How bad is Mahomes' high ankle sprain? What's next for the QB and Chiefs

KANSAS CITY, Mo. — Quarterback Patrick Mahomes and the Kansas City Chiefs were hopeful immediately after advancing to next Sunday’s AFC Championship Game that his high ankle sprain would be healed to the point where he could not only play in the conference title game but be effective.

Mahomes said he planned to take as much treatment as would be helpful and do whatever else was necessary to get himself ready. He was thinking an extra day of rest — the Chiefs beat the Jacksonville Jaguars in the divisional round Saturday — would make a difference.

But there’s no guarantee Mahomes will play, or play well if he does. There’s no guarantee backup Chad Henne will be as effective if he has to play as he was on his only possession against the Jaguars, when he led a 98-yard touchdown drive.

That means there’s a lot for the Chiefs to sort through. How to adjust their AFC Championship Game plan to accommodate a hobbled Mahomes? What’s the best way to use Henne if he has to play instead?

Here are some answers about the injury itself and how the Chiefs might manage it from ESPN injury analyst Stephania Bell and Chiefs reporter Adam Teicher:

What exactly is a high ankle sprain, and how does it affect quarterbacks?

A high ankle sprain is also referred to as a syndesmosis sprain. It’s an injury to the tibiofibular ligaments that join the two lower leg bones — the tibia and fibula — that results in an injury to the roof of the ankle joint, hence the term “high ankle.” If the ligament injury is severe enough to result in a gapping or widening between the two leg bones, the injury is considered far more serious and surgery may be required.

There are several ways an athlete can suffer a high ankle sprain, but perhaps the most common is when the foot is forced into eversion (where the foot/toes are rotated outward relative to the lower leg) beyond its normal range. The torsion creates stress on both the inner ankle and the “high” ankle ligaments. The most severe form of injury can also result in a fracture.

Stability of the lower leg over the ankle is critical for all movement. Normally with each step, the shin bone (tibia) advances over the main ankle bone (talus) to propel the body forward. If the supportive ligaments are injured, there is instability and the athlete can’t place full weight on the ankle as a result. Rotational movements are even more compromised due to pain and instability. For a quarterback, this can present problems both when trying to drive power through the leg, when handing the ball off (requires rotation of the ankle) and any scrambling/pivoting/torsional movements. In essence, it can impact any type of quarterback, but for one who relies on mobility, it can significantly impact that element of his game. — Bell

Does it get worse in the days after the injury?

It can certainly feel worse. Adrenaline is a powerful thing and often helps propel athletes through a game, despite injury. After the game, when any taping and footwear has been removed, the swelling can increase and the pain can as well. Immediate steps are taken postgame by the athletic training staff to help mitigate those factors and aid in recovery. — Bell

Are there recent cases of quarterbacks having the same injury?

This injury is so common that no position is immune to it, whether it’s a player who plays in the trenches or a skill position player. Quarterbacks are no different. Just this year, Mac Jones suffered a significant high ankle sprain and was said to be considering surgery. He ultimately returned to play but appeared to struggle at times as a result of his ankle. Eagles quarterback Jalen Hurts suffered a high ankle sprain last year and had surgery in the offseason. He clearly returned to top form and has had no limitations this year. Jimmy Garoppolo suffered this injury in 2020, missed two weeks and returned only to aggravate the injury and miss the remainder of the season. — Bell

How concerned should the Chiefs be about Mahomes’ ankle issues?

It’s certainly not ideal to have this happen with only a week to recover between games, but it also is a matter of severity, which has not been reported. A mild sprain can resolve within a couple of weeks, whereas a moderate sprain can require more than a month to fully recover. A severe sprain may ultimately require surgery. The early positive news around Mahomes is encouraging, but it is too soon to project what he will or won’t be able to do in a week, including whether or not he’ll be able to play. Much will depend on how his ankle responds to treatment as the week progresses. He’ll no doubt be pushing to play but his functional performance as the game approaches will dictate the team’s decision. — Bell

What game adjustments could the Chiefs make to manage the injury?

Mahomes’ creativity and ability to make off-schedule throws are a large part of what makes him the player he is, but the Chiefs would likely make Mahomes a pocket passer, as they did in the second half against the Jaguars. He threw no passes from outside the pocket after returning to the game for the start of the second half. That’s only the second time this season Mahomes went for a half without making an outside the pocket throw. Mahomes threw more passes from outside the pocket (113) than any other quarterback during the regular season and was tied for second with seven touchdown passes.

According to NFL Next Gen Stats, Mahomes scrambled against Jacksonville at least 8 yards six times on his first 12 passes, before the injury. He scrambled just once on a pass attempt after the injury. So this is a dramatic change to the Chiefs’ offense, and it’s unclear how well Mahomes could make it work over the course of a full game. — Teicher

How much does the Chiefs’ offense change with a compromised Mahomes?

Mahomes’ running, or at least the threat of it, is no small part of the Chiefs’ offense. He was their second-leading rusher during the regular season with 358 yards. He also rushed for four touchdowns and 25 first downs. All of that goes away if he’s as limited in terms of mobility as he was in the second half against the Jaguars. Opponents have at times used a spy against Mahomes to take away his running threat. There’s no need to do that if he is hobbled.

That defender can be used in coverage or as an extra rusher, which brings up another point: Can Mahomes move well enough to avoid the rush? That would seem to be a baseline for the Chiefs in determining whether he could play in the AFC Championship Game. If he isn’t at least so mobile that he can protect himself, he shouldn’t and probably wouldn’t play. — Teicher

If Mahomes’ injury worsens, what would change with Chad Henne under center?

The passing game was mostly quick, short throws for the one drive in which Henne replaced Mahomes against Jacksonville. Henne threw for 23 yards on seven attempts, which is fewer than 3.3 yards per attempt. As a comparison, Mahomes was second in the league during the regular season at 8.1 yards, while the league average was 7.1 yards.

It’s a small sample size for Henne against the Jaguars, but it’s still a reasonable expectation for him in the AFC Championship Game, if he has to play. The Chiefs also were more balanced on Henne’s 12-play drive, running the ball on five of the plays. It’s always risky to predict that coach Andy Reid will call more running plays, but if ever the situation called for it, this would be the one. — Teicher