Losing a game is bad enough. Losing a star player to injury makes that loss even more painful. Pittsburgh Steelers fans experienced both yesterday when the Steelers played the Philadelphia Eagles on the road. Late in the fourth quarter, down 27-13 with the Eagles driving, the Steelers saw their star pass rusher T.J. Watt go down, grabbing his left foot and appearing to be in significant pain.
There was plenty to be concerned about, with Dr. David Chao suggesting that Watt might have sustained a 5th metatarsal fracture, otherwise known as a Jones fracture:
T.J. Watt was taken to the locker room. As the Eagles ground out the clock in a long drive to seal their win, Watt was done for the day. Teammates Alex Highsmith, Nick Herbig, and Preston Smith filled out the defensive snaps at outside linebacker.
After the game, the news was better. Speaking to the media in the locker room, Watt described the injury as rolling his ankle. He revealed that he had already undergone X-rays and they were negative. In his post-game comments to the media, Head Coach Mike Tomlin described Watt’s injury as “low ankle.”
It’s a virtual certainty that Watt will undergo MRI once he returns to Pittsburgh, primarily to confirm the lack of fracture than might be missed on plain X-ray as well as assess for significant ligament damage. With a short week to their next game, Tomlin will be speaking to the media tomorrow instead of his usual Tuesday session. It is possible that a full update won’t be available by then. For now, we will work off the initial diagnosis of a low ankle sprain.
A low ankle sprain is much less challenging than a high ankle sprain, which I have posted about in the past, as it has a longer recovery time.
Let’s start with some basic ankle anatomy:
Figure 1 https://www.orthonorcal.com
A nice summary from the American Academy of Orthopaedic Surgeons:
- Ligaments are strong, fibrous tissues that connect bones to other bones. The ligaments in the ankle help to keep the bones in proper position and stabilize the joint.
- Most sprained ankles occur in the lateral ligaments on the outside of the ankle. Sprains can range from tiny tears in the fibers that make up the ligament to complete tears through the tissue.
- If there is a complete tear of the ligaments, the ankle may become unstable after the initial injury phase passes. Over time, this instability can result in damage to the bones and cartilage of the ankle joint.
A twisting force to the ankle, common is sports like football that require cutting when running, can cause a tear of one or more ligaments. The lateral ligaments are more commonly injured.
Figure 2 https://www.oastaug.com
Ankle sprains can be defined by two different classification criteria, as described by the Hospital for Special Surgery in New York City:
Anatomic Classifications
- Grade I ankle sprain – lateral ligaments are strained (overstretched)
- Grade II ankle sprain – partial tearing of one or several of these ligaments
- Grade III ankle sprain – complete rupture (tear) one or more of the lateral ligaments
Functional Classifications
- Grade I injury – the patient is able to fully weight bear and walk
- Grade II injury – the patient walks with a noticeable limp
- Grade III – the patient is unable to walk
There is every reason to be optimistic that Watt suffered only a Grade 1 low ankle sprain. As he walked to the locker room, Watt did not appear to be limping:
According to reporters present in the locker room to interview Watt after the game, he was not wearing a walking boot and did not use crutches. Obviously, this already looks much less serious than the low ankle sprain his fellow pass rusher Alex Highsmith suffered a month ago. Initially unable to put weight on that leg, Highsmith was using crutches that day. He was later reported to be wearing a boot and using a scooter in the training facility.
Hopefully, Tomlin will add further detail the next time he meets the media. For now, it certainly appears that Watt — and the Steelers — got lucky, and he has only sustained a minor low ankle sprain.
If that is the case, there is a very good chance that Watt could play against the Ravens this Saturday in a crucial game the will potentially determine the AFC North champion. History is on his side, after all. He has already accomplished that feat in 2021, when he sustained an ankle injury and didn’t miss a game. There is every chance he will do it again.
“Melanie H. Friedlander, M.D., F.A.C.S. is a doctor at Association of South Bay Surgeons in Torrance, California. Dr. Friedlander enjoys all aspects of general surgery, but her primary areas of focus are breast surgery and advanced laparoscopic surgery. She recently adopted an advanced, minimally invasive technique that reduces scar size in thyroid surgery. Dr. Friedlander is a member of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) and the Society of Laparoscopic Surgeons. She developed and published many scientific studies in highly esteemed medical journals.”
