground and walking on slick surfaces when possible, and take your time walking downstairs. Strengthening your ankle muscles, particularly your peroneals that move your ankle outward, can also help support and stabilize your ankle joint to reduce the risk of injury.

Summary

A sprained ankle and a broken ankle can both result from twisting, rolling, or trauma to the ankle, although broken ankles result from more traumatic and higher impact injuries. Both types of injuries can result in ankle pain, difficulty or inability with bearing weight on the affected ankle, inability or difficulty walking, swelling, bruising, and reduced range of motion, with more severe symptoms and limitations with a broken ankle.

An X-ray will diagnose whether you have a broken or sprained ankle, and treatment for both injuries will involve rest, ice, exercise, and possibly physical therapy. Severely broken ankles often need surgery to realign the broken bones and involve more limitations in the early stages of recovery, including immobilization with a cast or walking boot and non-weight bearing for four to eight weeks with the use of an assistive device like crutches, a walker, scooter, or wheelchair.

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Pflüger P, Braun KF, Mair O, Kirchhoff C, Biberthaler P, Crönlein M. Current management of trimalleolar ankle fractures.EFORT Open Rev. 2021 Aug 10;6(8):692-703. doi: 10.1302/2058-5241.6.200138.
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By Kristen Gasnick, PT, DPT
Kristen Gasnick, PT, DPT, is a medical writer and a physical therapist at Holy Name Medical Center in New Jersey.

Patrick Mahomes played on a high ankle sprain. Here’s why that’s so rare.

Patrick Mahomes tried to negotiate his way out of it. In the first quarter of the Kansas City Chiefs’ AFC divisional-round playoff win over the Jacksonville Jaguars, the quarterback crumpled to the ground with an injury to his right leg. He couldn’t go back on the field, Coach Andy Reid ordered — not until he underwent an X-ray.

Chiefs quarterback Patrick Mahomes limped back to the huddle in the first half of Kansas City’s game against the Jaguars in the divisional round.

Television cameras caught Mahomes slamming his helmet in frustration before walking to the locker room for testing.

“I’ve been in that X-ray room before, and it hasn’t worked out well for me,” Mahomes said last week in an interview on Fox Sports 1’s “First Things First.” “I thought I was good enough to play, and I wanted to at least get one more series to get out there and see if I could test it out. Coach Reid … said: ‘You’re getting the X-ray before you play. So you might as well go now.’ ”

The good news was Mahomes had avoided a fracture in his lower leg. The bad news was he had suffered a high ankle sprain — an injury that can sideline a player for six weeks, if not longer, and, depending on the severity, can require surgery.

Mahomes missed a series in the victory over Jacksonville, then played through the pain to lead the Chiefs past the Cincinnati Bengals in the AFC championship game, hobbling between series in the second half and taking extra measures to avoid landing on his ankle during his final run, which set up the game-winning field goal.

Now Mahomes faces the difficult task of doing it again in Super Bowl LVII on Sunday. After two weeks of rest and rehab, his ankle could be markedly improved, but it still has the potential to limit him on the biggest stage.

“Certainly some of it depends on how he plants and twists and how he gets hit. He’s still going to be at risk of it flaring up or getting worse during the game,” said Brian Polsky, a former Philadelphia Eagles team physician who is now an orthopedic surgeon based in Maryland. “I’m certain there will be less swelling. They’ll be giving him daily treatments. … I’m not privy to how bad his injury was, but I would bet that he can make very good progress.”

Ankle sprains and their recoveries can vary significantly. They usually range from a Grade 1 sprain — which is mild, with swelling and pain — to Grade 3 — which is severe, with torn ligaments. But they also can be distinguished by the location and the types of ligaments affected.

A low ankle sprain affects the ligaments connecting the bones in the foot. A high ankle sprain affects the tissue between the tibia and fibula in the lower leg. The recovery time for a high ankle sprain is typically longer than recovery from a low ankle sprain because of the constant weight-bearing and twisting and turning of the ligaments.

“The problem with a high ankle sprain … depending on the severity, is it can be as bad as crutches and non-weight-bearing and season-ending,” Polsky said. “Or it can be a little more mild, where it’s just kind of a sprain of that tissue, and someone can initially limp around on it, and it tends to heal over four to six weeks.”

Neither the Chiefs nor Mahomes have disclosed the severity or grade of his high ankle sprain, but his ability to play in the AFC championship game and walk fairly normally Sunday when the Chiefs arrived in Arizona offer a more promising outlook.

“My whole body was a little sore, so I don’t think I had any step backward or anything like that,” he told reporters Thursday. “I had no re-aggravation of the ankle — just the general pain I had playing with it. But other than that, I feel like I’m in a good spot.”

After the AFC championship game, Mahomes credited Julie Frymyer, an assistant athletic trainer and physical therapist with the Chiefs, for leading his rehab plan in the days before the game and helping to improve his mobility and range of motion.

To treat a high ankle sprain, typical methods — elevation, ice, massages, anti-inflammatory and prescription pain medicine and electric stimulation — may be used in conjunction with dry needling or laser therapy to reduce the swelling.

“Rehab ebbs and flows,” said former NFL safety David Bruton Jr., who is now a physical therapist in Colorado. “He’s going to see positive gains, and he might take a step back one day because he’s pushed it a little bit. Then he’ll see more gains with what he’s able to tolerate. He might be on anti-inflammatories . . . to get the swelling down. Whatever the case may be, I’m sure that training staff for the next two weeks is like, after the game: ‘Okay, let’s just chill; he played a whole game on it. Let’s get it to calm down and then reintroduce him to quarterback [movements].’ ”

It’s not common that an NFL player — or any athlete — plays through a high ankle sprain, given the pain and potential for long-term damage. Mahomes’s feat in the AFC title game was a testament to his mental fortitude (and adrenaline).

But he also wouldn’t be the first to play through significant injury in the NFL’s biggest game.

In the AFC championship game after the 2011 season, New England Patriots tight end Rob Gronkowski suffered what was reported to be a high ankle sprain. Speculation about his availability for Super Bowl XLVI was rampant, but he ended up playing and was limited to two catches for 26 yards in the Patriots’ 21-17 loss to the New York Giants. He underwent surgery days later.

Two years later, Seattle Seahawks cornerback Richard Sherman had to be carted off the field during Super Bowl XLVIII after suffering a high ankle sprain in the fourth quarter of a dominant win over the Denver Broncos.

“I’ve played through a pretty bad [ankle sprain], and that’s no fun — that’s for darn sure,” Bruton said. “It’s tough. It’s tough playing hurt, but even more so with an injury that you should be missing time for.”

Bruton broke his leg in a game while playing for the Broncos in 2015. He stayed in, not fully knowing the extent of the injury until the pain intensified and tests afterward showed a fractured fibula.

“During the season, it’s more of a triage: ‘Let’s get you back into a position to get back on the field,’ ” Bruton said. “It’s up to the players if they’re able to play through it. Obviously, consideration is given to whether they’d be doing more damage or if they’ve been able to tolerate some movement in the training room before they go on the field.”

Polsky added: “I’d imagine if this were the first game of the season, Mahomes would not be playing. They would take him out for a month, probably, and treat it week-to-week. But based on his MRI and physical exam, they decided … the benefit of treating this and playing vs. the risks were equal enough or in his favor.”

Sprained vs. Broken Ankle: How Can You Tell the Difference?

If you’ve recently hurt your ankle, you may be concerned that you have a sprained or broken ankle. Distinguishing between them can be difficult and an accurate diagnosis often requires an X-ray or other imagining test.

In this article we’ll look at the differences between a sprain and a broken ankle, and how these injuries are treated.

A sprained ankle is an injury to the ligaments of your ankle. Ligaments are dense pieces of connective tissue that hold your ankle bones together and help stabilize your joint.

Sprains usually occur when you suddenly twist your foot and overstretch your ligaments. Most often, the ligaments in the outer part of the foot get sprained. It’s less common to sprain your inner ligaments.

Some potential causes of a sprained ankle include:

walking or running on an uneven surface
landing on the side of your foot when running, jumping, or pivoting
twisting your ankle while falling
rolling your ankle while walking or running
having somebody land on your foot while playing sports

Most sprained ankles are minor injuries, but they can range in severity depending on the amount of damage to your ligaments. The severity of an ankle sprain can vary as follows:

Grade 1 sprain. One or more ligament is overstretched but not torn. You’ll likely be able to move your foot normally after a few days, and it will likely heal within 2 weeks .
Grade 2 sprain. A ligament is partially torn and your doctor may be able to feel instability when they move your ankle. It may take 6 to 8 weeks to heal.
Grade 3 sprain. The ligament is completely torn. It may take 3 to 6 months or longer to regain full strength and mobility.

Many people mix up the terms sprain and strain. However, the two injuries affect different structures in your body.

A sprain is an injury to a ligament connecting two bones together.
A strain is an injury to a muscle or a tendon that connects your muscle to the bone. A strain is also known as a pulled muscle or torn muscle.

A broken ankle — also called an ankle fracture — is when one or more of the bones around your ankle joint breaks.

There are three bones that make up your ankle joint. They include your:

tibia or shinbone
fibula, the smaller long bone in your lower leg
talus, the bone above your heel bone and below your fibula and tibia

Broken ankles are a relatively common injury that make up about 15 percent of ankle injuries seen in emergency departments. The severity can vary from a hairline fracture to a displaced fracture that requires surgery.

There are many potential causes of a broken ankle, but usually the injury results from a twisting injury. A broken ankle can also be caused by direct impact to the ankle, such as a car accident or a sports-related impact.

If you have a clean break that doesn’t require surgery, you can usually fully heal within 6 to 8 weeks . If you need surgery, it may take anywhere from 12 weeks to 2 years to regain full function of your ankle.

The symptoms of a broken and sprained ankle are similar, and the injuries can be difficult to tell apart, especially in cases of serious injuries that involve a lot of swelling. It’s also possible to have both a sprain and a fracture.

Sprained ankle symptoms

pain
swelling
bruising
tenderness
instability
restricted range of motion
popping sensation

Broken ankle symptoms

immediate sharp pain (often more painful than a sprain)
bruising
swelling
tenderness
a visible deformity (especially if your ankle is also dislocated)
trouble bearing weight on your foot

Asking yourself the following questions may help you narrow down what type of injury you have.

However, you should still have a medical professional examine your ankle even if you think you know what type of injury you have.

Are you dealing with severe pain that’s getting worse? If yes, you may have a sprained ankle. The pain with a broken ankle is usually felt immediately, whereas the pain with a sprain may get worse with time.
Did your injury result from a direct blow to your ankle and not from twisting, jumping, or rolling your ankle? If yes, there’s a higher chance that your ankle may be broken.
Did you hear a crack or pop when you injured it? If you heard a crack or pop at the time of the injury, you may be dealing with a break. However, spraining an ankle can also cause a popping sound in some cases.
Does it hurt more directly over a bone? If yes, your ankle may be broken.
Does it hurt more over a soft part of your ankle? If yes, you may be dealing with a sprain.

It’s important to get medical attention if you think you may have broken your ankle, or if you have severe pain, swelling, or bruising after injuring your ankle.

Your doctor or healthcare professional will carefully examine your ankle, foot, and lower part of your leg. They’ll also check for tenderness and move your foot to get an idea of how well you can move your ankle joint.

If your injury is more severe, your doctor may recommend one or more of the following imaging tests to help them accurately diagnose your injury:

Even though the symptoms of a sprained and broken ankle are similar, the treatments are quite different.

Treatment for a sprained ankle

Treatment for a sprained ankle aims to:

reduce pain and swelling
restore your full range of motion
return your ankle to full strength

For the first few days, you can follow the RICE method to reduce swelling:

Rest. Stay off your feet as much as possible.
Ice. Ice your foot for 15 to 20 minutes every 2 to 3 hours.
Compression. Wear an elastic bandage that provides compression around the injured area.
Elevation. Elevate your foot above the level of your heart when you’re resting.

You can also take over-the-counter pain relievers like ibuprofen to help manage pain.

Once the swelling passes, your doctor may recommend that you visit a physical therapist. A physical therapist can put together a customized plan of stretches and exercises to help restore the function of your ankle.

Surgery is rarely needed to treat ankle sprains.

Treatment for a broken ankle

With a broken ankle, your treatment plan will vary based on the location and severity of your fracture. Generally, it may include:

Immobilization. You’ll likely need to wear a protective boot or cast to give your bone time to heal.
Closed reduction. Your doctor may need to insert pins through your skin to realign the two ends of your bones if you have a displaced fracture.
Surgery. More severe breaks may need surgery to ensure your ankle bones stay aligned during the healing process.
Physical therapy. Once your bone is healed, a physical therapist can give you a customized stretching and exercise plan.
Pain relievers. Your doctor may recommend over-the-counter pain relievers such as Tylenol to help manage pain.

The best way to speed up your recovery from any injury is to listen to the advice of your healthcare professional and to follow their instructions.

For a sprained ankle:

Avoid putting weight on your ankle until the swelling subsides.
Once the swelling has gone down, you can try applying a heating pad to your ankle for 15 to 20 minutes several times a day.
Stretch your ankle regularly, but don’t do anything that hurts.

For a broken ankle:

Avoid bearing weight on your broken ankle until your doctor says it’s safe to do so.
Avoid carrying heavy objects.
Rest your ankle as much as possible and avoid playing sports until you’re fully healed.

Patrick Mahomes played on a high ankle sprain. Here’s why that’s so rare

Sprained Ankle vs. Broken Ankle: What Are the Differences?

Symptoms