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Injury Analysis from Dr. Budoff: Saquon Barkley Should Return as an Impact Player for the Fantasy Playoffs

Orthopedic surgeon and auction expert, Dr. Jeffrey Budoff, provides injury analysis for fantasy football owners during the 2019 NFL season. Today, he looks at the high ankle sprain suffered by Saquon Barkley.

Barkley suffered a right high ankle sprain during Week 2. A high ankle sprain is an injury to the Syndesmotic Ligaments that hold the two bones below the knee, the tibia and the fibula, together.

High ankle sprains usually occur during contact when the foot gets rotated away from the body.

High ankle sprains make it very difficult to cut or change directions quickly, which precludes NFL athletes from playing effectively in space. 

If the injury is stable, meaning that the tibia and fibula are still firmly attached, no surgery is required. In these cases, the injury simply needs rest to allow the syndesmotic ligaments to fully heal. For a mild high ankle sprain this averages zero to two weeks. For a moderate high ankle sprain, it’s two to four weeks, and a severe high ankle sprain averages four to eight weeks. Barkley’s estimate was at the high end of the timeline, so this means that his high ankle sprain is severe. Adam Schefter reported to expect this to be closer to eight weeks, rather than four. This is more severe than Tevin Coleman’s high ankle sprain; don’t compare them.

A recent systemic review1 of 10 research papers regarding 312 athletes with high ankle sprains noted that, following healing, 94% of athletes returned to their pre-injury level of play, if they were allowed to fully heal. The mean time to healing was 46 days. Another study from 20162 also showed an average of 6.5 weeks for those high ankle sprains not requiring surgery.

Seven weeks would be Week 10. That’s reasonable, but I doubt the Giants will take chances with their star runner by bringing him back before he’s 100%. And the Giants have a bye in Week 11. It seems likely that they would keep him out Week 10 to allow an extra couple of weeks to make sure his injury is fully healed. Week 12 might be the most likely time for him to return to the lineup, probably at very close to 100%, as that would be nine weeks of healing following this injury. Plan accordingly.


  1. Vancolen SY, Nadeem I, Horner NS, Johal H, Alolabi B, Khan M. Return to Sport After Ankle Syndesmotic Injury: A Systematic Review. Sports Health. 2019;11(2):116-122. 
  2. Calder JD, Bamford R, Petrie A, McCollum GA. Stable Versus Unstable Grade II High Ankle Sprains: A Prospective Study Predicting the Need for Surgical Stabilization and Time to Return to Sports. Arthroscopy. 2016;32(4):634-42. 
Image Credit: Mark Goldman/Icon Sportswire. Pictured: Saquon Barkley.

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