With the news that Buffalo Sabres centre Jack Eichel suffered a high-ankle sprain at practice on Wednesday, we went to the archives to get you the 411 on the injury. This article originally appeared in the March 26, 2012, edition of Sportsnet magazine.

COACHES, FANS AND FANTASY TEAM OWNERS all have an engineer-like ability to do mental math when it comes to player injuries. Before the gauze has turned from white to red, the calculations have already begun. Will the player miss a shift, a period or multiple games? If the words “ankle sprain” enter the equation, the next big question is whether it’s “high.”

The high-ankle sprain keeps players on the sidelines longer than a regular ankle sprain. When a typical sprain occurs, the prognosis is two to three weeks, as opposed to roughly six to eight weeks for a high-ankle injury.

On a basic level, a regular ankle sprain happens when a person “rolls” the foot inward, while a high-ankle sprain is due to an outward roll. To get a sense of it, put one foot behind you and drag your big toe along the carpet. This creates a strain on the ligament attaching the lower leg’s two bones—the tibia and fibula—as they pull apart just above the ankle.



High-ankle sprains are much harder to heal than their low-ankle counterpart. (Illustration by Bryan Christie)

Both the tibia (1)—the larger bone on the interior of the leg—and the fibula (2) attach to the ankle, which results in the two bumps on either side of your foot. The fibula runs just a bit further down than the tibia and is connected to the ankle by three ligaments, some or all of which can be damaged in a regular sprain. A high-ankle sprain can occur in a few ways, but most commonly happens when the ligament (3) that holds the tibia and fibula together is compromised, causing the bones to pull apart.

Mike Vogt, head athletic therapist for the Columbus Blue Jackets, points out that because 90 percent of a person’s body weight is supported by the tibia, the high-ankle sprain is much harder to heal than its low-ankle counterpart.

“We can tape you, we can brace you,” says Vogt of low-ankle sprains.

“But to keep those bones from separating with a high-ankle sprain is very difficult, it takes a lot of time for that ligament to heal because there’s a lot more pressure in that junction than there is lower down with other [regular] ligament sprains.”

Vogt likes to treat high-ankle sprains with a walking boot as scar tissue builds to reattach the ligaments. However, while ligaments stretch like an elastic band, scar tissue is more like paper and can rip. A player can often be feeling better as scar tissue repairs the ligaments, only to suffer a setback when the tissue tears. Over time, the scar tissue becomes more dynamic.

“They’re going to have those little tweaks, those little pops where you tear the scar tissue, then you move on,” says Vogt. “It’s part of the process.”