Mariota & Carr – a tale of two ankles

Christmas eve was unfortunately a big day for injuries. As I was wrangling an over-sugared and under-rested 2 year old at a crowded church service my phone was silently buzzing away in my pocket. Tennessee Titans QB Marcus Mariota and Oakland Raiders QB Derek Carr both went down with similar ankle injuries that will sadly sideline them for the remainder of the season.

In the third quarter of the Titans-Jaguars game, Marcus Mariota was taken down by Jaguars DT Sheldon Day. As he goes down, Mariota’s right foot gets stuck between the ground and Day’s right shoulder and it is forced into external rotation (rotates to the right/outward) while the shin rotates inward.

A little over an hour later, in Oakland, rising star Raiders QB Derek Carr suffers the same fate. Colts OLB Trent Cole sacked Carr late in the 4th quarter. As he was spun to the ground, Carr’s right foot got trapped against the turf as his lower leg is rotated in the opposite direction.

Both quarterbacks suffered a high energy injury to their ankle. When the ankle rotates that significantly, it most often results in a fracture of the fibula and tear to the syndesmotic ligament. The syndesmotic ligaments are the rubber band-type structures that connect the lower leg bones (tibia and fibula) to each other.
high-ankle-sprain

A stretch or partial tear of these ligaments is called a high ankle sprain. Tearing of the syndesmotic ligaments along with a fibula fracture results in an ankle that is unstable (it’s basically a dislocation of the joint).

The images above are from two different patients. The image on the left depicts an injury like the one Mariota and Carr suffered pre-surgery. Notice that the ankle appears asymmetric, with widening on the medial (inner) side. If an athlete were to try to walk on that foot the ankle would dislocate – it is an unstable joint. This is why surgery is required. In the image on the right you can see the construct of how a surgeon might repair a fractured fibula with a torn syndesmotic ligament complex. In general, an injury like this takes about 6 months for a full recovery. Derek Carr and Marcus Mariota should both make full recoveries and be ready for the 2017 NFL season.

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