Ronald Darby Injury Assessment

In Week 1 of the 2017-18 NFL campaign, the Philadelphia Eagles were facing off with the Washington Redskins. Ronald Darby, a cornerback for the Eagles, was in coverage when he rolled his ankle. Everyone watching knew his injury was serious because his foot was pointing in the wrong direction. Diagnosed with an ankle dislocation, Ronald Darby avoided significant injury and should be expected back this season. In this article, we break down the important structures in the ankle, ankle dislocations, recovery time and rehabilitation.

Ankle Dislocations Introduction

  • Ankle dislocations are commonly linked to a fall, sports injury, or trauma.
  • Ankle dislocations that result in no other injury to the surrounding bones, ligaments, nerves, or veins are very rare. In most circumstances, there is a corresponding fracture of the bone(s) in the ankle joint.
  • Along with the frequent bone breaks, there can also be damage to the ligaments in the ankle, nerves and blood vessels.
  • A medical team’s first responsibility is to reduce the dislocation to prevent further damage to the soft tissues and to realign the bones. The ankle will be splinted and immobilized to prevent further injury.
  • Surgery may be necessary to repair any bone, ligament, nerve, or blood vessel damage.

Ankle Anatomy

Ankle anatomy of a dislocated ankleThe ankle is a joint that acts as a hinge. There are different structures that all help ankle stability and support the weight of the body. It facilitates a smooth gait (pattern of movement) and the muscles, tendons, and ligaments help people balance, move, and explode into movement.  The ankle joint is supported by the connection of three bones, the talus, the tibia or shin bone, and the fibula. The bottom of the talus rests on the calcaneus, also known as the heel bone. The talus and the two shin bones allow upward and downward movements of the foot. The bones are connected by groups of ligaments between each other and on the outside and inside of the ankle.  Tendons run down from the lower leg over the ligaments and connect supporting muscles to bones. Lastly, there are important nerves and blood vessels that provide commands from the brain and oxygen to the bones and structures of the ankle.


Ankle Dislocations

Ankle DislocationWhen an ankle is dislocated, the bones, which form the ankle joint, are no longer in their normal position. It means that the ligaments, tendons, and muscles the joint were exposed to such force or trauma that they unable to maintain bone alignment. It is common to find extensive damage to the surrounding soft tissues. Common damage would include fractures to the tibia or fibula or tears in the ligaments supporting the bones of the ankle joint.

In the case of Ronald Darby, he was running at full speed when his ankle rolled. As he was planting on that foot to adjust his defensive coverage to the wide receiver, he attempted to explode off an ankle that had rolled underneath him. Ronald Darby’s ankle dislocated and later in this post; we will explain just how rare his injury is.

A posterior ankle dislocation is most common. This injury means that talus has moved backward beyond its normal position below shin bones. As seen in Darby’s injury, his toes were pointing down, and the ankle was forced inward as it rolled underneath him. When this occurs, it is very common to suffer fractures and ligament tears, as well as extensive damage to the muscle tissues supporting the ankle.

Signs and Symptoms of Ankle Dislocations

Ankle dislocations present themselves with the disfigurement of the ankle joint. It is an excruciating injury, difficult to stand on, and there may be numbness and tingling in the foot. Bruising and swelling will set in immediately. As previously stated, it is very common to identify broken bones, torn ligaments, and other damage upon further imaging by X-ray, ultrasound, or MRI.

Treatment for a Dislocated Ankle

The first stage of treatment is to realign the bones of the ankle joint, known as “reducing” the ankle. The closer the bones are returned to their normal positions the less likely serious complications are to occur. Complications can be pinched or injured nerves, scar tissue, or restricted blood flow. Once the bones are back into their normal position, the ankle will be splinted to immobilize it. If there are broken bones, torn ligaments, or other damage to the supporting structures of the ankle joint, surgery may be required.

The rehabilitation protocol for dislocated ankles with change and vary based on the severity of damage that exists from the injury. Commonly, the patient will be in a splint or boot without putting weight on it and will begin isometric exercises without taking off the immobilization device. An example of an isometric exercise inside the boot or split would be toe curls. With input from the supervising Orthopedic Surgeon, the physiotherapist will slowly progress the volume and complexity of exercises until the 4-6 week. At this point, the physiotherapist will start working on re-establishing normal range of motion in the ankle. Weight bearing should commence between weeks 6-8. During weeks 8-12, the patient will increase weight-bearing activities and try to normalize control and stability of the ankle. At week 12 and onwards, the patient will focus on sport specific training and return to sports activities.


Ronald Darby’s Rare Injury

Ronald Darby avoided serious injury. His gruesome injury made most cringe because his foot should not look like it did. So what makes his injury rare? Ankle dislocations happen once in a while, so what’s the big deal? Well, the big deal is that not only did Ronald Darby not fracture any bones, but it was also reported that he did not have any ligament, tendon, nerve or blood vessel damage. Surgery was not required, and he is expected to be back on the field in 4-6 weeks. See News Article

In a highly stable joint, how does one suffer this kind of gruesome injury, and against the odds, not severely damage any structures of the joint? One can speculate, but it may have to do with joint hypermobility. Some individuals have very loose ligaments, or ligamentous laxity, which allows joint structures to be more flexible than normal. Lax ligaments are common for people that suffer a shoulder or patellar dislocations.

We hope Ronald Darby has a quick and safe return to the NFL. If you’ve suffered an ankle dislocation, ensure you seek immediate medical attention. Without proper medical intervention, serious complications can occur.

If you have suffered an ankle dislocation and are looking for physiotherapy in Etobicoke, our team is here to help. It would be advised to schedule an initial assessment with our sport medicine doctor to help guide the rehabilitation process. Whatever keeps you active, we’ll keep you going.


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