How Taylor Hall’s Ankle Got High

Thursday, March 3rd Edmonton rookie Taylor Hall had his first career NHL fight against Derek Dorsett of the Columbus Blue Jackets.  The end result was, at best, lame as hell.  After much sweater-holding and getting whacked by Dorsett, the two fell and Hall’s left ankle twisted in a truly awful way.

John Ulan - The Canadian Press/AP

The upshot of all of this is Hall’s season is likely over, and an MRI the day after the fight showed he has a high ankle sprain.  This of course begs the question…

What’s a high ankle sprain, exactly?

Let’s start at the beginning.  A sprain is a stretch or tear in the ligaments that hold a joint together.  Sprains can be mild (just a stretch), or catastrophic – completely torn ligaments, resulting in joint instability.

Ankle sprains are pretty common – usually a result of a twist or misstep – and generally mild. The average ankle sprain is to the anterior talo-fibular ligament, or ATFL – which is fancy talk for “the little ligament that connects the leg bone to the foot bone on the outside of the joint”.  Generally mild sprains heal in a few weeks with no problems and little intervention – rest, ice, maybe an ace wrap, keeping your foot propped up while you mope around the house itching to get back on the ice.

Severe ankle sprains are a different (and ugly) animal.  When ligaments are torn and joints are unstable you’re looking at several weeks of immobilization, medications, and rehab.  Weeks can often extend into months.  Therapies can sometimes extend to surgery.  People who’ve had severe sprains will tell you they can be harder to heal than fractures.

The high ankle sprain in particular is tricky, because it involves several ligaments that actually hold the two bones in the lower leg (the tibia and fibula) together.  The injury is usually because of an outward rotation of the lower leg (see above – feet aren’t supposed to do that).  The problem with a severe high ankle sprain is that obviously you’re going to have a leg that not only hurts, but that can be very, very unstable. Those two bones in the lower leg need to work together as a unit, and if you tear the ligament that holds them together (the interosseus ligament) you’re left with a leg that’s very painful and weak, especially with any kind of twisting motion.

Tearing this is bad news.

A regular ankle sprain can often be braced so that an athlete can return to action sooner with added support in the injured area.  Tape or a plastic brace are used to minimize ‘rolling’ of the ankle joint.  With a high ankle sprain, trying to stabilize the connection between those two bones verges on the impossible – you can’t just squish them together, you have to account for rotational forces as well.  If the damage in a high ankle is bad enough the repair can involve casting the lower leg for several weeks, or a surgical repair (using a screw, wire, or thick suture to fix the tibia and fibula together until the ligaments heal).

Obviously we don’t know how extensive the damage to Hall’s ankle is.  All we know is the basics of the injury.  With luck it’s not severe, and after a few weeks of immobilization and rehab he’ll be back to skating.  It’s safe to assume he’s done for this season, though.  Sorry, Edmonton.

– Jo