Falcons All-Pro Center Alex Mack is off injury report – will he be effective?

Falcons Center Alex Mack injured his left ankle in the Conference Championship game two weeks ago. On film, it looked like a high ankle sprain. He was held from practice last week and this week practiced on a limited basis. Late last week his injury was listed on the team’s injury report as a “fibula.” A fibula injury is typically not an ankle sprain. The fibula is a bone on the lateral (outer) side of the ankle. To list a bone as being injured implies a fracture. Yet, it was odd that he would have a significant fibula fracture and not be seen in a walking boot. I would typically treat even a significant sprain with a chip fracture off of the fibula with a boot to reduce swelling and pain – the Patriots put Danny Amendola in a boot for a month for his recent high ankle sprain. Usually when an injury doesn’t seem to add up like this there is more to the story.

When I looked into Mack’s injury history, I found that he suffered a significant high ankle sprain and fibula fracture on that same left ankle in 2014. The injury that he had was similar to the ankle injuries that Marcus Mariota and Derek Carr sustained earlier this season. Watch as Mariota’s right foot externally rotates (rotates outward) as his shin rotates internally (inward).

This is a classic injury pattern for a high ankle sprain with a fibula fracture. The X-ray image below shows a left ankle that is facing you. The syndesmosis is the set of ligaments or rubber bands that connecting the tibia (bone on the left) to the fibula (bone on the right).


When the syndesmosis tears and the fibula fractures, the ankle joint is considered unstable and requires surgery. The X-ray below shows what the ankle would look like with hardware in place to stabilize the syndesmosis and repair the fibula.


Alex Mack’s injury 2 weeks ago looked like a high ankle sprain mechanism. Assuming his hardware is still in place, you can imagine that re-torquing that ankle could result in a lot of pain. It is possible that the hardware/scar tissue around the fibula got inflamed by the most recent injury and that’s why they listed it as a “fibula” injury.  It is also possible that his most recent injury was a lateral ankle sprain and he has a small avulsion (pulled off) fracture at the tip of the fibula which would recover like a regular ankle sprain.

Mack is no longer listed on today’s injury report, so there is no question that he will be active for the Super Bowl. The real question is, after being limited in practice all week, how effective will the All-Pro center be? Yesterday Falcons coach Dan Quinn said he was “concerned” about the injury and Mack was seen in practice coaching up his backup. It is clear that the center will not be at 100% on Sunday, which could prove to be a significant challenge for the Falcons’ running game.

Follow me on Twitter @jessdeede for more Super Bowl LI injury updates!

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