Rory McIlroy’s Ankle Sprain

Written by Michelle Champlin BSc Pod., M.Ch.S., S.R., Ch., (UK)
Golf’s world number one and defending champion Rory McIlroy has pulled out of the Scottish Open starting next week. He has reportedly suffered a rupture of his left ATFL – or ‘anterior talofibular’ ligament whilst playing football with friends. The ATFL runs from the fibular malleolus to the talus bone. As one of the lateral ligaments of the ankle – at the outside of the ankle – it stops the foot sliding too far forward. Anterior Tibiofibular Ligament (Left) – connecting the tibia & fibula
This ligament is the most common ligament injured in an ankle sprain.
Diagnosis
As part of McIlroy’s assessment, his medical team will have carried out a number of orthopaedic tests, including a ‘drawer test’ in addition to understanding the mechanism of the injury, a thorough physical exam and radiographic / MRI scans.
Ankle sprains such as McIlroy’s, to the outside of the ankle, are the most common sports injury, thought to account for 10-15% of sports injuries and responsible for up to 10% of emergency room visits.
How Does an ATFL Sprain Happen?
The extent of damage that occurs during an injury such as McIlroy’s depends on the direction and magnitude of the forces and the position of the foot and ankle during the trauma. Ankle sprains occur significantly more often in athletes who have had previous ankle sprains.
Michelle Champlin, Chief Podiatrist at Dubai Podiatry Centre says that there are also different foot postures and biomechanics that can increase your risk: “Pes cavus (high arches), rearfoot varus, tibial varus, and previous sprains are factors that may raise your risk of an ankle sprain.”
McIlroy’s type of ankle sprain tends to occur when the foot and ankle are ‘plantar flexed.’ This means that the toes are pointed downwards. (The ankle joint is a hinge type joint that only allows two movements – plantar and dorsal flexion, or in other words, toes pointing down or toes pointing up). The actual bones of the ankle joint keep it stable, along with ligaments on the outside and inside of the ankle.
When your foot is ‘plantar flexed’, or pointing downwards, the ankle joint is much less stable. This is when the ankle is most at risk of a sprain. The ankle joint is much more loose and less stable when pointed down. Try pointing your foot upwards and moving your foot side to side (lateral). Then do the same with it pointing downwards. You will notice how much freer your foot is to move side to side when it’s pointed downwards.
This is why women are much more likely to sprain their ankle in high heels – the ankle is put into an unstable position – and why your ankle is more unstable hiking downhill than uphill.
Whilst McIlroy hasn’t disclosed exactly how his footballing injury happened, it’s likely that his foot was plantar flexed at the time – most injured athletes describe ‘rolling’ their ankle to cause injury. In sports, we tend to see this type of outside ankle injury also when a player lands awkwardly on an opponent’s foot, catching the outside of the foot on the ground, or a sliding tackle that contacts the inside of an opponent’s weight bearing leg. The injured ankle tends to also, unfortunately, be the athlete’s leading, or dominant leg.
Ankle Sprains – the signs
Ankle sprains are graded 1-3 in severity. Signs and symptoms include:
• Popping sound at the time of injury
• Swelling, pain and bruising to the ankle / foot
• Inability to bear weight on the injured ankle
• Reduced range of motion at the ankle
Grading of the sprain depends on whether the ligament(s) are stretched, partially torn, or completely ruptured. McIlroy is already in a lightweight ‘aircast’ type brace that provides stability and support to the ankle, allowing it to heal. The ligaments can take 6 weeks or more to heal plus time for physical rehabilitation, including strengthening exercises.
Treatment
Sprains can be just as serious as fractures to the bone and should be treated with immediate RICE (see here for more information), taping and/or bracing and follow up physical therapy. In addition, patients should be assessed for any underlying biomechanical anomaly that can place you at greater risk of ankle sprains. Long-term effects of ankle sprains can include chronic ankle pain, arthrosis and ankle instability. Most often, a combination of RICE, bracing and physical therapy is enough to heal – in some severe cases though, surgery can be necessary.
We recommend visiting a qualified Podiatrist specializing in biomechanics and/or sports podiatry even after you are healed. We can carry out a full lower leg and foot exam amongst a range of tests to determine if there are any residual effects from the sprain and provide a rehabilitation program to get you back to training, sports and every day life safely. This may include the prescription of custom sports orthotics designed specifically for the motion and dynamics of your sport (rapid cutting / change of direction seen in football, or lots of lateral movement as in tennis for example) as well as correcting any biomechanical anomaly with your foot / ankle. Mrs Champlin says that in terms of golfing related ailments, issues such as plantar fasciitis tend to be common.
McIlroy seems to be on the road to recovery – possibly with further tests and scans scheduled to determine the extent of his injury and involvement of any other structures. We’re wishing him a speedy recovery and return to the game.
If you’ve found yourself in a similar painful condition with any form of ankle injury, it’s never too late to seek help from the experts at Dubai Podiatry Centre. Contact us on +971 4 3435390.