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Covering sports injuries from the perspective of a certified athletic trainer and backed by analytics.

Understanding Markelle Fultz’s Ankle Sprain

In Philadelphia, 76ers fans have endured “the Process” in hopes of returning to prominence. Former general Sam Hinkie initiated the rebuild by stocking piling assets and making moves intended to better position the team in the draft lottery. One often overlooked aspect of Hinkie’s plan was a willingness to invest in players with risky medical profiles. In 2013, he acquired center Nerlens Noel, a top-rated prospect who was still recovering from a torn ACL suffered while at Kentucky. Hinkie repeated the strategy the following year when he selected Joel Embiid, another talented frontcourt option with an assortment of injuries, including a fractured navicular bone in his right foot. Injuries continued to influence the Process even after Bryan Colangelo replaced Hinkie as general manager. Ben Simmons, the team’s top pick in the 2016 draft, missed all 82 games last year after suffering a fractured fifth metatarsal in training camp. The team had hoped the end of “the Process” was near following the selection of Markelle Fultz. However, an injury is once again threatening to delay the progression and has left Sixers fans distressed.

Fultz suffered an ankle sprain in Philadelphia’s first game of the Las Vegas Summer League. The first overall pick stepped on the heel of Warriors guard Jabari Brown while attempting to block a shot. The misstep forced Fultz’s left ankle violently inward in a direction known as inversion. He fell to the court and would be helped to the locker room by teammates. The injury was initially diagnosed as a high ankle sprain according to ESPN’s Ramona Shelburne but was later downgraded to a lateral ankle sprain.

Ankle sprains are one of the most common injuries in the NBA. Last season nearly 200 individual ankle sprains were reported with these injuries accounting for seven percent of the total games lost to injury. InStreetClothes.com has twice created a primer to help understand injuries to the ankle joint but let’s once again take an in-depth look.

The ankle is comprised of three bones, the tibia and fibula of the lower leg and the talus of the foot and multiple stabilizing ligaments. These structures come together to create three different joints that work together as a single functional unit.

The talocrural joint is the “true” ankle joint. It is formed from the distal ends of the tibia and fibula and talus. The ends of the tibia and fibula are known as malleoli (the big bumps on either side of your foot). The malleoli and the surface of talus create the ankle mortise and the hinge joint of the ankle. This construction allows for the up and down motions known as plantar flexion and dorsiflexion.

To fortify and stabilize the talocrural joint, multiple ligaments surround the area. On the inside or medial of the ankle is the strong triangle-shaped deltoid ligament that prevents excessive inward motion. The outer or lateral aspect of the ankle is stabilized by three more ligaments, the anterior talofibular ligament (ATFL), the posterior talofibular ligament (PTFL), and the calcaneofibular ligament, (CFL). These are the most commonly injured ligaments as their positioning makes them susceptible to injury when the foot is forced inward.

The subtalar joint is formed between the talus and the calcaneus (heel bone). This unique positioning makes the motions of inversion and eversion possible. Subtalar sprains generally occur in conjunction with a lateral ankle sprain.

The final joint of the ankle is the distal tibiofibular joint. It is located at the distal end of the leg, just above the talocrural joint. Here the tibia and the fibula are connected by three ligaments.  The strong interosseous ligament stretches across the joint to unite the two lower leg bones. Two complementary ligaments, the anterior and posterior tibiofibular ligaments, assist in stabilizing the ankle mortise. If one of the ligaments of the distal tib-fib is sprained, the injury is classified as a “high ankle” or syndesmotic sprain. A high ankle sprain can be isolated but may occur in conjunction with a lateral ankle sprain.

The timeline of recovery for ankle sprains widely varies based on a number of factors including the severity of damage, the involved joint, and any other accompanying injury. However high ankle sprains tend to take longer to heal that isolated lateral ankle sprains. A big reason for this extended recovery time is linked to the disruption of overall stability and potential widening of the ankle mortise.

Last year Lakers center Ivica Zubac suffered a season-ending high ankle sprain and missed LA’s final seven games. The average missed time for high ankle sprains over the past five NBA seasons is 10.8 games or roughly three weeks.

While the change in diagnosis is a win for the Sixers,  Fultz will not play again this summer and should be ready for the start of training camp. However, don’t be surprised if Philadelphia takes a conservative approach to Fultz’s recovery based on the importance of his long-term health.