Dr. Blue's Health of the Franchise: Gonzalez

by LovinBlue on Sep 15, 2010 1:30 PM EDT in 2010 Colts Analysis

I really wanted the Dr. Blue series to be quiet this year, but the reality of the NFL is otherwise. Remember, I am NOT a doctor. These articles are based on my ability to find, read and interpret information on-line.

Anthony Gonzalez, WR
Date of Injury: September 12, 2010
Nature of Injury: High ankle sprain
Typical Rehab Process/Duration: Depends on severity; could be a few weeks to several months.
Players who have suffered similar injuries: Bob Sanders, Max Starks, Michael Turner

Luckily or unluckily, I was able to dust off my very first Dr. Blue FanPost to find information on high ankle sprains. A high ankle sprain injures the ligament above the ankle that joins together the tibia and fibula in the lower leg. It occurs when that ligament is stretched or torn. Recovery from this injury depends (naturally) on the severity of the damage.

If the damage is minimal, and the patient's lower leg bones are stable, the patient can wear a simple cast for a few weeks while the ligament repairs itself. If the lower leg bones are found to be moving around more than they should, surgery may be indicated to essentially fasten the leg bones in proper place while the ligament heals. If surgery is required, the patient may have to wait 3 months before starting rehab, and another several months of rehab thereafter, up to 6 months for the non-athlete.

Most of us are familiar with ankle sprains where your foot "rolls up" and inward - this is called a lateral ankle sprain, and is a common basketball injury. A lateral sprain was what Dwight Freeney suffered in last year's AFCCG game against the Jets. By contrast, high ankle sprains are caused when a foot is forced to rotate outwards.

According to Dr. Chris Chiodo of Massachusetts (thank you, TheAngelsColts),

High ankle sprains are usually more severe injuries than lateral ankle sprains, and patients are often unable to bear weight on the injured extremity. [They] should be treated differently than lateral ankle sprains and can take twice as long to heal.

I strongly recommend reading Dr. Chiodo's write-up on high ankle sprains, as he offers much more technical detail and treatment approach.

The Colts have not published the severity of Gonzo's sprain, and it's unclear whether the shot we saw on TV of him talking to trainers took place before or after he sustained the injury. If it was after, we might take some solace in the fact that Gonzo looked able to walk around, and the severity might not be as bad as it could be. Still, we already know that Gonzo was ruled out for Week 2, and it is unrealistic to expect him back until at the absolute earliest, Week 4 (@ Jacksonville).

Assuming the coaching staff continue their conservative approach with injuries, and given Gonzo's injury history, it is not unreasonable to expect the staff to keep him sidelined an additional week or two. I agree with BBS that this points to after the bye week.

Dr. Blue's Prognosis - Likely Week 8 Appearance: Medium

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Comments

Thanks LB.

always good info….. i feel bad for Gonzo… but i hope after he recovers, he can focus on just playing good to get his job back….. and stay healthy.

If you see my smilieys, think of E.M.H. - our COLTs King of Smileys!

by Manning4ever on Sep 15, 2010 1:42 PM EDT reply actions

good article

I am a doctor ( but not an ortho), but most likely he will be back after the break. They should send him to Canada where they inject hyaluronic acid in the injured area and studies in Canada have shown and it promotes faster healing. I do not know if anyone is doing it in the USA. Go Colts.

by OBGYNOSUPREME on Sep 15, 2010 1:45 PM EDT reply actions

Something about sending him to another country for alternative healing processes...

Is awesome. I really can’t imagine that happening, but I thoroughly enjoy the idea. Go Colts.

by strootster on Sep 15, 2010 1:54 PM EDT up reply actions

studies say it works

and you can take it orally for joint maintenance , works better than glucosamine, IM form is to treat injuries

by OBGYNOSUPREME on Sep 15, 2010 1:57 PM EDT up reply actions

I am a disabled ankle surgeon since 1988 , technigues have changed , for most part I agree with article, also personal experience as had it & worse

Much will be repeated but all high ankle sprains involve some degree of excess motion at the ankle area by definition we used to use as explained below but thats not what would make it unstable. There would have to be really severe ligament tearing so the leg bones can really move about and not secure the ankle

A high ankle sprain injures the ligament above the ankle that joins together the two bones of the leg. the tibia (shin ) and fibula, They are joined together by the “sydesmotic ligament.” Those with high ankle sprains can also have an associated injury with more common low ankle sprains, and even ankle fractures.

A high ankle sprain causes symptoms similar to other ankle sprains, but patients often complain of pain when the ankle is externally rotated (turned to the outside) or when the calf is squeezed. This later finding, the so-called “squeeze test,” is the classic test for syndesmotic injuries, but it is not very reliable for diagnosis.

Taking x-rays Under stres , that is moving the ankle to extremes and comparing to other ankle & standard movement levels reveals a greater movement than normal between the 2 leg bones the ligament would otherwise restrict if uninjured.

If the injury is stable, WHICH I IMAGINE GONZOS IS AS HE WAS STANDING ON IT then the high ankle sprain can be treated pending the injury level with taping & walking cast boot or may be advised to be off it , or real full cast usually for a period of 6 weeks. But for an athelete sometimes things are often done bit differently so doesnt weaken muscle with cast atrophy & with the constant daily attention he will get and with proper PT time oftened is lessened to get back to play .
I didnt treat athletes and modern technigues have changed AGAIN DEPENDS ON DEGREE OF INJURY TO LIGAMENT , ITS A LONG LIGAMENT< JUST HOW MUCH IS DAMAGED IS KEY. MRI SHOULD HELP & THE STRESS X_RAYS comparison to see how much excess movement is present

If the injury is unstable, LIKE I HAD then a “syndesmotic screw” can be placed between the tibia and fibula to hold the bones in proper position while the syndesmotic ligament heals. PLUS I broke the bottom of the tibia and each bump, malleoli on the ankle sides and so many broken bone pieces that they cut off the ankle ligaments on both sides so I needed the syndesmodic screw, , 6 other screws and a metal plate as well as each torn ligament repaired.

My other ankle was simpler , just 1 bone fractured .

PARADOX, I did ankle reconstruction as my specialty and do to hospital medicine problem causing seizure after my neck surgery I ended up with the major ankle fracture I noted and the 2nd 1 later from my balance problem and fall
Neck infection ended my carreer.

Ankle fracture was 1 week after leaving hospital after 45 days or so, also after 95 ectra as took 9 months to diagnose neck while I sytill did surgery and actually should have been a cripple so just gained weight as went from aerobics 4 days a wek to just limping about for 9 months.

++ I started swimming PT in 4 months if remember correctly to let u know & I was obviously ouit of shape and still not on correct medicine whose improper stoppage caused the incident, & delayed the start of therapy as without it My legs were constantly in spasm

Please Read My 1st paragraph of profile to realize my multiple disabilities making it hard to type correctly if there are many typos etc

by bayone on Sep 15, 2010 2:13 PM EDT reply actions

REMEMBER PT also delayed as had worse type of medial & lateral ligament tears, other lig tears & multiple fractures

called 3 maeloi , the 2 bumps on ankle sides and more than 35% of bottom of TIBIA, the thick leg bone , as well as multiple smaller fracture fragments , and the multiple ligament tears on both sides of ankle and orther areas, Basicaly an extra showed a floating fractrured ankle between 2 wide leg bones, Sio I was an extreme case

Please Read My 1st paragraph of profile to realize my multiple disabilities making it hard to type correctly if there are many typos etc

by bayone on Sep 15, 2010 2:30 PM EDT up reply actions

thats xray not extra

Please Read My 1st paragraph of profile to realize my multiple disabilities making it hard to type correctly if there are many typos etc

by bayone on Sep 15, 2010 2:31 PM EDT up reply actions

not really a paradox.... more like irony

"To be a great football coach, you have to be smart enough to do it well, and dumb enough to think it's important." -- Can't remember whom I am paraphrasing.

by zherebyonki on Sep 15, 2010 6:16 PM EDT up reply actions

i read your profile Bayone, and that's a great story about becoming a Colts fan!

Sorry if my comment above seemed jerk-like. Wasn’t meant to be. After posting, I realized the connotation that most people have with irony is its use in humor, and I’d be mortified if anyone thought I was being flippant about your medical condition.

Thanks for sharing the knowledge.

Another poster on another thread said something odd about Bob Sander’s bicep ligament tears (first one arm and then the other) being symmetrical like cavities supposedly often are. Any truth to that? I know during rehab people often injure the other side when overcompensating for the hurt side, but I figured Bob’s original arm had healed. Do you figure Bob just has packed on too much upper body mass for his small-ish frame?

{I’d have quoted that fan, willyduer, if only i knew how to do those blue quote boxes. “Where do they get those wonderful toys?”}

"To be a great football coach, you have to be smart enough to do it well, and dumb enough to think it's important." -- Can't remember whom I am paraphrasing.

by zherebyonki on Sep 15, 2010 7:08 PM EDT up reply actions

Just a quick note LB

Exactly what Starks’ injury is is still up in the air ATM. It was originally reported as a high ankle sprain, but Tomlin said it was a regular(low) ankle sprain.